Coronavirus pandemic non-socio-political discussions

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RxCowboy

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#41
One of the positives about this virus is the presence of a steady, consistent genome irrespective of noted mutation. This indicates any successful vaccine developed will be effective should there be a future outbreak. I've not read up on the rna/dna present (if any since some viruses have little or none). Maybe @RxCowboy can speak to that and its relevance.
See today's update. It seems to be mutating slowly, so there is some hope for a vaccine.
 

RxCowboy

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#42
From Jama:

April 6, 2020
The COVID-19 Pandemic in the US: A Clinical Update
Saad B. Omer, MBBS, PhD1,2; Preeti Malani, MD, MSJ3,4; Carlos del Rio, MD5,6

JAMA. Published online April 6, 2020. doi:10.1001/jama.2020.5788

Since the first US case of coronavirus disease 2019 (COVID-19) infection as identified in Washington State on January 20, 2020, more than 235?000 cases have been identified across the US in just over 2 months. Given the challenges in expanding testing capacity and the restrictive case definition of persons under investigation, the true number of cases is likely much higher.

By March 17, the outbreak had expanded from several isolated clusters in Washington, New York, and California to all 50 states and the District of Columbia. As of April 2, there have been more than 5000 COVID-19–associated deaths in the US. With a global total now of more than 1 million cases, the US is now the country with the largest number of reported cases, comprising about one-fifth of all reported infections.

With community transmission firmly established, the US epidemic enters the exponential growth phase in which the number of new cases is proportional to the existing number of cases. This phase continues until either enough susceptible individuals become immune as a result of infection, stringent public health measures are followed, or both.

Case Fatality

A yet unanswered question that adds to uncertainty around the outbreak involves the case-fatality rate (CFR), defined as the percentage of deaths among all cases. Presently, global mortality is reported at 4.7% but this varies widely by location from a high of 10.8% in Italy to a low of 0.7% in Germany. Several factors influence the CFR including a reliable estimate of the total number of cases. Among the first 140?904 cases in the US, 1.7% died; however, given the uncertainty in the denominator, this is not a reliable CFR estimate. For example, the crude CFR in Wuhan, China, was reported to be 5.8% on February 1, whereas more methodologically robust estimates using novel methods to estimate the actual number of cases reported the CFR as 1.4%.1

In the coming weeks, surge capacity at US hospitals will influence the CFR. However, to have reliable estimates, better approximations of the overall population (denominator) are essential, and methods such as serosurveys using statistical sampling generalizable to the populations of interest will inform these estimates.

New Clinical and Epidemiological Insights

Is PCR Always Positive? What Is the Meaning of a Negative PCR? Several types of tests are being used to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).2 These can be classified into 2 general categories: molecular diagnosis/polymerase chain reaction (PCR)–based testing and serological testing. In clinical settings, PCR-based testing remains the primary method of identifying SARS-CoV-2. Given the lack of a reference standard for diagnosing COVID-19, the sensitivity and specificity of diagnostic testing are unknown. In addition, inadequate sample collection may reduce test sensitivity. In a study of 5 patients, individuals with chest computed tomography findings compatible with COVID-19, and a negative reverse transcriptase (RT)–PCR result for SARS-CoV-2, tested positive on subsequent testing, suggesting that certain patients (eg, with compatible radiological findings) might require repeat testing with specimens collected from multiple sites in the respiratory tract.3

It is likely that lower respiratory samples (eg, minibronchial alveolar lavage) are more sensitive than a nasopharyngeal swab. Thus, it is important to emphasize that, depending on the clinical presentation, a negative RT-PCR result does not exclude COVID-19. Multiple serological tests are in various stages of development. With wider availability of serological testing, it will be possible to determine whether patients have a false-negative PCR result.

Can Patients Become Reinfected? Reports from China and Japan have indicated that some patients with COVID-19 who were discharged from the hospital after a negative RT-PCR result were readmitted and subsequently tested positive on RT-PCR. It is unclear from the available information if these were true reinfections or the tests were falsely negative at the time of initial discharge. However, while other coronaviruses demonstrate evidence of reinfection, this usually does not happen for many months or years. Therefore, it is unlikely that these were true cases of reinfection. Some reassuring evidence comes from a challenge study among rhesus macaques.4 After initial challenge and clearance of SARS-CoV-2, the animals were rechallenged with the virus but were not infected. While the evidence on reinfection is evolving, current data and experience from previous viruses without substantial seasonal mutation do not support this hypothesis.

How Long Does Immunity Last? Presently, there is no validated immune correlate of protection for SARS-CoV-2, ie, antibody level or another immunological marker associated with protection from infection or disease. However, in a study that included 82 confirmed and 58 probable cases of COVID-19 from China, the median duration of IgM detection was 5 days (interquartile range, 3-6), while IgG was detected at a median of 14 days (interquartile range, 10-18) after symptom onset.5 Because the outbreak is only a few months old, there are no data on long-term immune response. Data from SARS-CoV-1 indicate that titers of IgG and neutralizing antibodies peaked at 4 months after infection, with a subsequent decline through at least 3 years after infection.

