Coronavirus pandemic non-socio-political discussions

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RxCowboy

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https://www.pnas.org/content/early/2020/05/12/2006874117

The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission
Valentyn Stadnytskyi, Christina E. Bax, Adriaan Bax, and Philip Anfinrud
PNAS first published May 13, 2020 https://doi.org/10.1073/pnas.2006874117
Edited by Axel T. Brunger, Stanford University, Stanford, CA, and approved May 4, 2020 (received for review April 10, 2020)

Abstract
Speech droplets generated by asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly considered to be a likely mode of disease transmission. Highly sensitive laser light scattering observations have revealed that loud speech can emit thousands of oral fluid droplets per second. In a closed, stagnant air environment, they disappear from the window of view with time constants in the range of 8 to 14 min, which corresponds to droplet nuclei of ca. 4 µm diameter, or 12- to 21-µm droplets prior to dehydration. These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments.
 

RxCowboy

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May 22

Covid-19 Update: Friday 5/22
Hand sanitizer, Sweden, Influenza, the Numbers and Masks
Happy Friday of a LONG weekend! There will be no Monday report unless something big happens.

1. Hand sanitizer is back in the news. This time not because people are drinking it, but because of it's potential to start a fire. The Wisconsin Fire Department is cautioning people to remember that hand sanitizer is flammable and shouldn't be used near open flames. As summer is coming (or has arrived depending on what part of the country you are in) they also mention that while unlikely, it is possible if left in direct sunlight the bottle could ignite in your car. Unlikely but possible.

2. In the last 17 days 23K Americans have died from Covid-19 and our total daily case counts have been back up. You may recall we were looking for cases below or near 20k a day to show progress. Yesterday we ended at 28k new cases. We have had multiple days above the 20k mark. This would indicate we are holding steady.

3. Sweden's death rate from Covid is now the highest per capita in the world. When measuring their immunity to determine where they are in developing herd immunity they found that in Stockholm they were around 7%. In other less densely populated areas immunity was around the 3% range.

4. Influenza and Covid comparisons continue so I thought I would cover this again. Yes, more people in America get the flu in a season (3%) than Covid (0.49%) -thus far, and with COVID intervention. But case fatality rate (CFR) from the flu is typically <0.1%. When I calculate our deadliest flu season of the last 20 years against the lowest infection rate to get the highest possible CFR in the last twenty years it is 0.15%. During the Spanish Flu of 1918 CFR was 2.5%. Covid-19 CFR is 6%. And just to have a solid picture let's look at the deaths per 100K for flu compared to Covid. Because we have more flu data, and because flu years vary, I took the flu average. On average, Flu kills 10.59 people per 100k in America each year. COVID has killed 28.1 people per 100k in America in 5 months.

5. Finally, there is information going around that says wearing a mask will give you the disease. I just want to ask you one question regarding that. If that is the case, why do healthcare professionals wear masks and why don't they all have it? You do need to wear it correctly and remove it correctly.

FINAL THOUGHTS: I would like to take a moment to remember those who have given their lives for this nation and the freedoms we so often take for granted. Freedoms that include having differing opinions, believing conspiracy theories and engaging in heated debates over to mask or not to mask. Independence, free will, free thought, and freedom did not come to us without sacrifice. This weekend as we BBQ and experience the long weekend in quarantine fashion, take pause to remember those who gave their lives for this. Fly your flag, wear your red, white and blue, and honor that sacrifice in large and small ways. Allow your fellow Americans the right to have ideas far different than your own because hundreds of thousands of men and women have died so that we could. May we never grow deaf to the tears of their loved ones. Thank you to our military and their families, and to those who have given their lives defending our freedoms, and especially to those who will be grieving the loss of their loved one this Memorial Day.
 

RxCowboy

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From The Lancet:

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis
Prof Mandeep R Mehra, MD
Sapan S Desai, MD
Prof Frank Ruschitzka, MD
Amit N Patel, MD
Published:May 22, 2020DOI:https://doi.org/10.1016/S0140-6736(20)31180-6

Summary
Background
Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.

