COVID-19 Coronavirus current events

[Mendel]

They must be using the very test you posted about, non?

If they're doing research, they are not limited to FDA-approved tests. I would expect different test procedures, performed in a suitable laboratory, to be more sensitive, and for Stanford to use them.
The package insert for the test I talked about said that fingerprick samples are not recommended and have not been examined for performance.

 

[Trailspotter]

There is a News article published in Nature on April 3.

How sewage could reveal true scale of coronavirus outbreak

More than a dozen research groups worldwide have started analysing wastewater for the new coronavirus as a way to estimate the total number of infections in a community, given that most people will not be tested. The method could also be used to detect the coronavirus if it returns to communities, say scientists. So far, researchers have found traces of the virus in the Netherlands, the United States and Sweden.
…
Early-warning sign
Infection-control measures, such as social distancing, will probably suppress the current pandemic, but the virus could return once such measures are lifted. Routine wastewater surveillance could be used as a non-invasive early-warning tool to alert communities to new COVID-19 infections, says Ana Maria de Roda Husman, an infectious-disease researcher at the Netherlands National Institute for Public Health and the Environment in Bilthoven. The institute has previously monitored sewage to detect outbreaks of norovirus, antibiotic-resistant bacteria, poliovirus and measles.

 

[TEEJ]

I think it's ok to do something like that. they didn't say "this is Belleview Hospital" or anything.

I'm not sure you are even allowed to film patients in the United States. (or to bring a camera crew into covid-19 infected areas!), so I personally didn't think it was a NY hospital. Plus.. I did previously see the 'bubbles-over-their-heads' when they ran out of ventilators with Italian footage, so I took/take that shot as "this is the future of NY because Orange Man bad", which is kinda the context of what they are talking about.

But that's me.

I noticed that some media were claiming that it was Sky News footage, but in fact it was footage from CBS This Morning. CBS reporters were one of several news agencies allowed access to the Italian hospital. I agree with you they were simply using footage to highlight the bit about ventilators.

See from 1:47


Source: https://www.youtube.com/watch?v=t8Mdk1jPZYQ

 

[deirdre]

The EU is not a government, that is not a good analogy.

I was going more for a 'size' analogy. (although eu is like 500mill vs usa at 330mill)

Germany is a federal republic

ah. I did not know that.

New York has 100000 active cases, Connecticut has 5000

my point is more that any state can become NY. (say within the next month). it's not like once you send all the reserve ventilators to NYC that NYC will be giving any of them up anytime soon to NJ or Louisiana etc.

 

[TEEJ]

Here in the UK some people are burning down 5G towers and equipment. Some of the die hard conspiracy theorists who believe that 5G and Coronavirus are linked have been visited by the police after making posts on Facebook. Several of their Facebook and other social media posts have been removed after they were reported.

The following video was filmed by one Facebook poster as he was being advised by police.


Source: https://www.youtube.com/watch?v=bxDK9ZA9POg


The guy is still out harassing telecommunications workers.


Source: https://www.youtube.com/watch?v=Od6YgXaMCMI


From his You Tube Channel

https://www.youtube.com/channel/UCzohrSx6PXeDt-3SAyYEgnQ/videos

The following from Huffington Post UK

Conspiracy theories about 5G technology and coronavirus have been strongly condemned by the government after two phone masts were apparently set on fire at the end of this week.

At a press conference on Saturday, Cabinet Secretary Michael Gove labelled theories spreading on the internet as "dangerous nonsense", whilst Stephen Powis, the medical director for NHS England called it "the worst kind of fake news".

Video footage of a mast on fire in Sparkhill, Birmingham on Thursday evening was widely shared on Twitter, while the Liverpool Echo reported in the early hours of Saturday morning that a mast was also ablaze in Melling, Merseyside – hours after the city's mayor Joe Anderson criticised the theories as "bizarre".

From Huffington Post UK link.

https://uk.news.yahoo.com/coronavirus-5g-conspiracy-theories-condemned-160943070.html


Source: https://twitter.com/imjustbrum/status/1245833218634506240

 

[Rory]

I noticed that some media were claiming that it was Sky News footage, but in fact it was footage from CBS This Morning.

That news report was from Saturday 28th March, while the Sky News report was from March 19th, nine days earlier.

Also, the footage from Sky was from Bergamo, whereas the CBS guy was in Parma, 70 miles away.

Seems to me CBS intercut footage that was in the Sky report with actual footage of their reporter.

 

[deirdre]

NEW YORK (AP) — A tiger at the Bronx Zoo has tested positive for the new coronavirus, in what is believed to be the first known infection in an animal in the U.S. or a tiger anywhere, federal officials and the zoo said Sunday.

https://www.msn.com/en-us/health/me...e-for-coronavirus/ar-BB12coPu?ocid=spartanntp

 

[Arugula]

Novartis, a major producer of Hydroxychloroquine (and one of the biggest drug companies in the world) appears to have paid Donald Trump's former personal attorney Michael Cohen more than $1 million for access to the president in 2016:

President Donald Trump on Sunday once again touted the potential life-saving benefits of treating coronavirus patients with hydroxychloroquine, a powerful anti-malaria drug, despite a dearth of medical professionals or clinical evidence supporting his claims. It just so happens that one of the largest manufacturers of the drug, Novartis, previously paid Trump's now-incarcerated former personal attorney Michael Cohen more than $1 million for healthcare policy insight following Trump's election in 2016.

The Swiss drug maker signed a contract that paid Cohen's newly formed limited-liability corporation Essential Consultants $100,000 per month in February of 2017. After details of the deal were leaked by the now-jailed Michael Avenatti, whose then-client Stormy Daniels was engaged in a legal dispute with the president, the company's CEO issued a public apology saying Novartis "made a mistake" in contracting with the president's personal attorney.

Source: https://lawandcrime.com/covid-19-pa...ccess-to-trump/amp/?__twitter_impression=true

Going back to Cohen's trial, Cohen claims that they sent a contract to him specifically to lobby the President, but that Cohen crossed out that paragraph of his contract.

WASHINGTON (Reuters) - U.S. President Donald Trump's former personal attorney Michael Cohen testified on Wednesday that Swiss drugmaker Novartis AG initially wanted him to lobby for the company when it retained him with a $1.2 million contract, but that Cohen refused.