Should Everyone Wear a Mask in Public? Current guidelines from the Centers for Disease Control and Prevention (CDC) do not recommend routine use of medical masks among healthy individuals and suggest limiting mask use to health care workers and those caring for patients with COVID-19. However, this guidance is likely to be modified. Regardless, any change in policy should prioritize the availability of masks for health care workers. Priority should also be given to others with risk of exposure such as first responders and incarcerated individuals. Due to the current scarcity of masks, many in the community have begun sewing masks for themselves and for health care workers. A fitted N95 respirator is the preferred type of medical mask for health care workers; however, supplies in the US are very limited. Medical masks are also recommended for symptomatic individuals to prevent them from transmitting the virus.

The rationale supporting the recommendations comes from studies finding limited to no efficacy of masks in protecting healthy individuals from influenza infection and also for the need to preserve supplies. However, evidence from influenza studies might not be relevant for COVID-19. For example, in a systematic review, masks, particularly combined with other measures such as handwashing, were found to be effective in preventing SARS-CoV-1 infection.6 Moreover, with the increasing evidence of presymptomatic transmission of SARS-CoV-2, there might be value in the use of masks among individuals at risk of transmission.7

How Does SARS-CoV-2 Spread? Current evidence suggests that SARS-CoV-2 is primarily transmitted through droplets (particles 5-10 µm in size). Person-to-person transmission occurs when an individual with the infection emits droplets containing virus particles while coughing, sneezing, and talking. These droplets land on the respiratory mucosa or conjunctiva of another person, usually within a distance of 6 ft (1.8 m) but perhaps farther.8 The droplets can also settle on stationary or movable objects and can be transferred to another person when they come in contact with these fomites. Survival of the virus on innate surfaces has been an important topic of discussion. While there are few data, the available evidence suggests that the virus can remain infectious on inanimate surfaces at room temperature for up to 9 days. This time is shorter at temperatures greater than 30° C. The good news is that cleaning and disinfection are effective in decreasing contamination of surfaces, emphasizing the importance of high-touch areas.9

Transmission through aerosols, particles smaller than 5 µm, can also occur under specific circumstances such as endotracheal intubation, bronchoscopy, suctioning, turning the patient to the prone position, or disconnecting the patient from the ventilator. Cardiopulmonary resuscitation is another important aerosol-generating procedure.

In a recent study of environmental sampling of rooms of patients with COVID-19, many commonly used items as well as air samples had evidence of viral contamination.10 In the context of the heterogeneity in evidence and possibility of aerosolization of the virus during certain medical procedures, public health agencies (including the CDC) recommend airborne precautions in situations involving patients with COVID-19.

When Can Social Distancing Measures Be Lifted? With the exponential increase in US COVID-19 cases and deaths, several jurisdictions have implemented social-distancing measures. Modeling and empirical studies suggest that social-distancing measures can help reduce the overall number of infections and help spread out cases over a longer period of time, thus allowing health systems to better manage the surge of additional patients. However, long-term social distancing can have detrimental effects on physical and mental health outcomes as well as the economy.

A few changes may allow for easing restrictions: First, an aggressive program of testing to identify asymptomatic and mild cases combined with proactive contact tracing and early isolation as well as quarantine of contacts. Second, there must be a focus on reducing home-based transmission. In Wuhan, particularly after the initial phase, most transmissions occurred within households. While the CDC has published guidelines for preventing household transmission, it did not place enough emphasis on the importance of having the infected person always wear a mask. Third, even a treatment that only shortens an intensive care unit stay by 20% to 30% can have a substantial benefit on health system capacity.

When Will a Vaccine Be Available? The ultimate strategy for controlling this pandemic will depend on a safe and efficacious vaccine against SARS-CoV-2. However, only 3 vaccine candidates are currently in phase 1 human trials: a messenger RNA vaccine and 2 adenovirus vector-based vaccines. The estimated timeline for availability of an initial vaccine is between early and mid-2021.

Conclusions

As the COVID-19 outbreak expands in the US, overall understanding of this disease has increased, with more information available now than even a few weeks ago. However, more evidence is needed, particularly for public health and clinical interventions to successfully prevent and treat infections. Even during a pandemic, obtaining rigorous, reliable data is not a distraction, rather it is essential for accurately measuring the extent and severity of COVID-19 and assessing the effectiveness of the response.

Corresponding Author: Carlos del Rio, MD, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, FOB Room 201, Atlanta, GA 30303 (cdelrio@emory.edu).

Published Online: April 6, 2020. doi:10.1001/jama.2020.5788

Conflict of Interest Disclosures: Dr del Rio reported receiving grants from the National Institutes of Health/National Institute of Allergy and Infectious Diseases. No other disclosures were reported.
 

RxCowboy

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#43
April 7

Covid19 Update: Today I just want to offer a refresh on something we already talked about because it seems to still be a point of confusion. Is Covid19 airborne?

I believe the confusion comes from different people using the term differently. And in part because Scientist themselves don't quite agree. So let's break it down.

To be sure I am not confusing anyone, Covid19 is the name of the disease/illness - the virus is SARS-Cov2 so really (if we are being technical) we are asking if the virus is airborne - not the disease.

But we don't need to be that technical for our purposes, most people won't and it takes longer to type - so let's stick with Covid19 as a generic today.

As an epidemiologist and researcher, operational definitions are important to me. I.e. making sure we are all using a word the same way with the same definition/understanding of it. So let's make sure we are all referring to "airborne" the same way.

Some people are saying "airborne" and they mean it is floating about freely in the air like pollution. Let me assure you, the air itself is not contaminated and is nothing to fear. That would be a totally different virus that would have to be combated in completely different ways and the recommendations would look very different. We would be talking about ways to seal up your windows and change your air filter and N95 masks would be a must for us all.

