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and system administrators health issues

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Programmers and system administrators are mass profession. There were approximately 435K programmers in the USA in 2006. I think number of system administrators are roughly the same, so we can speak about the labor army of one million people.

Contrary to superficial impression of individual cubicles and nice environment, IT is actually very unhealthy profession. With a high chance to be unemployed after 50.  More often then not, there are periods of considerable stress. Some are caused by catastrophic failures of hardware equipment, some by unrealistic schedules and workloads, some by own errors of particular programmer or sysadmin.

Overtime is common. Job security is deteriorating as outsourcing is rampant.  Employment after 50 is not guaranteed. Environment changes way too fast, and not always for good. Fashion rules (remember The Devil Wears Prada). Toxic managers are common (remember Office Space ;-)

So sooner of later a programmer need to face "medical-industrial complex" of the USA. And this is a dangerous "for profit" beast with tremendous appetite which maims and kills annually considerable amount of people. Living under Neoliberalism with its "greed is good" mentality and "homo homini lupus est" slogan is indeed dangerous  and requires knowledge of elementary "self-defense". Hippocratic oath no longer applies to medical profession in the USA. Most doctors still follow it, but there real sharks among them (with some ending their careers in jail like regular criminals) and you need to hope for the best but  prepare for the worst.  Especially rampant abuse is with cardiac stents (Overuse of Cardiac Stents Linked to Patient Deaths) with around a dozen of cardiologists serving jail terms (see for example Stent doctor Salisbury stent doctor sentenced to federal prison )

As USA Today reported (Doctors perform thousands of unnecessary surgeries):

Since 2005, more than 1,000 doctors have made payments to settle or close malpractice claims in surgical cases that involved allegations of unnecessary or inappropriate procedures, according to a USA TODAY analysis of the U.S. government's National Practitioner Data Bank public use file, which tracks the suits. About half the doctors' payments involved allegations of serious permanent injury or death, and many of the cases involved multiple plaintiffs, suggesting many hundreds, if not thousands, of victims.

Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support installing the devices.

"Don't just take a doctor's word," says Patty Skolnik, who founded Citizens for Patient Safety after her son, Michael, died at 22 from complications in what she says was unnecessary brain surgery. "Research your doctor, research the procedure, ask questions, including the most important one: 'What will happen if I don't get this done?'"

A 1982 study in the journal Medical Care found that a mandatory second opinion program for Massachusetts Medicaid patients led to a 20% drop in certain surgeries, such as hysterectomies, that were considered more likely to be done unnecessarily. A 1997 study in the Journal of the American College of Surgeons looked at 5,601 patients recommended for surgery and found that second opinions found no need for the operation in 9% of the cases. Among those who got the countervailing second opinion, 62% opted not to have the operation.

But many patients simply aren't inclined to question their doctors.

"We expect the physician to know what's best for a patient," says William Root, chief compliance officer at Louisiana's Department of Health and Hospitals. "

We put so much faith and confidence in our physicians, (and) most of them deserve it. But when one of them is wrong or goes astray, it can do a lot of damage."

Chronic stress, overload, long hours, unhealthy diet  and other environmental factors  deeply and negatively affects the lifestyle of programmers and system administrators.  So there is nothing surprising that despite pretty comfortable work conditions many programmers/system administrators suffer from assortments on various diseases. Like other workers who spend long periods in front of a computer terminal typing at a keyboard, programmers are susceptible to:

Additional health problems are typical for those who experience constant stress and/or are typical "diseases of civilization". Among them

Also many programmers/sysadmins works as contractors and either do not have health insurance or have very basic health insurance. This is typical for young programmers and those who are over 50 and were let go on their previous jobs die to outsourcing

Low and middle income US citizens  spends far more on health care than any other country but gets only mediocre care in return for its investment. The U.S. national average score on 37 separate measures of health care falls far short when compared either to a few centers of excellence within the country, or to other countries, the report from the Commonwealth Fund found. And that's true not only in terms of mortality statistics but also in terms of quality of life.

The main problems with US healthcare are:

Programmers and system administrators can do much better is maintaining their health. And they are naturally equipped for dealing with complex system and thus able to navigate the maze of the USA "medical industrial complex"

A lot of outcomes depends on the level of individual knowledge. Knowledge is power both for avoiding unnecessary procedures (with some causing irreversible damage) , unnecessary overprescribed drugs, and when negotiating with health care providers.