"Novartis sent me their contract, which stated specifically that they wanted me to lobby. That they wanted me to provide access to government, including the president, " Cohen said.

"That paragraph was crossed out by me, initialed, and written in my own handwriting that says I will not lobby or do government relations work," he told members of the House Oversight Committee.

Source: https://www.reuters.com/article/us-...-wanted-him-to-lobby-he-refused-idUSKCN1QG2DU

Novartis, and their subsidiary Sandoz, is a leading generics producer, and has committed to donating 130 million doses to support the COVID-19 pandemic response through May. It is a good case of corporate philanthropy, but keep in mind they have not committed to anything after May, when we could continue to see localized cases all over over the world for another year or so before a vaccine is ready and mass produced. So, they could stand to profit from Hydroxychloroquine being a popularized treatment in the long-term.

Basel, March 20, 2020 - Novartis announced today its commitment to donate up to 130 million doses of generic hydroxychloroquine to support the global COVID-19 pandemic response. Hydroxychloroquine and a related drug, chloroquine, are currently under evaluation in clinical trials for the treatment of COVID-19. Novartis is supporting ongoing clinical trial efforts, and will evaluate needs for additional clinical trials.

https://www.novartis.com/news/media...ine-support-global-covid-19-pandemic-response

The question is, is something fishy happening here? Lobbying is extremely common from Big Pharma. Novaris spends on politicians on both sides of the aisle (though not nearly as much as they spent on Cohen). This is their spending through the 2020 campaign: https://www.opensecrets.org/orgs/recipients?id=D000022163

Bankrolling the President's personal lawyer is highly odd and questionable, and its healthy to be skeptical of who is in a policymaker's ears. However, independent of what any politician is saying, we also know a lot of doctors are touting it as a promising treatment - not a miracle cure. As discussed earlier in this thread, Chloroquine and Hydroxychloroquine are still considered 'experimental for treating COVID-19' because no clinical trials have been completed specifically for COVID-19 - so we won't really know the true effectiveness we have more data.

 

[qed]

The question is, is something fishy happening here?

Conspiratorially fishy? If so, then it will soon be exposed. That's the nature of plain old conspiracies versus conspiracy theories.

 

[Trailspotter]

Just in on the BBC News site:

Coronavirus: YouTube tightens rules after David Icke 5G interview

YouTube has banned all conspiracy theory videos falsely linking coronavirus symptoms to 5G networks.

The Google-owned service will now delete videos violating the policy. It had previously limited itself to reducing the frequency it recommended them in its Up Next section.

The move follows a live-streamed interview with conspiracy theorist David Icke on Monday, in which he had linked the technology to the pandemic.

moderator add: (from article)

"We have clear policies that prohibit videos promoting medically unsubstantiated methods to prevent the coronavirus in place of seeking medical treatment, and we quickly remove videos violating these policies when flagged to us," a spokeswoman for YouTube told the BBC.

"Now any content that disputes the existence or transmission of Covid-19, as described by the WHO [World Health Organization] and local health authorities is in violation of YouTube policies.

"This includes conspiracy theories which claim that the symptoms are caused by 5G.

 

[Vic Thornley]

Should we be more proactive in this by reporting offending videos, or is it automatic.
In other words, given that there will be a large number of these videos, how do they get 'flagged'

 

[TEEJ]

Should we be more proactive in this by reporting offending videos, or is it automatic.
In other words, given that there will be a large number of these videos, how do they get 'flagged'

Yes, I would report these offending videos if you stumble upon them. I've just reported a video that was encouraging criminal damage against 5G equipment.

 

[Graham2001]

On the subject of Coronavirus conspiracy theories, skeptical YouTuber Myles Power has started a series on people exploiting the crisis to promote conspiracy theories, the first video covers anti-GMO activist Vandana Shiva and her claims that the virus originated in GMO foods.


Source: https://www.youtube.com/watch?v=NTqkB3JbCc4

 

[Mendel]

Source: https://youtu.be/SHfSSlcKuq0

[5:20][A friend who is a psychiatrist] told me that his patients with paranoid tendencies have been extremely troubled by the conspiracy theories flying around the internet and have markedly deteriorated.

 

[Z.W. Wolf]

https://www.sciencealert.com/the-us...od-tests-to-hunt-down-immunity-to-coronavirus

The United States has begun taking blood samples from across the country to determine the true number of people infected with the coronavirus, using a test that works retrospectively .

"We're just starting to do testing and we'll report out on these very quickly," said Joe Bresee, deputy incident manager for the Center for Disease Control and Prevention's pandemic response, according to the health website Stat News.

He added the CDC would conduct three surveys: The first on blood samples from undiagnosed people from some of the country's coronavirus hot spots, the second a national survey from different parts of the country, and the third a study on health workers.

The first survey has already begun as of the weekend, but no firm timeline has been issued for the other two.

This is in addition to the Stanford Study in this post: https://www.metabunk.org/threads/covid-19-coronavirus-current-events.11085/post-237772

Same article mentions that study

Separately, Stanford University conducted its own serological survey on Saturday in the city of Santa Clara, Jay Bhattacharya, a professor of medicine at the university told AFP.

"We collected finger prick blood samples from about 2,500 volunteer participants selected to be representative of the county and about 500 of their children," he said, adding the results would be released soon.

​

 

[Mendel]

The United States has begun taking blood samples from across the country to determine the true number of people infected with the coronavirus, using a test that works retrospectively .

In yesterday's press conference, the director of the RKI revealed in response to a question that Germany is doing a quick survey using 2500 samples from blood donors.

The test procedure they're most likely using is ELISA:

The enzyme-linked immunosorbent assay (ELISA) (/ɪˈlaɪzə/, /ˌiːˈlaɪzə/) is a commonly used analytical biochemistry assay, first described by Engvall and Perlmann in 1971.[1] The assay uses a solid-phase enzyme immunoassay (EIA) to detect the presence of a ligand (commonly a protein) in a liquid sample using antibodies directed against the protein to be measured. ELISA has been used as a diagnostic tool in medicine, plant pathology, and biotechnology, as well as a quality control check in various industries.