Some people are saying "airborne" and they mean that you breathe the virus in and it travels via respiratory droplets. Yes this is how it is spread, but this is not the scientific definition of airborne either.

So what is airborne transmission? Airborne transmission is when tiny respiratory droplets are so small they become aerosolized which allows them to get caught in the air-currents and travel longer than normal. For this to happen, two things are required. The droplets must be very small, and (that is an important "and") there must be enough of them to make someone sick. These tiny droplets are called bioaerosols. Even in this case, the droplets first must be expelled by an infected person. Then the "air travel" is still limited, feet, not miles. (Remember the MIT study we discussed previously?)

Certain medical procedures cause aerosolization of a virus that otherwise wouldn't be. For example, removing a patient from a ventilator. This puts our medical professionals at particularly high risk while performing those procedures. But that risk is typically contained within the room and poses no risk to the average person, just those in the room. This, of course, is why PPE is so critical for them. And again the virus isn't airborne forever, it just takes a little longer for these small particles to land.

Covid19 is to big to be considered a bioaerosol and there has been no proof of true airborne transmission with the small exception of during medical procedures that cause aerosolization.

Think about a watermelon seed spitting contest. Even if you have never had one yourself, surely you have seen it on TV? In this scenario, the seed is the virus. The "spitter" shoots the seed out as far as they can and for just a second it is airborne flying to its destination. Then, it lands and that's that. This virus moves the same way. How far it travels is a little bit dependent on the "spitter" and just how robust that sneeze was. The virus sails through the air for a few glorious seconds only after sneezed out, coughed out etc. It can't just float along indefinitely.

Further research is being done to determine just how far Covid19 droplets can go - but for now we will stick with 5- 6 feet which is what current research tells us. This could change as we learn more but right now this is what we know.

FINAL THOUGHT: Being outside is a good thing and is safe. It is good for your soul. I go out in my backyard every day, usually multiple times a day. So backyard BBQs, gardening, going for a run, baseball in the yard, Duck Duck Goose, hopscotch, sidewalk chalk, yard work, jump rope - all of these are safe and good as long as you are doing them only with those who you are quarantined with. Fresh air, sunshine and distractions are your quarantine friend. So grab a picnic basket and head to the back yard!
 

kadune

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#44
To be sure I am not confusing anyone, Covid19 is the name of the disease/illness - the virus is SARS-Cov2 so really (if we are being technical) we are asking if the virus is airborne - not the disease.
I hadn't seen this differentiation before. So, to clarify, the virus is the cause, and the disease is the effect? Would you say that asymptomatic carriers could transmit the virus, but they themselves aren't experiencing COVID-19?
 

RxCowboy

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#45
I hadn't seen this differentiation before. So, to clarify, the virus is the cause, and the disease is the effect? Would you say that asymptomatic carriers could transmit the virus, but they themselves aren't experiencing COVID-19?
Yes, that is exactly right. When you read popular media, however, COVID-19 is being used to refer to both the disease and the virus, so you have to pay careful attention to what they are saying.

Coronavirus - a group of viruses that includes SARS-Cov-2 which came from Wuhan, aka Wuhan Coronavirus.

COVID-19 - the symptoms and disease caused by SARS-Cov-2. The acronym stands for COronaVIrus Disease 2019.
 

RxCowboy

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#46
The meds that are going into clinical trial for COVID-19 are faster than I can keep up with, but there is one vaccine that looks promising and it would be delivered in a patch. Just slap the patch on and that's it. I don't know how that works, because there are certain drug characteristics that make them absorbable transdermally, and the viral antigen would have to meet those characteristics. But it would sure make delivery easy.
 

RxCowboy

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#47
This is a Jama article from back in January, but it is good overview of the Coronaviruses and Dr. Fauci is a co-author.

January 23, 2020
Coronavirus Infections—More Than Just the Common Cold
Catharine I. Paules, MD1; Hilary D. Marston, MD, MPH2; Anthony S. Fauci, MD2

JAMA. 2020;323(8):707-708. doi:10.1001/jama.2020.0757

Human coronaviruses (HCoVs) have long been considered inconsequential pathogens, causing the “common cold” in otherwise healthy people. However, in the 21st century, 2 highly pathogenic HCoVs—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—emerged from animal reservoirs to cause global epidemics with alarming morbidity and mortality. In December 2019, yet another pathogenic HCoV, 2019 novel coronavirus (2019-nCoV), was recognized in Wuhan, China, and has caused serious illness and death. The ultimate scope and effect of this outbreak is unclear at present as the situation is rapidly evolving.

Coronaviruses are large, enveloped, positive-strand RNA viruses that can be divided into 4 genera: alpha, beta, delta, and gamma, of which alpha and beta CoVs are known to infect humans.1 Four HCoVs (HCoV 229E, NL63, OC43, and HKU1) are endemic globally and account for 10% to 30% of upper respiratory tract infections in adults. Coronaviruses are ecologically diverse with the greatest variety seen in bats, suggesting that they are the reservoirs for many of these viruses.2 Peridomestic mammals may serve as intermediate hosts, facilitating recombination and mutation events with expansion of genetic diversity. The surface spike (S) glycoprotein is critical for binding of host cell receptors and is believed to represent a key determinant of host range restriction.1

Until recently, HCoVs received relatively little attention due to their mild phenotypes in humans. This changed in 2002, when cases of severe atypical pneumonia were described in Guangdong Province, China, causing worldwide concern as disease spread via international travel to more than 2 dozen countries.2 The new disease became known as severe acute respiratory syndrome (SARS), and a beta-HCoV, named SARS-CoV, was identified as the causative agent. Because early cases shared a history of human-animal contact at live game markets, zoonotic transmission of the virus was strongly suspected.3 Palm civets and raccoon dogs were initially thought to be the animal reservoir(s); however, as more viral sequence data became available, consensus emerged that bats were the natural hosts.