Methods
We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19. The registry comprised data from 671 hospitals in six continents. We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2. Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a macrolide), and patients who received none of these treatments formed the control group. Patients for whom one of the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation, as well as patients who received remdesivir, were excluded. The main outcomes of interest were in-hospital mortality and the occurrence of de-novo ventricular arrhythmias (non-sustained or sustained ventricular tachycardia or ventricular fibrillation).

Findings
96?032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study period and met the inclusion criteria. Of these, 14?888 patients were in the treatment groups (1868 received chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received hydroxychloroquine with a macrolide) and 81?144 patients were in the control group. 10?698 (11·1%) patients died in hospital. After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality. Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.

Interpretation
We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.

Funding
William Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women's Hospital.
 

Pokey

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From The Lancet:

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis
Prof Mandeep R Mehra, MD
Sapan S Desai, MD
Prof Frank Ruschitzka, MD
Amit N Patel, MD
Published:May 22, 2020DOI:https://doi.org/10.1016/S0140-6736(20)31180-6

Summary
Background
Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.

Methods
We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19. The registry comprised data from 671 hospitals in six continents. We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2. Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a macrolide), and patients who received none of these treatments formed the control group. Patients for whom one of the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation, as well as patients who received remdesivir, were excluded. The main outcomes of interest were in-hospital mortality and the occurrence of de-novo ventricular arrhythmias (non-sustained or sustained ventricular tachycardia or ventricular fibrillation).

Findings
96?032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study period and met the inclusion criteria. Of these, 14?888 patients were in the treatment groups (1868 received chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received hydroxychloroquine with a macrolide) and 81?144 patients were in the control group. 10?698 (11·1%) patients died in hospital. After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality. Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.

Interpretation
We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.

Funding
William Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women's Hospital.
Great! Supposedly Stitt bought $2 million worth. Maybe he’ll sell it to lupus patients cheap.
 

RxCowboy

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EID Journal
Volume 26
Early Release

Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Volume 26, Number 7—July 2020
Research
High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2
Steven Sanche1, Yen Ting Lin1, Chonggang Xu, Ethan Romero-Severson, Nick Hengartner, and Ruian Author
Author affiliations: Los Alamos National Laboratory, Los Alamos, New Mexico, USA

Abstract
Severe acute respiratory syndrome coronavirus 2 is the causative agent of the 2019 novel coronavirus disease pandemic. Initial estimates of the early dynamics of the outbreak in Wuhan, China, suggested a doubling time of the number of infected persons of 6–7 days and a basic reproductive number (R0) of 2.2–2.7. We collected extensive individual case reports across China and estimated key epidemiologic parameters, including the incubation period. We then designed 2 mathematical modeling approaches to infer the outbreak dynamics in Wuhan by using high-resolution domestic travel and infection data. Results show that the doubling time early in the epidemic in Wuhan was 2.3–3.3 days. Assuming a serial interval of 6–9 days, we calculated a median R0 value of 5.7 (95% CI 3.8–8.9). We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus.
 

wrenhal

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Finally, there is information going around that says wearing a mask will give you the disease.
There is no known respiratory illness you can give yourself because, and this should be obvious, if you're contagious then you already have it.
I think this is being confused by people that are not understanding that there are some people having sinus and respiratory issues due to prolonged mask wearing at like restaurants. People who aren't used to wearing them for so long.

Sent from my Moto Z (2) using Tapatalk
 

RxCowboy

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I think this is being confused by people that are not understanding that there are some people having sinus and respiratory issues due to prolonged mask wearing at like restaurants. People who aren't used to wearing them for so long.

Sent from my Moto Z (2) using Tapatalk
I don't know a bout it being confused, but I've had people tell me straight up on Facebook that they don't want to wear a mask because they're afraid they will infect themselves. It simply makes no sense.
 

RxCowboy

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May 26
Covid-19 Update: Tuesday May 26th
Welcome back. Death tolls, vertical transmission, things to monitor and long term effects.