An ELISA being developed with TMB

In the most simple form of an ELISA, antigens from the sample are attached to a surface. Then, a matching antibody is applied over the surface so it can bind to the antigen. This antibody is linked to an enzyme, and in the final step, a substance containing the enzyme's substrate is added. The subsequent reaction produces a detectable signal, most commonly a color change.

https://en.m.wikipedia.org/wiki/ELISA

As with the RT-PCR test used to detect SARS-CoV-2 (the novel coronavirus), the machines to run this test are already in common use, and test kits for use with these machines have been available since February or earlier, though the performance of the test needed to be studied and production capacity created for this test to be deployed for common diagnostic use. If you google "elisa test sars-cov-2", you can find several suppliers for research use.

This is not a "quick" test (although it runs faster than rt-PCR), but you can test 92 samples at once. Here is some information from a supplier I picked at random, I expect this to be true in general for this type of test:

2. Why not use PCR and Rapid Tests?

Polymerase Chain Reaction (PCR) is a diagnostic test designed to confirm a clinical disease through the amplification of DNA and RNA. However, PCR can only achieve a sensitivity of 50 to 79%, presents issues during the isolation of the virus from clinical specimen, and requires biosafety level 3 laboratory facilities. Rapid Test Diagnostics (RTD) are lateral-flow assays, that use a dipstick or cassette format to perform a qualitative detection of a disease. However, due to the format of the assay, they can only achieve a sensitivity of 30%. For these reasons, Epitope Diagnostics, Inc. does not offer either of these tests for the detection of COVID-19.

3. How do I use your tests?

The kit contains a 96-well ELISA microtiter plate and all the reagents and control materials required to run the test. Each kit can run up to 92 patient samples in singlet, or 46 in duplicate depending on the preference of the laboratory. Tests can be performed manually with any spectrophotometric microplate reader capable of reading absorbance at 450 nm and a ELISA multichannel wash bottle or automatic (semi-automatic) washing system. Assays can be performed on automated instruments with additional validation.

http://www.epitopediagnostics.com/covid-19-elisa
The kits are marked "Research use only" and "not reviewed by the FDA".
From their IgG kit IFU:

LIMITATIONS OF THE PROCEDURE
1. This test is only for qualitative detection. Test results should not be the sole basis for clinical diagnosis and treatment. The confirmation of infection with novel coronavirus (COVID-19) must be combined with the patient's clinical signs in conjunction to other tests.
2. In the first week of the onset of the infection with the novel coronavirus (COVID-19) patients results may be negative for IgG. In addition, patients with low immunity or other diseases that affect immune function, failure of important systemic organs, and use of drugs that suppress immune function can also lead to negative results of new coronavirus IgG. Previous infection of SARS or other coronavirus strain may cause a light IgG positive in view of similarity of different strains.
3. Bacterial or fungal contamination of serum specimens or reagents, or cross-contamination between reagents may cause erroneous results.
4. Water deionized with polyester resins may inactive the horseradish peroxidase enzyme.

CLINICAL TESTING
Serum samples from two cohorts of patients were tested using the IgG ELISA kit at the Jiaxing City Center for Disease Control and Prevention and Zhejiang University Hospital. The combined cohort consisted of normal healthy patients with samples collected prior to the COVID-19 outbreak [December 3, 2019] (n = 54) and RT-PCR confirmed positive patients in after the second week of the onset of the disease (n = 30). The results are as follows:

The diagnostic sensitivity is 100%. The diagnostic specificity is 100%. The negative predictive value is 100%. The positive predictive value is 100%.

The fact that this test requires the body to have developed an immune response to the virus makes it less suitable as a diagnostic tool if you want to detect the infection early, but it'd be great for retrospective analysis, though I don't see that it has been validated for that yet. I'd assume the universities using the test for population screening are doing that; they'd have to check that the test is sensitive enough to detect post-infection levels of these antibodies, and develop procedures that increase its sensitivity if it isn't.

 

[Mendel]

Source: https://mobile.twitter.com/CBSEveningNews/status/1247675561192890368

The coronavirus entered Milwaukee from a white, affluent suburb. Then it took root in the city's black community and erupted.

As public health officials watched cases rise in March, too many in the community shrugged off warnings. Rumors and conspiracy theories proliferated on social media, pushing the bogus idea that black people are somehow immune to the disease. And much of the initial focus was on international travel, so those who knew no one returning from Asia or Europe were quick to dismiss the risk.

Then, when the shelter-in-place order came, there was a natural pushback among those who recalled other painful government restrictions — including segregation and mass incarceration — on where black people could walk and gather.

As of Friday morning, African Americans made up almost half of Milwaukee County's 945 cases and 81% of its 27 deaths in a county whose population is 26% black. Milwaukee is one of the few places in the United States that is tracking the racial breakdown of people who have been infected by the novel coronavirus, offering a glimpse at the disproportionate destruction it is inflicting on black communities nationwide.

In Michigan, where the state's population is 14% black, African Americans made up 35% of cases and 40% of deaths as of Friday morning. Detroit, where a majority of residents are black, has emerged as a hot spot with a high death toll. As has New Orleans. Louisiana has not published case breakdowns by race, but 40% of the state's deaths have happened in Orleans Parish, where the majority of residents are black.

https://www.propublica.org/article/...d-and-died-of-coronavirus-at-an-alarming-rate


Hoaxes can kill people.

 

[DavidB66]

In the UK there are also reports of disproportionate impact on some ethnic groups. Anecdotally, it has been suggested that elderly South Asians (i.e. mainly people of Indian, Pakistani, and Bangladeshi origins) are more likely to be infected because they often live with younger generations of their family. Some Jewish communities in north London are also said to be severely infected, possibly because gatherings at synagogues were an early focus of infection.
Most of this has been anecdotal, but a new report by the Intensive Care National Audit and Research Centre finds that

about a third of the people analysed who were critically ill with Covid-19 were from black, Asian or minority ethic backgrounds. These communities represent about 13 per cent of the UK population. (Report in The Times, 7 April 20200.)

I found the full report here: https://www.icnarc.org/About/Latest...On-2249-Patients-Critically-Ill-With-Covid-19
The disproportionate impact could be even greater if account is taken of the age distribution, as the representation of these ethnic backgrounds in the older, more at-risk, age groups is probably lower than the stated 13 per cent UK population average. On the other hand, the rate of infection is highest in the London area, which has a higher proportion of ethnic minorities. Another possible factor is that ethnic minorities may be more heavily represented in at-risk occupations such as bus-driving and nursing.