Common symptoms of SARS included fever, cough, dyspnea, and occasionally watery diarrhea.2 Of infected patients, 20% to 30% required mechanical ventilation and 10% died, with higher fatality rates in older patients and those with medical comorbidities. Human-to-human transmission was documented, mostly in health care settings. This nosocomial spread may be explained by basic virology: the predominant human receptor for the SARS S glycoprotein, human angiotensin-converting enzyme 2 (ACE2), is found primarily in the lower respiratory tract, rather than in the upper airway. Receptor distribution may account for both the dearth of upper respiratory tract symptoms and the finding that peak viral shedding occurred late (˜10 days) in illness when individuals were already hospitalized. SARS care often necessitated aerosol-generating procedures such as intubation, which also may have contributed to the prominent nosocomial spread.

Several important transmission events did occur in the community, such as the well-characterized mini-outbreak in the Hotel Metropole in Hong Kong from where infected patrons traveled and spread SARS internationally. Another outbreak occurred at the Amoy Gardens housing complex where more than 300 residents were infected, providing evidence that airborne transmission of SARS-CoV can sometimes occur.4 Nearly 20 years later, the factors associated with transmission of SARS-CoV, ranging from self-limited animal-to-human transmission to human superspreader events, remain poorly understood.

Ultimately, classic public health measures brought the SARS pandemic to an end, but not before 8098 individuals were infected and 774 died.2 The pandemic cost the global economy an estimated $30 billion to $100 billion.1 SARS-CoV demonstrated that animal CoVs could jump the species barrier, thereby expanding perception of pandemic threats.

In 2012, another highly pathogenic beta-CoV made the species jump when Middle East respiratory syndrome (MERS) was recognized and MERS-CoV was identified in the sputum of a Saudi man who died from respiratory failure.3 Unlike SARS-CoV, which rapidly spread across the globe and was contained and eliminated in relatively short order, MERS has smoldered, characterized by sporadic zoonotic transmission and limited chains of human spread. MERS-CoV has not yet sustained community spread; instead, it has caused explosive nosocomial transmission events, in some cases linked to a single superspreader, which are devastating for health care systems. According to the World Health Organization (WHO), as of November 2019, MERS-CoV has caused a total of 2494 cases and 858 deaths, the majority in Saudi Arabia. The natural reservoir of MERS-CoV is presumed to be bats, yet human transmission events have primarily been attributed to an intermediate host, the dromedary camel.

MERS shares many clinical features with SARS such as severe atypical pneumonia, yet key differences are evident. Patients with MERS have prominent gastrointestinal symptoms and often acute kidney failure, likely explained by the binding of the MERS-CoV S glycoprotein to dipeptidyl peptidase 4 (DPP4), which is present in the lower airway as well as the gastrointestinal tract and kidney.3 MERS necessitates mechanical ventilation in 50% to 89% of patients and has a case fatality rate of 36%.2

While MERS has not caused the international panic seen with SARS, the emergence of this second, highly pathogenic zoonotic HCoV illustrates the threat posed by this viral family. In 2017, the WHO placed SARS-CoV and MERS-CoV on its Priority Pathogen list, hoping to galvanize research and the development of countermeasures against CoVs.

The action of the WHO proved prescient. On December 31, 2019, Chinese authorities reported a cluster of pneumonia cases in Wuhan, China, most of which included patients who reported exposure to a large seafood market selling many species of live animals. Emergence of another pathogenic zoonotic HCoV was suspected, and by January 10, 2020, researchers from the Shanghai Public Health Clinical Center & School of Public Health and their collaborators released a full genomic sequence of 2019-nCoV to public databases, exemplifying prompt data sharing in outbreak response. Preliminary analyses indicate that 2019-nCoV has some amino acid homology to SARS-CoV and may be able to use ACE2 as a receptor. This has important implications for predicting pandemic potential moving forward. The situation with 2019-nCoV is evolving rapidly, with the case count currently growing into the hundreds. Human-to-human transmission of 2019-nCoV occurs, as evidenced by the infection of 15 health care practitioners in a Wuhan hospital. The extent, if any, to which such transmission might lead to a sustained epidemic remains an open and critical question. So far, it appears that the fatality rate of 2019-nCoV is lower than that of SARS-CoV and MERS-CoV; however, the ultimate scope and effects of the outbreak remain to be seen.

Drawing on experience from prior zoonotic CoV outbreaks, public health authorities have initiated preparedness and response activities. Wuhan leaders closed and disinfected the first identified market. The United States and several other countries have initiated entry screening of passengers from Wuhan at major ports of entry. Health practitioners in other Chinese cities, Thailand, Japan, and South Korea promptly identified travel-related cases, isolating individuals for further care. The first travel-related case in the United States occurred on January 21 in a young Chinese man who had visited Wuhan.