Some facts:


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Old News ;-)

[May 24, 2020] It all points to social economic status and povert: one argument against shutting down economies so drastically

May 24, 2020 | www.moonofalabama.org

Blue Dotterel , May 24 2020 16:29 utc | 8

"It all points to social economic status and poverty," Gray Molina said.

This is probably true. It was one argument against shutting down economies so drastically. This is less of a problem in the wealthier countries for the moment, but in a second or third wave, you will probably see more deaths among the below 60s due to increasing poverty caused by poorly managed lockdowns this time around.

[May 24, 2020] 'How Could the CDC Make That Mistake?' The government's disease-fighting agency is conflating viral and antibody tests, compromising a few crucial metrics that governors depend on to reopen their economies. Pennsylvania, Georgia, Texas, and other states are doing the same.

Notable quotes:
"... "According to CDC, the disease of obesity affects about 78 million Americans 1 and the ASMBS estimates about 24 million have severe or morbid obesity." ..."
May 24, 2020 | www.moonofalabama.org

Richard Steven Hack , May 24 2020 23:54 utc | 46

And the government botching of this crisis continues...

'How Could the CDC Make That Mistake?' The government's disease-fighting agency is conflating viral and antibody tests, compromising a few crucial metrics that governors depend on to reopen their economies. Pennsylvania, Georgia, Texas, and other states are doing the same.
https://tinyurl.com/y92ea59f

And overseas as well...

'Politicised nature' of lockdown debate delays Imperial report
https://tinyurl.com/y7csboom

And of course, the effect of that...

Nearly half of US states haven't contained their coronavirus outbreaks, a new study finds
https://tinyurl.com/yc72pd8t

And no, Sweden is not doing better...

Just 7.3% of Stockholm had Covid-19 antibodies by end of April, study shows
Official findings add to concerns about Sweden's laissez-faire strategy towards the pandemic
https://tinyurl.com/yahnmb3a

Finally, a large scale study on HCQ - 86,000 patients, with 15,000 receiving HCQ...

Trump drug hydroxychloroquine raises death risk in Covid patients, study says
https://www.bbc.com/news/world-52779309

The color of coronavirus:
COVID-19 deaths by race and ethnicity in the U.S.
https://www.apmresearchlab.org/covid/deaths-by-race

Blacks are *twice* as likely to get it as whites and Latinos. American Indians are *five times* more likely to get it. They conclude the best indicator is poverty.

From The Lancet, a study of New York patients... Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study https://tinyurl.com/yblmszsx

Between March 2 and April 1, 2020, 1150 adults were admitted to both hospitals with laboratory-confirmed COVID-19, of which 257 (22%) were critically ill.

The median age of patients was 62 years (IQR 51–72), 171 (67%) were men. 212 (82%) patients had at least one chronic illness, the most common of which were hypertension (162 [63%]) and diabetes (92 [36%]).

119 (46%) patients had obesity.

As of April 28, 2020, 101 (39%) patients had died and 94 (37%) remained hospitalised.

203 (79%) patients received invasive mechanical ventilation for a median of 18 days (IQR 9–28), 170 (66%) of 257 patients received vasopressors and 79 (31%) received renal replacement therapy.

The median time to in-hospital deterioration was 3 days (IQR 1–6).

In the multivariable Cox model, older age (adjusted hazard ratio [aHR] 1·31 [1·09–1·57] per 10-year increase), chronic cardiac disease (aHR 1·76 [1·08–2·86]), chronic pulmonary disease (aHR 2·94 [1·48–5·84]), higher concentrations of interleukin-6 (aHR 1·11 [95%CI 1·02–1·20] per decile increase), and higher concentrations of D-dimer (aHR 1·10 [1·01–1·19] per decile increase) were independently associated with in-hospital mortality.

Note: 36% had diabetes; 46% were fat. Like I've said before, "diabetes" is a code word for "fat." And how many people in the US are fat and thus at risk? "According to CDC, the disease of obesity affects about 78 million Americans 1 and the ASMBS estimates about 24 million have severe or morbid obesity."

So much for "let's just isolate the elderly"...so we can attend our baseball games this summer and stuff ourselves with crap food...