 

[Z.W. Wolf]

In the most simple form of an ELISA, antigens from the sample are attached to a surface. Then, a matching antibody is applied over the surface so it can bind to the antigen. This antibody is linked to an enzyme, and in the final step, a substance containing the enzyme's substrate is added. The subsequent reaction produces a detectable signal, most commonly a color change.

I don't understand this. It seems backwards. I would expect it to be antibodies from the (blood) sample. And antigens applied during the test.

What am I getting wrong?

 

[Mendel]

In the most simple form of an ELISA, antigens from the sample are attached to a surface. Then, a matching antibody is applied over the surface so it can bind to the antigen. This antibody is linked to an enzyme, and in the final step, a substance containing the enzyme's substrate is added. The subsequent reaction produces a detectable signal, most commonly a color change.

I don't understand this. It seems backwards. I would expect it to be antibodies from the (blood) sample. And antigens applied during the test.

What am I getting wrong?

You're getting wrong that this is not the "most simple form", but rather a kind of sandwich ELISA, as explained further down the wikipedia page.

Let's look at the diagram for this test again:

For the IgG test on the left, the microwell Surface is coated with artificial COVID-19 protein S. The sample containing the antibodies Y is added. They bind to S, and in the next step, the tracer antibody Y* binds to Y. The substrate and stop solution then makes Y* visible.

Their IgM test works similarly, but kind of in reverse, but the principle is the same: the sample binds to a protein already in the wall, and a tracer attaches to it. You need the wall attachment so that you can wash the tracer away if the sample is negative, and don't wash it away if it's positive.

Bascially, it's a clever way to glue antibodies in place and make them visible.
If I understand the above diagrams correctly, the IgG test "glues" only Covid-19 antibodies, and the IgM test glues any antibody but only makes Covid-19 antibodies visible. (Keep in mind that this is for this specific manufacturer.)

 

[deirdre]

Hoaxes can kill people.

while I agree with this sentiment, you need to remember that those numbers only represent people who have symptoms severe enough to be tested and as your article points out in the paragraph following your quote, the black community has higher rates of health issues which would leave them vulnerable. The Westchester (NY) and Westport(Connecticut) areas are primarily non-black but they were wiped out (infected) by the virus too.

I'm not saying we don't have issues with health in the black communities but I don't think you can point to those numbers and conclude it's all because of internet hoaxes or civil rights rebellion issues.

 

[Mendel]

while I agree with this sentiment, you need to remember that those numbers only represent people who have symptoms severe enough to be tested and as your article points out in the paragraph following your quote, the black community has higher rates of health issues which would leave them vulnerable. The Westchester (NY) and Westport(Connecticut) areas are primarily non-black but they were wiped out (infected) by the virus too.

I'm not saying we don't have issues with health in the black communities but I don't think you can point to those numbers and conclude it's all because of internet hoaxes or civil rights rebellion issues.

I did not say or imply "it's all because", hoaxes are listed in that quote as a contributory cause because they may have led people to behave less cautiously than they otherwise would have, and thus raised the number of infections.
Obviously, "it's just like a flu" achieves the same end without regard to race.

Data from a predominatly single-race area is irrelevant here, as it does not allow a comparison. In a mixed-race town or state, one race acts as a "control group" for the other, allowing a conclusion to be drawn.

 

[scombrid]

There is a News article published in Nature on April 3.

How sewage could reveal true scale of coronavirus outbreak

More than a dozen research groups worldwide have started analysing wastewater for the new coronavirus as a way to estimate the total number of infections in a community, given that most people will not be tested. The method could also be used to detect the coronavirus if it returns to communities, say scientists. So far, researchers have found traces of the virus in the Netherlands, the United States and Sweden.
…
Early-warning sign
Infection-control measures, such as social distancing, will probably suppress the current pandemic, but the virus could return once such measures are lifted. Routine wastewater surveillance could be used as a non-invasive early-warning tool to alert communities to new COVID-19 infections, says Ana Maria de Roda Husman, an infectious-disease researcher at the Netherlands National Institute for Public Health and the Environment in Bilthoven. The institute has previously monitored sewage to detect outbreaks of norovirus, antibiotic-resistant bacteria, poliovirus and measles.

I'm filing that under "why didn't I think of that?". We are using environmental DNA these days to detect the presence of a minnow in a river system. Of course a similar tool should work to find out where and maybe even what is the average "load" of a virus in a community.

 

[deirdre]

Obviously, "it's just like a flu" achieves the same end without regard to race.

Exactly. and the "international travel risk" which was pushed in the beginning.
I do emotionally find that article offensive. the wording. it makes it sound like black people are more stupid or "sensitive".. which certainly they are not any more stupid or "sensitive" than any other ethnic group who also

too many in the community shrugged off warnings

 

[Agent K]

As public health officials watched cases rise in March, too many in the community shrugged off warnings. Rumors and conspiracy theories proliferated on social media, pushing the bogus idea that black people are somehow immune to the disease. And much of the initial focus was on international travel, so those who knew no one returning from Asia or Europe were quick to dismiss the risk.
Then, when the shelter-in-place order came, there was a natural pushback among those who recalled other painful government restrictions — including segregation and mass incarceration — on where black people could walk and gather.

Hoaxes can kill people.

No kidding.
https://www.msn.com/en-us/news/us/e...-ship-part-of-government-takeover/ar-BB122Sbm

A train engineer at the Port of Los Angeles was arrested Wednesday for allegedly derailing a locomotive at full speed near the USNS Mercy hospital ship being used to ease hospital beds during the coronavirus pandemic.
Eduardo Moreno, 44, of San Pedro, was charged in a criminal complaint with one federal count of train wrecking...
During an initial interview with port police, prosecutors say Moreno admitted crashing the train, saying he was suspicious of the Mercy and believed it had an alternate purpose related to COVID-19, such as a "government takeover."
Moreno later stated in a second interview with FBI agents that "he did it out of the desire to 'wake people up,'" according to the affidavit. "Moreno stated that he thought that the U.S.N.S. Mercy was suspicious and did not believe 'the ship is what they say it's for'".