Additionally, biomedical researchers are initiating countermeasure development for 2019-nCoV using SARS-CoV and MERS-CoV as prototypes. For example, platform diagnostic modalities are being rapidly adapted to include 2019-nCoV, allowing early recognition and isolation of cases. Broad-spectrum antivirals, such as remdesivir, an RNA polymerase inhibitor, as well as lopinavir/ritonavir and interferon beta have shown promise against MERS-CoV in animal models and are being assessed for activity against 2019-nCoV.5 Vaccines, which have adapted approaches used for SARS-CoV or MERS-CoV, are also being pursued. For example, scientists at the National Institute of Allergy and Infectious Diseases Vaccine Research Center have used nucleic acid vaccine platform approaches.6 During SARS, researchers moved from obtaining the genomic sequence of SARS-CoV to a phase 1 clinical trial of a DNA vaccine in 20 months and have since compressed that timeline to 3.25 months for other viral diseases. For 2019-nCoV, they hope to move even faster, using messenger RNA (mRNA) vaccine technology. Other researchers are similarly poised to construct viral vectors and subunit vaccines.

While the trajectory of this outbreak is impossible to predict, effective response requires prompt action from the standpoint of classic public health strategies to the timely development and implementation of effective countermeasures. The emergence of yet another outbreak of human disease caused by a pathogen from a viral family formerly thought to be relatively benign underscores the perpetual challenge of emerging infectious diseases and the importance of sustained preparedness.

Corresponding Author: Anthony S. Fauci, MD, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, 31 Center Dr, MSC 2520, Bldg 31, Room 7A-03, Bethesda, MD 20892-2520 (afauci@niaid.nih.gov).

Published Online: January 23, 2020. doi:10.1001/jama.2020.0757
 

RxCowboy

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#48
April 8

Covid19 Update: I want to cover two items today, a new recommendation by Veterinarians and a discussion of what steps need to be taken when you bring items into your home. Tomorrow we can talk about how this all ends - i.e. what do the next steps look like.

1) Veterinarians are now suggesting that cats can get Covid19 based on the Bronx zoo cats. While prior cases of dogs testing positive exist, the dogs never got sick and they don't seem to transmit it. Cats on the other hand seem to get sick and to pass it to each other (not to humans). There is some concern over if they could become fomites (i.e. your outdoor cat encounters a sick person and then brings it come on their fur) this risk is very very low and not confirmed by science - its just the next thing they have to answer. The bigger concern is that if you get it, your cat may get sick too. Pet ferrets also seem to be able to get sick from it and spread it to other ferrets. Although, all of this is preliminary findings seen thus far in small groups and is still being researched, there is enough evidence for us to be mindful of it. So stayed tuned for more.

2)Do I need to sanitize my groceries when I bring them home? I am seeing this question a lot so I think it is worth discussing. Keep in mind that we are all in a different boat. Are you in a high risk group? If so, then you are going to take different precautions than the rest of us. If you don't sanitize your groceries is it going to cause you anxiety and stress as you worry? Then by all means sanitize them. But for the average person, in the average situation, this is not necessary. Here is the thing, have you ever caught a virus from your cereal box? It would be pretty hard to do. I mean, don't bring the groceries home and lick them - that would just be weird but you don't have to be afraid of them either.

The truth is, we have no idea how long Covid19 is viable on surfaces. We have theories based on the other coronaviruses and some new data looking at how it has done in the lab (under ideal circumstances) or in hospital rooms where seriously ill patients have been. That is good to have and know but it doesn't translate into "normal" life and even then it was trace amounts of the virus detected, 0.1% to be exact. So the risk is extremely minimal under ideal circumstances. Most of us don't live in ideal circumstances.

So here are a few practical tips for dealing with items you bring into your home, like mail and groceries and those Amazon packages. You don't need to do all four of these, just pick the one that works best for you. (again, if you are in a high risk category - you may want to take extra precautions).

a)Open the outer box/package and remove the inner contents when you can (like letters, Amazon boxes, Poptarts etc.) dispose of the packaging, wash your hands. Done. The threat has been neutralized. Don't touch your face during this process - doing so is like licking the package - well not quite that bad but you get the idea.

b)For things like milk, (or items where removing the outer package etc isn't feasible) you can wipe it down with warm water and soap. I wouldn't spray with Lysol or use disinfecting wipes because replacing those things (the disinfectant) is nearly impossible. Just put it in the fridge or pantry and wash your hands. Wash your hands each time you have to handle the item for the next few days. Threat neutralized.

c)Let things sit. Bring it in and let it sit for a couple of days before handling it. Wash your hands after bringing it in. The virus will shrivel up and "die" while it waits. Threat neutralized.

d)Wash counter tops and door handles frequently - they are a bigger threat than your groceries and mail so keep these areas clean.

Of course, these are just recommendations. You have to do what is right for you and your family and sometimes that means washing your milk because not doing so will cause you to worry and we don't need additional reasons to worry. But remember, there is no recorded case of anyone ever getting the virus, or any natural virus from their milk carton. If you are washing your hands and not touching your face you are doing the right things. Cross this off your list of things to worry about.