[May 24, 2020] Private Equity Is Ruining Health Care, Covid Is Making It Worse: Investors have been buying up doctor s offices, cutting costs, and, critics say, putting pressure on physicians by Heather Perlberg

Highly recommended!
So not only ambulance service was destroyed by private equity, they now added other specialties. I wonder is those criminals who insert unnecessary stents in patients are connected to private equity.
Images removed
Notable quotes:
"... "You can't serve two masters. You can't serve patients and investors" ..."
"... Morganroth's defense of pandemic Botox might seem odd, but it made perfect sense within the logic of the U.S. health-care system, which has seen Wall Street investors invade its every corner, engineering medical practices and hospitals to maximize profits as if they were little different from grocery stores. At the center of this story are private equity firms, which saw the explosive growth of health-care spending and have been buying up physician staffing companies, surgery centers, and everything else in sight. ..."
"... But some doctors say that the private equity playbook, which involves buying companies, drastically cutting costs, and then selling for a profit -- the goal is generally to make an annualized return of 20% to 30% within three to five years -- creates problems that are unique to health care. "I know private equity does this in other industries, but in medicine you're dealing with people's health and their lives," says Michael Rains, a doctor who worked at U.S. Dermatology Partners , a big private equity-backed chain. "You can't serve two masters. You can't serve patients and investors." ..."
"... Yet over the past decade, lawyers devised a structure that allows investors to buy a medical practice without technically owning it: the MSO, or management service organization. Today, when an investment firm buys a doctor's office, what it's actually buying are the office's "nonclinical" assets. In theory, physicians control all medical decisions and agree to pay a management fee to a newly created company, which handles administrative tasks such as billing and marketing. ..."
"... Businessweek ..."
"... When individual doctors sell, they generally receive $2 million to $7 million each, with 30% to 40% of that paid in equity in the group. After the acquisition, doctors get a lower salary and are asked to help recruit other doctors to sell their practices or to join as employees. ..."
"... Patients, for the most part, are in the dark. Unlike when your mortgage changes hands, you usually aren't notified when a big investment firm buys your doctor. Sometimes the sign on the door bearing the physician's name stays put, and subtle changes in operations or unfamiliar fees may be the only clues that anything has happened. ..."
"... At Advanced Dermatology & Cosmetic Surgery , the largest private equity-backed group in the field, with more than 150 locations across the U.S., that sense of discomfort came shortly after Audax Group bought a controlling stake in what was then a much smaller chain in 2011. The new management team introduced a scorecard that rewarded offices with cash if they met daily and monthly financial goals, according to a lawsuit filed in 2013 against the company by one of its dermatologists. The doctor alleged that the bonus program encouraged staff to do as many procedures as possible, rather than strictly addressing patients' medical needs. ..."
"... Most dermatologists use outside labs and pathologists, but private equity-owned groups buy up existing labs and hire their own pathologists. Then doctors are encouraged to refer patients within the group and send biopsy slides to the company-owned labs, keeping the entire chain of revenue in-house. ..."
"... Now comes the cost-cutting. This is supposed to be the hallmark of private equity, and, done right, it can work to the benefit of doctors and patients. But there are pitfalls unique to medicine, where aggressive cuts can lead to problems, some of them merely inconvenient and some potentially dangerous. ..."
"... A doctor at Advanced Dermatology says that waiting for corporate approvals means his office is routinely left without enough gauze, antiseptic solution, and toilet paper. Even before the great toilet paper shortage of 2020, he would travel with a few rolls in the trunk of his car, to spare patients when an office inevitably ran out. The company declined to comment. ..."
"... One paradox of the Covid-19 pandemic has been that even as the virus has focused the entire country on health care, it's been a financial disaster for the industry. And so, while emergency room doctors and nurses care for the sick -- comforting those who would otherwise die alone, and in some cases dying themselves -- private equity-backed staffing companies and hospitals have been cutting pay for ER doctors. These hospitals, like the big medical practices, make a large portion of their money from elective procedures and have been forced into wrenching compromises. ..."
"... For investors with capital, on the other hand, the economic fallout from the virus is a huge opportunity. Stay-at-home orders have left small practices more financially strained than they've ever been. That will likely accelerate sales to private equity firms, according to Marc Cabrera, an investment banker focused on health-care deals at Oppenheimer & Co. Independent doctors or groups that previously rebuffed offers from deep-pocketed backers "will reconsider their options," he says. ..."
"... Many doctors may ultimately come to regret cashing out, but it's hard to get out once you're in. As part of an acquisition, the private equity groups typically require doctors to sign yearslong contracts, with noncompete clauses that prevent them from working in the surrounding area. ..."
May 20, 2020 | www.bloomberg.com

Not long after Gavin Newsom, the governor of California, ordered the state's 40 million residents to stay home to stop the spread of the new coronavirus, Dr. Greg Morganroth called his team of doctors and said their dermatology group was staying open.