"Anthony Fauci's security is stepped up as doctor and face of U.S. coronavirus response receives threats"
https://www.msn.com/en-us/news/us/a...navirus-response-receives-threats/ar-BB122LOX

Fauci has become a public target for some right-wing commentators and bloggers, who exercise influence over parts of the president's base. As they press for the president to ease restrictions to reinvigorate economic activity, some of these figures have assailed Fauci and questioned his expertise. Last month, an article depicting him as an agent of the "deep state" gained nearly 25,000 interactions on Facebook — meaning likes, comments and shares — as it was posted to large pro-Trump groups with titles such as "Trump Strong" and "Tampa Bay Trump Club."
... The headline in the American Thinker referred to Fauci as a "Deep-State Hillary Clinton-loving stooge."

Reminds me of attacks on Ebola responders in eastern Congo

https://www.foxnews.com/world/ebola-response-workers-killed-in-armed-attacks-in-eastern-congo-un
Three health workers were killed when Mai-Mai fighters attacked a base of the United Nations health agency overnight in Biakato... Warnings had been posted earlier demanding that the health workers leave or face "the worst," the official said.
...
Several rebel groups are active in the region, and local officials say some believe Ebola is nothing but a political ploy.
"Imagine, a doctor leaves home in the U.S. or elsewhere to come sleep in a tent to help save us from this scourge of Ebola and yet poorly educated young people want to attack him. ... It is very deplorable," said Fiston Kamango, a youth leader in Biakato.

 

[Mendel]

There are currently 51 clinical trials concerning Covid-19 registered in the EU, the database is at https://www.clinicaltrialsregister.eu/ctr-search/search?query=covid-19

The European Union Clinical Trials Register allows you to search for protocol and results information on:
* interventional clinical trials that are conducted in the European Union (EU) and the European Economic Area (EEA);
* clinical trials conducted outside the EU / EEA that are linked to European paediatric-medicine development.

Most of these are trials of existing drugs, and many of those are about Chloroquin.

Some of the drug trials target suppressing the immune reaction (cytokine release), which is a common cause of Covid-19 patients suddenly dying. If this is successful, I expect a big impact on the death rate quickly.

One trial is examining the efficacy of plasma treatment:

A 3.1 Title of the trial for lay people, in easily understood, i.e. non-technical, language
Clinical Study to assess positive value of blood plasma from donors having built immunity against the new corona virus (SARS-CoV-2) transfused to patients suffering from SARS-CoV-2 infection

https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001310-38/DE
The study is a cooperation between the German Red Cross blood donation service, a transfusion clinic, and the ministry of health.

I also found a Dutch trial that tries to protect healthcare workers by vaccinating them against something else (tuberculosis). The idea is that it might prevent the infection, or that it might make the symptoms less severe than they would otherwise be, because the vaccination puts the immune system of the recipients "on alert". This general effect has been studied before, but obviously not with regard to Covid-19.

Reducing health care workers absenteeism in SARS-CoV-2 pandemic by enhanced trained immune responses through Bacillus Calmette-Guérin vaccination, a randomized controlled trial (COVID-19).

The intervention has a protective objective which is to improve the clinical course of SARS-CoV-2 infection in Health Care Workers. Health Care Workers are, in general, healthy.

Main objective of the trial: To reduce absenteeism among HCW with direct patient contacts during the epidemic phase of SARS-CoV-2.
Secondary objectives of the trial: To reduce hospital admission, ICU admission or death in HCW with direct patient contacts during the epidemic phase of SARS-CoV-2.

https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-000919-69/NL
I think that's really imaginative and hope it works out!

P.S.: A database for the US is at https://clinicaltrials.gov/ct2/home

Explore 335,688 research studies in all 50 states and in 210 countries.
ClinicalTrials.gov is a resource provided by the U.S. National Library of Medicine.
IMPORTANT: Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.

It currently lists 440 studies related to Covid-19, from countries all over the world.

 

[Mendel]

On April 9th, the FDA issued an Emergency Use Authorization for a blood cleaning (aspheresis) machine that removes cytokines from blood plasma. The machine itself already existed for other blood cleaning purposes, but the manufacturer has now FDA approval to treat Covid-19 with it.

There are no FDA approved, licensed, or cleared device treatments for COVID-19. Based on a number of tests and clinical case series, FDA has concluded that the unapproved use of the cleared Spectra Optia Apheresis System may effectively separate plasma from whole blood, and the Depuro D2000 Adsorption Cartridge may remove various pro-inflammatory cytokines from that plasma. FDA believes based on the totality of scientific evidence available, that the removal of pro-inflammatory cytokines may ameliorate cytokine storm due to the overabundance of pro- inflammatory cytokines and, in turn, provide clinical benefit.

https://www.fda.gov/media/136834/download
For hospitals that already have the machine, this could be very useful if it helps. The device contains a centrifuge (9 is the access door for that), and the operating manual is almost 300 pages long.

https://www.fda.gov/media/136838/download

Device Description
The Depuro D2000 Cartridge consists of a sterile, self-contained disposable Cartridge. The Cartridge is intended to assist in blood detoxification. It can be used in instances of drug overdose, hepatic encephalopathy, liver failure, in any condition which results in the release of endotoxin into the bloodstream, and in any condition which generates excess inflammatory response, such as sepsis, septic shock, or systemic inflammatory response syndrome (SIRS).
The Depuro D2000 Cartridge operates in conjunction with standard CRRT devices, or with any plasma separation device in the hospital. The Cartridge is integrated into the extracorporeal circuit, downstream from where the plasma is separated. After priming the D2000 Cartridge and assembling the inlet and outlet lines to the plasma separation extracorporeal circuit, plasma filtration should run for 4 hours, to be repeated as needed.
In bench testing, the Depuro D2000 Cartridge has been shown to remove statistically significant proportions of IL-3, IFN-gamma, IL-10, IL-1B, IL-6, IL-8, MCP-1, TNF-alpha, creatinine, bile acids, and bilirubin when compared to control. The adsorption materials used in the D2000 Cartridge have also been demonstrated to be efficacious in the treatment of drug overdose, including acetaminophen overdose, uremia, barbiturate poisoning, and in the removal of glutethimide.
Treatment duration and indication for exchange of the cartridge depend on the clinical course. The maximum treatment time per single cartridge is 4 hours.

https://www.fda.gov/media/136839/download

 

[Ravi]

On April 9th, the FDA issued an Emergency Use Authorization for a blood cleaning (aspheresis) machine that removes cytokines from blood plasma. The machine itself already existed for other blood cleaning purposes, but the manufacturer has now FDA approval to treat Covid-19 with it.
[ cut ]

I am not a doctor, but I know about cytokines. It is an extremely complex matter and there are pro-inflammatory cytokines and anti-inflammatory cytokines.. I am sure it is not just a matter of "removing them and all is good".