FINAL THOUGHT: Maya Angelou is quoted as having said, "Every storm eventually runs out of rain" or something to that effect. This will eventually end and we will return to normal and that will feel weird for a minute. But we will get there. Thank you to everyone who has listened and heeded the call to stay home. It requires caring about humanity and laying aside your own desires in order to do what is right for the greater good, and it is making a difference. When this is all over, it will be you that kept the death rates down. Thank you to everyone who has had to go to work everyday despite the threat. You are keeping us afloat. It takes courage to walk out into the madness every day. It requires sacrifice. When this is all over, it will be you that kept our economy from complete destruction. Each of us has a role to play, and each role has its own unique challenges and requires sacrifices of different kinds. Thank you to all of you who have done what needed to be done to contribute to the greater good to those who had indeed spread light and kindness and compassion. It restores my hope in humanity.
 

RxCowboy

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#49
From medscape:

COVID-19: Are Acute Stroke Patients Avoiding Emergency Care?
Damian McNamara

April 08, 2020
Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Neurologists across the country are reporting a substantial drop in the number of acute stroke patients seeking emergency care during the COVID-19 pandemic ? suggesting that some patients may be intentionally staying home rather than risking coronavirus exposure at hospital emergency departments (EDs).

Stroke specialists in New Orleans, Chicago, Seattle, and elsewhere told Medscape Medical News they are seeing a precipitous drop in the number of acute strokes at their institutions ? and not just in the number of milder cases. Doctors on Twitter are sharing similar reports and are using social media to highlight this issue.

Gabriel Vidal, MD, a vascular and interventional neurologist at the Ochsner Medical Center, New Orleans, Louisiana, said there are "definitely" fewer patients with stroke and transient ischemic attack (TIA) seeking care at his facility and others throughout the New Orleans area, which has been hard hit by COVID-19.

"Even in Louisiana, we have a very large 53-hospital telestroke network, and the number of consults has diminished greatly," Vidal added.

In Chicago, emergency medical service activations for patients with suspected strokes are down about 30%, Shyam Prabhakaran, MD, professor and chair of neurology at the University of Chicago Biological Sciences, Illinois, told Medscape Medical News.

"It appears to be that mild stroke and TIA patients may be more likely to stay at home and seek alternative care rather than come to the ED," Prabhakaran said. However, "the severe strokes may be less affected and continue to come to emergency departments."

"Getting the Word Out"
That may not be the whole story in Seattle, Washington, where a stroke specialist at Harborview Medical Center reported a drop in patients across the stroke-severity spectrum.

Some patients with milder strokes no longer come to Harborview for a comprehensive evaluation and workup, but that is only "a partial explanation," said David Tirschwell, MD, medical director of comprehensive stroke care at the University of Washington (UW) Medicine Stroke Center at Harborview and a professor of neurology at UW.

"The thrombectomies are down also," he added. "It's hard to have great numbers in real time, but it's probably safe to say it's at least a 50% reduction in the number of admissions."

As a stroke referral center, his institution is seeing fewer local cases and referrals from outside hospitals. "I think both of those sources for admissions of stroke cases are down," Tirschwell said.

Recognizing the seriousness of forgoing essential care for acute stroke, neurologists, institutions, and medical groups are taking to social media to potentially save lives.

"Across our @FLStrokeReg we are seeing less patients with #stroke symptoms coming to our hospitals. We need to get the word out that our teams are working hard to safely provide care when needed during #COVID19," tweeted Ralph Sacco, MD, chief and professor of neurology, University of Miami Miller School of Medicine in South Florida, shared this tweet:


Although Florida Stroke Registry data are not publicly available, anecdotal reports suggest that stroke admissions are down among many hospitals, Sacco told Medscape Medical News.

Furthermore, this is not a phenomenon only in the United States. "This has also been reported in other nations hit by COVID-19," he said.

China is a prime example. There, many stroke centers have shown reduced functioning "because of fear of in-hospital cross infection and lack of experienced stroke care experts," Jing Zhao, MD, PhD, and colleagues write in an editorial published online March 31 in Stroke.

Preliminary data show that "thrombectomies in Shanghai decreased by 50% in the first month after the Spring Festival compared with the same period in 2019," write the editorialists, who are from Kings College London and the University of Pennsylvania in Philadelphia.

"Although the control of the COVID-19 is very important, at the same time, the management of stroke must not be neglected," they add.

"Over 9000 new stroke cases occur each day in China alone. It cannot be right that treatment for one potentially curable disease is euthanized at the expense of another."

Fear Factor?
The reasons individuals who may have experienced a stroke are avoiding emergency care is unclear at the moment. "I'm not really sure anyone really understands why, quite honestly," Tirschwell said.

Until survey data or other data emerge, many experts are assuming that fear of COVID-19 is trumping other medical concerns, including emergency treatment of stroke.

"We believe this could represent patients being fearful to come to medical facilities with stroke-like symptoms, given the COVID-19 pandemic," said Sacco, who is also incoming editor-in-chief of Stroke.

The BBC has been getting the word out in the United Kingdom via social media, with a tweet to "Dial 999 for stroke emergencies despite coronavirus."


The World Stroke Campaign is also using Twitter to emphasize the need for urgent stroke care when appropriate:

"Don't let concerns about COVID19 prevent you from seeking emergency treatment for stroke. If you spot the signs of stroke act FAST. Get emergency medical assistance," the group urged in a tweet.


Don't Hesitate
The American Heart Association (AHA) has addressed this troubling trend as well.

"People with serious symptoms shouldn't ignore them," Sarah Perlman, MD, associate professor of emergency medicine at the University of Colorado School of Medicine, Denver, states in an article on the AHA website.

Perlman added that some individuals who have signs of stroke and heart disease may hesitate to seek care because of fear that they are adding to an overburdened healthcare staff and system. However, she dismissed those concerns outright.