1. I have seen lots of headlines about Covid being the third leading cause of death in the US and that it has now killed more people than the Vietnam war and Korean war. These headlines are partially true. We have surpassed the war death tolls. But Covid is not the third leading cause of death in the US. Those models are built around either a one month death toll (meaning more people died in one month from Covid than do in one month from everything but cancer and heart disease) or they used projections to predict where we would be in a year. Neither approach is great, but both are useful if considered in context. Currently Covid is the 7th leading cause of death in the US. In order to be in the #3 slots (as the articles claim) 70k more people would have to die. But do keep in mind Covid has only been a thing for 5 months - and not quite 5 full months so we have a way to go.

2. There is still no evidence of vertical transmission (transmission from mother to unborn child). This is good news. However, 60% of babies born to Covid positive moms appear to be born prematurely. This was a single study so additional research is still needed.

3. We should hit 100k deaths today. Things to monitor this week include if we stay under 20k cases a day (signs of improvement) or if we go over and by how much. The closer to 20k the better. Another thing to monitor is how long until we hit 2 million cases - if we hit before Saturday we are moving too fast.

4. Don't believe news stories that say a state reopened and 2 days later they saw a spike in deaths or cases. Deaths take time, you aren't going to see mass people catch the virus and die within 2 days. And most people have an incubation period of 4-5 days. So....if they opened and saw spikes immediately (in less than 4 days) something else is happening, something that started 4-5 days prior.

5. We don't know the long term effects of surviving severe Covid-19 but some preliminary findings suggest that the damage to the lungs may be severe and require long term recovery. Like most things, individual responses vary so we would expect that some people would recover more easily but some early indications are that full recovery will take time and some people may experience permanent/long term effects.

6. The CDC didn't say oops - they said, the virus doesn't spread easily on surfaces. We have really suspected this all along and now they have the evidence to support that. The primary route of transmission is via droplets - so in person transmission. This isn't new. They are now exploring how long you need to be exposed - that should be the next big bit of news.

FINAL THOUGHTS: Another week has begun. I hope you took time this weekend to leave social media behind and ignore debates over masks and the economy and what we need to be doing. Let's pull up our socks and make this week a good one. One full of love and light and joy and helping others. Let's agree to scroll past things that will only make us angry, and to hold our tongues from saying things that won't build others up. Let's make this a great week!
 

SLVRBK

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https://www.dailynews.com/2020/05/2...ts-accused-of-hyping-covid-19-antibody-study/

Stanford coronavirus research: Did politically-motivated scientists hype their speedy study?

In the race to combat the COVID-19 pandemic, the world’s scientists have embraced a radically new method of disseminating information about their research, offering it quickly and without filters in the effort to understand and control this deadly disease.

But their new communication model is striking at the heart of scientific integrity, publicizing research that has been corrupted by speed, sloppiness and opacity. And now the academic world is being roiled by a question for which millions of lives hang in the balance: Is the public being well-served by the fast and free flow of research — or dangerously misled?

Nowhere is the question over scientific conduct louder than at Stanford University, where a trio of researchers are accused of promoting faulty analysis and “tipping the scale” on antibody studies that they say proves the virus is more widespread and less lethal than we feared, and that public health restrictions are too strict.

And now the university, which has also come under fire, is investigating the veteran professors’ research, a significant step in a world that cherishes credibility and reputation.
____________________________________________

When the Stanford team — Drs. Jayanta Bhattacharya, John Ioannidis and Eran Bendavid — released the first draft of their Santa Clara County-based preprint, the news was stunning. The nation’s first study of its type, it found that the virus was astoundingly 50 to 85 times more prevalent than presumed. But that meant the death rate was far lower.

Yet the project raised eyebrows from the start.

Even before they started collecting data, the researchers openly questioned “stay at home” orders. Ioannidis wrote a provocative article arguing that if COVID-19 is less deadly, widespread restrictions “may be totally irrational.” A Wall Street Journal editorial by Bhattacharya and Bendavid was entitled “Is the Coronavirus as Deadly as They Say?” Bhattacharya revisited that theme in the Hoover Institution and Fox Nation program “Questioning Conventional Wisdom.”