 

[Mendel]

I am not a doctor, but I know about cytokines. It is an extremely complex matter and there are pro-inflammatory cytokines and anti-inflammatory cytokines.. I am sure it is not just a matter of "removing them and all is good".

The point is to be able to treat the "cytokine storm", i.e. a runaway inflammatory reaction that cases patients' vitals to "crash" and then them to die.
I have absolutely no experience with treating Covid-19 and I'm not a doctor, but I understand that when an ECMO is attached for severe cases, the "tubing" for the aspheresis is already in place, and the risk is there. The description I quoted suggests that this cartridge has been successfully used to treat septic shock and SIRS, so I'd expect that this cartridge can be used to suppress the cytokine storm when it starts. This wouldn't be something you do prophylaxtically: there are drug trials for IL-6 blockers and similar things, which act a lot more specifically than what this cartridge does, and may be able to stop the cytokine storm from occurring in the first place. But if the patient is actively dying, removing the chemicals that actively kill the patient seems like a good idea.

It could be that similar machines are already used in hospitals to treat sepsis, and with that indication used to treat Covid19, and that this specific machine/cartridge just didn't have FDA approval yet?

 

[Agent K]

Thanks to the shutdowns, Tokyo, New York, and Los Angeles are among the cities with the cleanest air in the world. Kathmandu is the second-most polluted. Its residents may need to wear respirators.
https://www.iqair.com/us/world-air-quality-ranking

 

[Mendel]

I'm not really sure if I should continue sharing these EUA reports, or how detailed they should be.
Anyhow, the CDC Emeregncy Use Authorizations are published at https://www.fda.gov/medical-devices...-medical-devices/emergency-use-authorizations , and the IFU documents (Instructions For Use, or package inserts) are usually the best way to find out about an item.

Face Shields
I have seen news reports of grassroots efforts to make clear plastic face shields, and as of April 9th, they're allowed to be used if they're nonflammable and properly labeled.

Spoiler: Detailed Requirements for face shields

Authorized Face Shields
Face shields for use by HCP as PPE are authorized under this EUA when they are intended for use by HCP as PPE in healthcare settings in accordance with CDC recommendations to cover the front and sides of the face and provide barrier protection and meet the following requirements:
A. The product is labeled accurately to describe the product as a face shield for medical purposes and includes a list of the body contacting materials (which does not include any drugs or biologics);
B. TheproductisnotintegratedwithanyotherarticleofPPEsuchasafacemask,butrather is for use as a standalone face shield.
C. The product includes labeling that describes the product as intended for either a single- user, single use, or for multiple uses by the same user, and includes instructions for recommended cleaning and/or disinfection materials and processes, if applicable.
D. The face shield does not contain any materials that will cause flammability, or the product meets Class I or Class II flammability requirement per 16 CFR 1610 (unless labeled with a recommendation against use in the presence of high intensity heat source or flammable gas);
E. The product is not intended for any use that would create an undue risk in light of the public health emergency; for example, the labeling does not state that use of the authorized face shield alone will prevent infection from microbes or viruses, or that it is effective against radiation protection. As indicated in Section I, face shields authorized by this EUA may be effective at preventing HCP exposure to certain particulates during face shield shortages by providing minimal or low barrier HCP protection to the wearer during COVID-19. All manufacturers are reminded that they must comply with all Conditions of Authorization, including those relating to advertising and promotion in Section IV of this letter.

Manufacturers of authorized face shields do not need to take any action, other than complying with the Conditions of Authorization (Section IV) in this letter of authorization to be an authorized face shield under this EUA if they are within the Scope of Authorization (Section II) of this EUA.

The FDA extended the authorization for FFP respirators to include more types coming from China.

They had an EUA for a NY company to sterilize N95 masks with hydrogen peroxide for reuse 2 weeks ago; now they've added an EUA to do that using hospital sterilization equipment that would normally be used to sterilize tools that can't suffer high temperatures. The masks are put in gas-permeable bags and then sterilized using a non-lumen cycle. The masks are marked with the user's name and a count of sterilizations (10 max).

There's a new lab test that works similar to the rt-PCR that's the standard now, but it doesn't need the thermal cycling that rt-PCR does, and it skips the step where the potential virus RNA is isolated from the sample first. Because of the latter, they ran a bunch of tests with samples contaminated with other things people might have in their nose (blood, nasal spray, antiviral medication) to ensure these don't affect the result. However, the test is less sensitive than rt-PCR and requires the samples to be processed within 12 hours, or frozen.

The iAMP COVID-19 assay's key differentiator from current rRT-PCR COVID-19 assays is its ability to detect SARS-CoV-2 RNA directly from samples without prior RNA extraction process. Swab specimens are inserted directly into our 1X iAMP COVID-19 Sample Buffer Mix with a 15 min incubation at room temperature and can be directly used for OMEGA isothermal amplification and signal detection. Sample to result takes less than 1.5 hours.

There is now another blood-cleaning system to remove cytokines; it's very simple, basically just a filter that you hook up to a blood pump and that removes hydrophobic particles of a certain size from the blood, as I understand it. You have to watch that it doesn't remove certain medications (e.g. chloroquine) from the blood stream, and it doesn't like intravenous feeding of the patients as the fat could clog it up.