"If you're experiencing warning signs of a heart attack or stroke, call 911," she said. "Clearly, if there's an emergency, we are available and capable and eager to take care of you."

Follow Damian McNamara on Twitter: @MedReporter. For more Medscape Neurology news, join us on Facebook and Twitter.
 
Sep 18, 2006
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#50
The meds that are going into clinical trial for COVID-19 are faster than I can keep up with, but there is one vaccine that looks promising and it would be delivered in a patch. Just slap the patch on and that's it. I don't know how that works, because there are certain drug characteristics that make them absorbable transdermally, and the viral antigen would have to meet those characteristics. But it would sure make delivery easy.
Is this the vaccine? I read about it a couple days ago. The delivery method sounds interesting. Thoughts?

______________________
https://pittsburgh.cbslocal.com/202...chool-coronavirus-potential-vaccine-unveiled/

Doctors believe it could change the way vaccines are delivered to people worldwide.

It looks like a small piece of Velcro, and it is officially called a Microneedle Array.

“It’s a lot like a band-aid with hundreds of small needles. In this particular case, the needles are made out of the sugar substance, and we actually incorporate the vaccine directly into the needles,” Dr. Louis Falo, of the University of Pittsburgh School, said.
...
From a clinical standpoint, Dr. Falo says the microneedle array has many advantages.

“So, this is an incredibly safe approach. There is no bleeding with this approach, there’s no pain because the needles are not long enough to reach the circulation or nerves,” said Dr. Falo. “In addition to that, the amounts of antigen that we’re using are so small that they don’t cause any adverse effects, in and of themselves.”

Each of the 400 microneedles are the width of a human hair, and they are only a half a millimeter long. The whole thing is made of liquid sugar and mixed with the antigen doctors want to use in their vaccine.

“When the microneedles are hard, they’re able to penetrate the outer layers of the skin. And, then, as they absorb moisture, they actually dissolve and release the antigen into the skin, so the needles are actually the vaccine,” Dr. Falo added.
 

RxCowboy

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#51
Is this the vaccine? I read about it a couple days ago. The delivery method sounds interesting. Thoughts?

______________________
https://pittsburgh.cbslocal.com/202...chool-coronavirus-potential-vaccine-unveiled/

Doctors believe it could change the way vaccines are delivered to people worldwide.

It looks like a small piece of Velcro, and it is officially called a Microneedle Array.

“It’s a lot like a band-aid with hundreds of small needles. In this particular case, the needles are made out of the sugar substance, and we actually incorporate the vaccine directly into the needles,” Dr. Louis Falo, of the University of Pittsburgh School, said.
...
From a clinical standpoint, Dr. Falo says the microneedle array has many advantages.

“So, this is an incredibly safe approach. There is no bleeding with this approach, there’s no pain because the needles are not long enough to reach the circulation or nerves,” said Dr. Falo. “In addition to that, the amounts of antigen that we’re using are so small that they don’t cause any adverse effects, in and of themselves.”

Each of the 400 microneedles are the width of a human hair, and they are only a half a millimeter long. The whole thing is made of liquid sugar and mixed with the antigen doctors want to use in their vaccine.

“When the microneedles are hard, they’re able to penetrate the outer layers of the skin. And, then, as they absorb moisture, they actually dissolve and release the antigen into the skin, so the needles are actually the vaccine,” Dr. Falo added.
That makes sense, it isn't being absorbed transdermally, the patch is administering subcutaneously.
 

RxCowboy

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April 8, follow-up

Check out the number of serious/critical cases we have compared to other industrialized nations (we have a LOT more) then check out the deaths per million we have compared to them. Our system is strong. Our math and science is strong. Our providers are strong. They are rockin it!
 

OSUCowboy787

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#53
April 8, follow-up

Check out the number of serious/critical cases we have compared to other industrialized nations (we have a LOT more) then check out the deaths per million we have compared to them. Our system is strong. Our math and science is strong. Our providers are strong. They are rockin it!
Supporting graph showing Deaths/1M Pop considerably lower than everyone else in the top countries in Serious/critical cases.

2020-04-08 13_35_39-Window.png
 

osupsycho

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Exactly. Even Wuhan residents know its a lie. They are cremating bodies 24/7 there to keep up. why do that if countrywide you only had 3,333 deaths. Estimates are around 40-50k deaths just for Wuhan.
But apparently they don't see it as lying. They are just only counting the death toward Covid 19 if the person had NO other possible condition that the death could be attributed to. So by that reasoning their 3,333 deaths were the previously completely healthy individuals that died from the virus. In that case it is kinda scary that number is that high for that group...
 

RxCowboy

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But apparently they don't see it as lying. They are just only counting the death toward Covid 19 if the person had NO other possible condition that the death could be attributed to. So by that reasoning their 3,333 deaths were the previously completely healthy individuals that died from the virus. In that case it is kinda scary that number is that high for that group...
I don't even believe that number. CCP and WHO have betrayed the world.
 
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I don't even believe that number. CCP and WHO have betrayed the world.
That's really a tough one. Clearly CCP downplayed the severity for their own political reasons, but they're not alone in that. But if I've read correctly, they shared all the details of the virus with the WHO as soon as they had them. The WHO is doing a great deal of appeasement with the CCP, but what else can they do?? The next one will also most likely originate in China, so do you alienate the CCP by castigating them publicly? Maybe then they decide against sharing any information and just do full denial, or withdraw completely from the WHO? If we don't learn anything else in this, it should be that borders and even oceans can't stop the spread of a virus anymore. This is/was a global problem.
 