Morganroth is chief executive officer of the California Skin Institute , which he founded in 2007 as a single office in Mountain View. He's since expanded to more than 40 locations using a financing strategy that's become exceedingly common in American health care: private equity. In this case, he took out a loan from Goldman Sachs Group Inc. that could eventually convert to an equity stake. CSI is now the largest dermatology chain in California.

But the Covid-19 pandemic put Morganroth in a precarious position. Most medical procedures were characterized as nonessential by government officials and practitioners. Doctors were closing offices, and patients were staying away to limit their potential exposure to the virus.

CSI took a different approach. Morganroth explained his thinking on April 2 in a Zoom call with more than 170 dermatologists from around the country organized by the Cosmetic Surgery Forum, an industry conference. Contrary to what they might have heard, Morganroth told them, they should consider staying open during the pandemic. "Many of us are over-interpreting guidelines," he said.

For a moment there was an awkward silence. Doctors had thought they were signing up for advice on how to apply for government money that would help them meet payroll while they were shut down; they hadn't expected to be told not to shut down at all. Morganroth continued: "We are going to be in a two-year war, and we need to make strategic plans for our businesses that enable us to survive and to rebound."

Back at CSI, the company's front-office staff was working the phones, calling patients in some of the worst-hit areas and reminding them to show up for their appointments, even for cosmetic procedures such as Botox injections to treat wrinkles. During the videoconference, Morganroth argued that offering Botox in a pandemic wasn't so different from a grocery store allowing customers to buy candy alongside staples.

"If I had a food supply company and had to stay open, and I had meat, bread, and milk, would I stop making lime and strawberry licorice?" Morganroth asked. "I would make everything and go forward."

From a public-health point of view, some of the doctors believed, this was questionable. Common reasons for visiting a dermatologist's office -- skin screenings, mole removals, acne consultations -- aren't particularly time sensitive. Serious matters, such as suspected cancers and dangerous rashes, can be handled, at least initially, with telemedicine consultations . Then doctors can weigh the risks for their patients and determine who needs to come in. In a statement, CSI says that it followed local and state laws for staying open, while providing "necessary care" for patients, and that it had not required doctors to come to work.

"You can't serve two masters. You can't serve patients and investors"

Morganroth's defense of pandemic Botox might seem odd, but it made perfect sense within the logic of the U.S. health-care system, which has seen Wall Street investors invade its every corner, engineering medical practices and hospitals to maximize profits as if they were little different from grocery stores. At the center of this story are private equity firms, which saw the explosive growth of health-care spending and have been buying up physician staffing companies, surgery centers, and everything else in sight.

Over the past five years, the firms have invested more than $10 billion in medical practices, with a special focus on dermatology, which is seen as a hot industry because of the aging population. Baby boomers suffer from high rates of two potentially lucrative conditions: skin cancer and vanity. Some estimates suggest that private equity already owns more than 10% of the U.S dermatology market. And firms have started to expand into other specialties, including women's health, urology, and gastroenterology.

There's nothing inherently wrong with any of this. But some doctors say that the private equity playbook, which involves buying companies, drastically cutting costs, and then selling for a profit -- the goal is generally to make an annualized return of 20% to 30% within three to five years -- creates problems that are unique to health care. "I know private equity does this in other industries, but in medicine you're dealing with people's health and their lives," says Michael Rains, a doctor who worked at U.S. Dermatology Partners , a big private equity-backed chain. "You can't serve two masters. You can't serve patients and investors."

Investment firms, and the practices they fund, say these concerns are overblown. They point out that they're giving doctors a financial shelter from the rapidly changing medical environment, a particularly attractive prospect now, and that money from private equity firms has expanded care to more patients. But they've also made it next to impossible to track the industry's impact or reach. Firms rarely announce their investments and routinely subject doctors to nondisclosure agreements that make it difficult for them to speak publicly. Bloomberg Businessweek spoke to dozens of doctors at 10 large private equity-backed dermatology groups. Those interviews, along with information obtained from other employees, investors, lawyers, court filings, and company records, reveal how the firms operate, and why they sometimes fail patients.

The process is never exactly the same, but there are familiar patterns, which tend to play out in five steps.

Step 1: Marriage

The strange thing about private equity money in medicine is that for-profit investors have long been prevented from buying doctor's offices. Corporate ownership goes against a doctrine set by the American Medical Association , the main trade group for doctors in the U.S., and is prohibited by law in many states, including Texas and New Jersey. For most of the past 100 years, if you wanted to make money on a medical practice, you needed to have a medical license.