Spoiler: CytoSorb IFU excerpts

1.1. Intended Use
The CytoSorb Device (CytoSorb) is a non-pyrogenic, sterile, single-use device containing adsorbent polymer beads designed to remove cytokines, as blood passes through the device. CytoSorb is placed in a blood pump circuit.
1.2. Indications
CytoSorb is indicated for use in conditions where elevated levels of cytokines are present. Maximum Treatment Time per Device: 24 hours.
Adminstration of Therapy:
Day 1: Change device every 12 hours; Day 2: Change device at 24 hours; Day 3: Change device at 24 hours.
Clinical assessment to be made after 72 hours of use to determine if patient is receiving clinical benefit for for continuation of therapy.
[...]
1.3. Contraindications
Patients with very low platelet counts (< 20,000/μL).
Any pre-existing contraindication to extracorporeal therapy
Known allergies to extracorporeal circuit components
History of heparin-induced thrombocytopenia
Acute sickle cell crisis.
Morbid obesity with BMI ≥ 40 kg/m2
Any pre-existing advanced medical disease with life-expectancy less than 1 month Treatment deemed clinically futile
Pregnancy

1.6. Warnings Related to Drug Removal
Hydrophobic drugs may be removed by the device.
Data on removal of antiviral medication is unfortunately still scarce. Results from animal studies point to very low removal of Ganciclovir, and anecdotal reports on CytoSorb therapy in influenza patients receiving Oseltamivir did not state any evidence of removal. There is no available data on the removal of remdesivir. Removal of hydroxycholoroquine and azithromycin by CytoSorb is possible. Due to the large size of tocilizumab (148 kDa), convalescent plasma antibodies (>150 kDa), and other biologics of similar size, these are NOT expected to be removed by CytoSorb.
The physician is advised to measure concomitant drug concentrations, where a test exists, after CytoSorb treatment and adjust drug dosing accordingly (see Section 11: Addendum to IFU for further guidance).

In addition, when nutritional supplementation is indicated, the physician is encouraged to administer gastric or other internal tube feeding rather than total parenteral intravenous nutrition and lipids. Lipid or fat emulsions may negatively affect CytoSorb. If lipids (e.g. lipid containing parenteral nutrition) are clinically indicated, then the physician is advised to administer these after CytoSorb treatment is completed or discontinue administration two (2) hours prior to the next CytoSorb treatment.

There's nothing really revolutionary this time, but steady progress is good!

 

[Rory]

Throughout the spread of the pandemic, there's been one chart that I've found the most interesting and which has informed my opinion of the direction and timing of the virus more than any other. This is the current version:

Source: https://www.bbc.com/news/world-51235105

Since I started looking at it maybe a month ago, it's suggested very strongly that the future (unforeseen second waves aside) is bright: that countries, quite literally, come out of the darkest days pretty quickly.

The big question was, would those countries that were lagging behind China in terms of timeframe follow China's trend, or would they do something different and lend further support to the skepticism around China's figures?

So far, it's looking to me like the former.

 

[Mendel]

I had a look at the worldwide data earlier, computing the ratio of new cases in the past 7 days vs. the seven days before. A fair number of countries in the dataset currently have ratios <1, including Iran, Spain, France, and Italy, and the US are at 1.1 and should cross below 1 tomorrow.

Ireland and Japan still have positive rates, Japan seems to continue to be exponential, but at a slower rate than most other countries with exponential growth.

But there is still a group of countries whose daily case numbers more than double each week. Bangladesh is currently exploding, doubling every two days; the case number still looks low, but if they're not already mitigating, this is going to be bad.
Other countries still spreading strongly include Russia, Belarus, Ukraine; Saudi Arabia, Oman, Bahrein; and Singapore(!).

I really hope that Bangladesh isn't going to be the next big epicenter of the pandemic; the country has a population of 161 million people with an area not much bigger than New York state.

Highlights
On 10 April 2020, the Ministry of Public Administration issued a notification informing that the general holidays are declared on 15-16 April and 19-23 April 2020 (17-18 April and 24-25 April are weekends). It specified that these holidays are not to be conside red as regular holidays and that the following regulations are to be strictly adhered to during the holiday period: all residents should stay at home and go out only in case of essential need; legal actions will be taken for those going out after 6:00pm; movement between different locations will be restricted; Government officials at the division, district, upazila and union levels are to stay at their workstations.

https://www.who.int/docs/default-so...uation-reports/who-ban-covid-19-sitrep-07.pdf
Finding a lot of cases once testing ramps up sounds very familiar, but it does seem like they didn't wait for those tests to start mitigation.

As of April 14, 2020, Bangladesh reported 1012 confirmed cases of COVID-19 within its borders. Among these, there have been 46 deaths.
The Government of Bangladesh announced a general holiday period from March 29 to April 25. Bangladeshi government offices and private sector organizations will largely be closed from March 26 to April 25 and the government has advised everyone to stay home during this period. Hospitals, pharmacies, and kitchen markets will remain open. Public transportation and banking services will be limited.
The Bangladesh army has been deployed to enforce social distancing measures.

https://bd.usembassy.gov/covid-19-information/

 

[Mendel]

On April 13th, the German science academy Leopoldina has released a third statement with recommendations for a political strategy after the shutdown, signed by academics from multiple disciplines (medicine, law, economics, education, engineering, ...). They have recommendations regarding testing, opening schools, what you would expect, but also an observation that surprised me.

Spoiler: German text of quote

Angesichts der tiefen Spuren, welche die Coronavirus-Krise hinterlassen wird, vor allem aber wegen der mindestens ebenso bedrohlichen Klima- und Biodiversitäts-Krise kann es nicht einfach eine Wiederherstellung des vorherigen Status geben. Nicht zuletzt gilt es, aus den Erfahrungen mit der Coronavirus-Pandemie und ihren Ursachen Lehren für die Zukunft zu ziehen. Die generelle Zunahme der Bevölkerung, Urbanisierung und globale Mobilität, die Vernichtung und Abnahme der Widerstandsfähigkeit von Ökosystemen durch Landnutzungsänderungen und der Klimawandel tragen wesentlich zum Ausbruch von Epidemien und Pandemien bei.