RxCowboy

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I just can't even...

March 30, 2020
Possible Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Public Bath Center in Huai’an, Jiangsu Province, China
Chao Luo, MD, PhD1; Lun Yao, MD2; Li Zhang, MD, PhD1; et alMengchu Yao, MD3; Xiaofei Chen, MD, PhD3; Qilong Wang, MD, PhD1; Hongbing Shen, MD, PhD4

JAMA Netw Open. 2020;3(3):e204583. doi:10.1001/jamanetworkopen.2020.4583

Introduction
In December 2019, a novel pneumonia named coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, and has since spread to 25 countries. Current reports show that SARS-CoV-2 is closely related to severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)1,2 and that it has a greater transmissibility than other coronaviruses. The confirmed transmission modes of SARS-CoV-2 include respiratory droplets and physical contact, and the incubation period for the virus is approximately 3 to 7 days, but it can be as long as 24 days.3 In this case series, we report a cluster-spreading event in Huai’an (700 km northeast of Wuhan) in Jiangsu Province, China, in which a patient with SARS-CoV-2 may have transmitted the virus to 8 other healthy individuals via bathing in a public bath center.

Methods
Data were collected from Huai’an No. 4 Hospital of Jiangsu Province, China. A total of 9 patients who had been to the same bath center were hospitalized and enrolled from January 25, 2020, to February 10, 2020. Throat swab samples were collected, and SARS-CoV-2 was detected using a quantitative reverse transcription–polymerase chain reaction assay. Computed tomography and hematological examinations were performed for auxiliary diagnoses. Data were analyzed with Prism version 7.00 (GraphPad). This study was approved by the ethics committee of Huai’an No. 4 Hospital, and written informed consent was obtained from all patients. This study followed the reporting guideline for case series. No prespecified threshold for statistical significance was set.

Results
The bath center for men was approximately 300 m2, with temperatures from 25 to 41 °C and humidity of approximately 60%. It contained a swimming pool, showers, and sauna. The first patient (patient 1) had traveled to Wuhan. He went to the bath center and showered on January 18, 2020. He started experiencing a fever on January 19, 2020, and was diagnosed with COVID-19 on January 25, 2020. The next 7 patients showered, used the sauna, and swam in the same center on January 19 (patients 2, 3, and 4), January 20 (patient 5), January 23 (patients 6 and 7), and January 24 (patient 8). The symptoms associated with COVID-19, including fever, cough, headache, and chest congestion, appeared between 6 and 9 days after visiting the bath center. Patient 9 was working in the bath center and experienced onset on January 30. Infection in all patients was confirmed by positive reverse transcription–polymerase chain reaction assay results (Figure).

The median (interquartile range) age of the patients was 35 (24-50) years. A total of 8 patients (89%) reported fever (mean [SD] duration, 5.78 [2.99] days), and 7 patients (78%) reported a cough. Few patients (3 [33%]) showed debilitation, chest distress (2 [22%]), or anorexia (1 [11%]). Diarrhea, myalgia, rhinorrhea, and headache were not reported. C-reactive protein levels were elevated in 9 patients (100%; mean [SD], 3.34 [3.18] mg/dL; to convert to milligrams per liter, multiply by 10). Lymphopenia occurred in 3 patients (33%), lactate dehydrogenase was increased in 3 patients (33%; mean [SD], 225.56 [85.33] U/L; to convert to microkatals per liter, multiply by 0.0167), and glutamic oxaloacetic transaminase was increased in 2 patients (22%; mean [SD], 30.22 [13.94] U/L) (Table).

Computed tomography examinations were performed, and the ground glass opacities were observed in all 9 patients. As of February 10, 2020, no patients required respiratory support.

Discussion
Previous studies have demonstrated that the transmission rate of a virus is significantly weakened in an environment with high temperature and humidity.4 However, judging from the results of this study, the transmissibility of SARS-CoV-2 showed no signs of weakening in warm and humid conditions. We noticed a clustered case occurring in a public bath center with high temperature and humidity. A total of 8 individuals who used or worked in the bath center experienced symptoms within 6 to 9 days of their visit to the center, suggesting that SARS-CoV-2 could spread and cause infection in such an environment. The transmission routes may also be respiratory droplets or contact, but our results suggest that the cluster transmission of SARS-CoV-2 can still arise in an environment with high temperature and humidity. These results provide a potential epidemiological clue for this novel coronavirus. This study was limited by a lack of detail regarding the transmission routes of the patients in the bath center.

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Article Information
Accepted for Publication: March 6, 2020.

Published: March 30, 2020. doi:10.1001/jamanetworkopen.2020.4583
 

RxCowboy

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That's really a tough one. Clearly CCP downplayed the severity for their own political reasons, but they're not alone in that. But if I've read correctly, they shared all the details of the virus with the WHO as soon as they had them. The WHO is doing a great deal of appeasement with the CCP, but what else can they do?? The next one will also most likely originate in China, so do you alienate the CCP by castigating them publicly? Maybe then they decide against sharing any information and just do full denial, or withdraw completely from the WHO? If we don't learn anything else in this, it should be that borders and even oceans can't stop the spread of a virus anymore. This is/was a global problem.
I get your point.