When their preprint was published, its conclusions backed the trio’s policy arguments – and it was saddled with statistical problems.

It failed to describe key calculations and made at least five material mistakes, according to Will Fithian, assistant professor in UC Berkeley’s Department of Statistics. The population-weighted intervals in a table were miscalculated. The authors plugged the wrong interval into a formula. They made two math errors in executing that formula. And, misreading their test kit’s manufacturer insert, they used the wrong numbers for the antibody test’s specificity.
 

RxCowboy

Has no Rx for his orange obsession.
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https://www.dailynews.com/2020/05/2...ts-accused-of-hyping-covid-19-antibody-study/

Stanford coronavirus research: Did politically-motivated scientists hype their speedy study?

In the race to combat the COVID-19 pandemic, the world’s scientists have embraced a radically new method of disseminating information about their research, offering it quickly and without filters in the effort to understand and control this deadly disease.

But their new communication model is striking at the heart of scientific integrity, publicizing research that has been corrupted by speed, sloppiness and opacity. And now the academic world is being roiled by a question for which millions of lives hang in the balance: Is the public being well-served by the fast and free flow of research — or dangerously misled?

Nowhere is the question over scientific conduct louder than at Stanford University, where a trio of researchers are accused of promoting faulty analysis and “tipping the scale” on antibody studies that they say proves the virus is more widespread and less lethal than we feared, and that public health restrictions are too strict.

And now the university, which has also come under fire, is investigating the veteran professors’ research, a significant step in a world that cherishes credibility and reputation.
____________________________________________

When the Stanford team — Drs. Jayanta Bhattacharya, John Ioannidis and Eran Bendavid — released the first draft of their Santa Clara County-based preprint, the news was stunning. The nation’s first study of its type, it found that the virus was astoundingly 50 to 85 times more prevalent than presumed. But that meant the death rate was far lower.

Yet the projectraised eyebrows from the start.

Even before they started collecting data, the researchers openly questioned “stay at home” orders. Ioannidis wrote a provocative article arguing that if COVID-19 is less deadly, widespread restrictions “may be totally irrational.” A Wall Street Journal editorial by Bhattacharya and Bendavid was entitled “Is the Coronavirus as Deadly as They Say?” Bhattacharya revisited that theme in the Hoover Institution and Fox Nation program “Questioning Conventional Wisdom.”

When their preprint was published, its conclusions backed the trio’s policy arguments – and it was saddled with statistical problems.

It failed to describe key calculations and made at least five material mistakes, according to Will Fithian, assistant professor in UC Berkeley’s Department of Statistics. The population-weighted intervals in a table were miscalculated. The authors plugged the wrong interval into a formula. They made two math errors in executing that formula. And, misreading their test kit’s manufacturer insert, they used the wrong numbers for the antibody test’s specificity.
i had problems with using Facebook for recruitment, it creates selection bias.
 
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i had problems with using Facebook for recruitment, it creates selection bias.
You can do facebook recruitment well these days. If done right, it's no worse than other modes of random sampling because you can now target random selections of individual users and include over samples based on profiles of users who are underrepresented either on facebook or in Facebook ad response, but your recruitment tokens absolutely have to be unique and triple checked in that regard. I've worked on projects where we do this. The issue is that their tokens were not unique and were not checked as rigorously as you need them to be. So, you take a random sample where you already have response biases (even if it's a true random invite, people who think they had it are more likely to respond) and add other similar biases in addition to dependence related biases because people who know each other are going to participate together and their risk of infection is dependent (if I know you and hang out with you, I'm going to be more likely to get it). That said, phone, mail, and email can all have their own issues that make Facebook appealing when done right.

Their LA sample seemed better, but details were lacking.

They also had to know scrutiny was coming. You want to be the leading edge and guide national policy on anything, don't make numerous basic effing mistakes.