Staatliche Maßnahmen, die nach dem Abklingen der Pandemie wirtschaftliche Tätigkeit wieder anstoßen, sollten daher die Kriterien der Nachhaltigkeit in den Vordergrund stellen. Mit einer nachhaltigen Ausrichtung der jetzt getätigten Investitionen und Programme entstünde die Freiheit der Beteiligten, die notwendi- gen Änderungen auf eine den jeweiligen lokalen und zeitlichen Gegebenheiten angemessene Weise umzusetzen, dringend nötige Technologieoffenheit beispielsweise bei der Energiewende herzustellen, regionale und globale Stoffkreisläufe zu schließen etc. Wird diese Chance vertan, so dürfte auf Grund der Größe der jetzigen Wirtschaftsprogramme ein später nötiges drastischeres Umsteuern extrem schwierig werden. Daher liegt in der Wahrnehmung dieser historischen Chance eine kaum zu überschätzende Verantwortung der Handelnden. Notwendig ist dabei eine transparente Kostendiskussion, die auch die massiven externen Kosten von Klima-, Umwelt- und nicht zuletzt daraus resultierenden Gesundheitsschäden berücksichtigt.

https://www.leopoldina.org/publikat...e-krise-nachhaltig-ueberwinden-13-april-2020/

My translation:

Considering the substantial marks that the the coronavirus crisis is going to leave on our society, but mainly because of the equally threatening climate and biodiversity crisis, we can't simply return to the old state of things before the crisis. The coronavirus pandemic and its root causes have a lesson to teach for our future. Population growth, urbanization and global mobility, the destruction of ecosystems and impairment of their resilience due to changed land use and climate change contribute substantially to the outbreak of epidemics and pandemics.

Public measures to restart the economy after the pandemic has subsided should therefore focus on sustainability. If the investment programs enacted now are oriented towards sustainability, those involved would be at liberty to implement the necessary changes in a way that fits the local circumstances and timeline, to create the necessary open technologies for e.g. the energy transition, close regional and global resource cycles, etc. If we miss this chance, the size of the current economic programs will make the drastic changes very difficult that are going to be required later. Therefore, the actors' responsibility to realize this historic opportunity can hardly be overestimated. A transparent public discussion of all costs is necessary, including the massive public costs of climate change, environmental damage, and the resulting public health issues.​

 

[Mendel]

At the press conference with the German health minister this morning, it was revealed that we actually have had enough test capacity to process more tests than the physicians requested, which means our backlog in the system should be mostly gone, and it supports my theory that test volume is driven by the size of the "suspect pool". They're planning to use the surplus capacity to protect retirement homes and hospitals.
A month of increasingly severe social distancing measures brought R0 down to 0.7 on average; some regions still have >1. The goal is to keep it below 1.

The FDA Emergency Use Authorizations now include an ELISA antibody test, similar to the one I presented earlier, and others. The recent EUAs about using hospital sterilizers to decontaminate N95 masks limit the number of reuses to 2 (used to be 10), and I noticed they state that the masks are not sterile after the process (as before, hence the need to tag them with the user name). A new device type (from two different manufacturers) is a "diaphragm pacer" which electrically stimulates the diaphragm so it starts to work again on its own after the patient has been on a ventilator for weeks and forgotten how to breathe. (This is one way Covid-19 is different from the flu: patients stay on respirators for longer.)

https://www.fda.gov/medical-devices...-medical-devices/emergency-use-authorizations

 

[Rory]

Throughout the spread of the pandemic, there's been one chart that I've found the most interesting and which has informed my opinion of the direction and timing of the virus more than any other. This is the current version:

View attachment 40335
Source: https://www.bbc.com/news/world-51235105

Since I started looking at it maybe a month ago, it's suggested very strongly that the future (unforeseen second waves aside) is bright: that countries, quite literally, come out of the darkest days pretty quickly.

The big question was, would those countries that were lagging behind China in terms of timeframe follow China's trend, or would they do something different and lend further support to the skepticism around China's figures?

So far, it's looking to me like the former.

All that said about my enthusiasm for this chart, I would perhaps rather the levels were based on percentage of population rather than number of cases: I guess there's a big difference between 5,000+ cases in the US and 5,000+ cases in Belgium.

Johns Hopkins - the source for the data for this chart - does have lots of other charts, including this one:

Source: https://coronavirus.jhu.edu/data/cumulative-cases

That shows cumulative number of deaths rather than daily totals, but is by per 100,000 of the population. If you click on the link above, there are interactive features also. Very interesting stuff: shows that Belgium, for example, has 4x the per capita death rate of the US.

 

[Mick West]

That shows cumulative number of deaths rather than daily totals, but is by per 100,000 of the population. If you click on the link above, there are interactive features also. Very interesting stuff: shows that Belgium, for example, has 4x the per capita death rate of the US.

The "Incident Rate" tab on the JHU map shows this in finer detail.
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Beligium is relatively small (11.5 million) dense (991 people per square mile region. The US has 30 times the people, and 1/10th the population density. So comparing Belgium to the US is not that useful, better to compare it to a more similar US state like those in the North East.

 

[Rory]

I think what I meant was being able to see the apparent 'curve' of the original chart in terms of per capita rate.

There's a strong sense of 'up and down' in that chart - countries working their way towards 5000+ cases per day and then coming out of it - but because it's number of cases rather than percentage of population, it's harder to gauge exactly what those curves/trends look like.

 

[DavidB66]

Mick makes a good point about population density. A large proportion (about a third) of the UK cases and deaths are in London and south-east England. The Paris area accounts for nearly half the cases in France. In Spain Madrid and Barcelona, the two largest cities, between them account for more than half. I wonder if the relatively low rate of serious cases in Germany has something to do with the population distribution there. No single city in Germany has the population size of the cities just mentioned. This may help Germany control the spread of infection both within and between different population centres. (The southern and western Lander have had fairly high rates of infection, but it does not seem to have spread in the north and east, and especially Berlin, in the way that might have been expected.)
But against any idea that large population centres are necessarily badly hit, the infection and death rates in Japan, with its huge cities, remain relatively low.

 

[Mendel]

No single city in Germany has the population size of the cities just mentioned.

That depends on who you ask.
The state of Berlin has 135 cases/100000 currently, German average is 165, and the state of Hamburg has 224. Bavaria is worst hit (closest to Italy) with 282, but still below Belgium.

@Rory (or anyone else), if you'd like to see a specific graph, I can probably generate it for you from the ECDC database (or another, ideally csv). Just drop me a PM with what you'd like to see and the countries you'd like to see it for. The 3day-average over the 14-day-sum plot is good.