Yet over the past decade, lawyers devised a structure that allows investors to buy a medical practice without technically owning it: the MSO, or management service organization. Today, when an investment firm buys a doctor's office, what it's actually buying are the office's "nonclinical" assets. In theory, physicians control all medical decisions and agree to pay a management fee to a newly created company, which handles administrative tasks such as billing and marketing.

In practice, though, investors expect some influence over medical decision-making, which, after all, is connected to profits. "When we partner with you, it's a marriage," said Matt Jameson, a managing director at BlueMountain Capital, a $17 billion firm that recently invested in a women's health company, while speaking at a conference in New York in September. "We have to believe it. You have to believe it. It's not going to be something where clinical is completely not touched." (When contacted by Businessweek , Jameson asked to clarify his comments. "Doctors and other qualified healthcare professionals at the providers we've invested in make medical decisions," he said in a statement.)

The typical buyout starts with the acquisition of a big, popular practice, often with multiple doctors and several locations, for as much as $100 million. (Investors typically pay between 9 and 12 times annual profit.) This practice functions as an anchor, like a name-brand department store at a shopping mall, attracting patients and doctors to the new group as it expands. Then comes the roll-up: The private equity firm purchases smaller offices and solo practices, giving the group a regional presence.

As part of the new structure, investors deal with paperwork and save money by buying medical supplies in bulk. Crucially they also negotiate higher insurance reimbursement rates. One dermatologist who sold her practice to the California Skin Institute says she was surprised to find out the bigger group's payouts from insurers were $25 to $125 more per visit.

When individual doctors sell, they generally receive $2 million to $7 million each, with 30% to 40% of that paid in equity in the group. After the acquisition, doctors get a lower salary and are asked to help recruit other doctors to sell their practices or to join as employees.

At first, doctors are generally thrilled by all of this. They have financial security and can focus on treating patients without the stress of running a business. Patients, for the most part, are in the dark. Unlike when your mortgage changes hands, you usually aren't notified when a big investment firm buys your doctor. Sometimes the sign on the door bearing the physician's name stays put, and subtle changes in operations or unfamiliar fees may be the only clues that anything has happened.

Step 2: Growth

The promise of more patients is a big draw for doctors. By sharing marketing costs and adding locations, the new companies can advertise more and attract customers. Private equity-owned practices have been diligent users of social media, announcing newly added doctors and posting coupons on Twitter and Instagram. But these practices can be aggressive in ways that make some doctors uncomfortable.

At Advanced Dermatology & Cosmetic Surgery , the largest private equity-backed group in the field, with more than 150 locations across the U.S., that sense of discomfort came shortly after Audax Group bought a controlling stake in what was then a much smaller chain in 2011. The new management team introduced a scorecard that rewarded offices with cash if they met daily and monthly financial goals, according to a lawsuit filed in 2013 against the company by one of its dermatologists. The doctor alleged that the bonus program encouraged staff to do as many procedures as possible, rather than strictly addressing patients' medical needs.

In some of the company's Florida offices, the doctor alleged, medical assistants responded to the bonus structure by ticking extra boxes on exam reports, stating that doctors checked many more areas of the body than they actually had. That led to higher patient bills, defrauding the government under its Medicare program, according to the lawsuit. The federal government declined to join the case, and it was dismissed about a year after it was filed. Advanced and Audax declined to comment.

One-Stop Skin Care

By buying up labs and adding specialists, private equity-owned dermatology groups get paid at every step of a patient's treatment.

Data: Estimated Medicare reimbursement rates for the Miami area, Sensus Healthcare sales presentation

Private equity-backed practices also try to increase revenue by adding more-lucrative procedures, according to doctors interviewed by Businessweek . In dermatology, this means more cosmetics, laser treatments, radiation, and especially Mohs surgeries -- a specialized skin cancer procedure that removes growths from delicate areas like the face and neck one layer at a time, to limit scarring. The surgery involves expensive equipment and specialized doctors, so some large medical groups keep costs down by assembling traveling Mohs teams, who fly in from other states. Others create mobile labs in vans that set up in clinics' parking lots.

Most dermatologists use outside labs and pathologists, but private equity-owned groups buy up existing labs and hire their own pathologists. Then doctors are encouraged to refer patients within the group and send biopsy slides to the company-owned labs, keeping the entire chain of revenue in-house. This takes advantage of a regulatory quirk that has made dermatology, and a handful of other specialties, attractive to private equity. Under the 1989 Stark Law, doctors aren't allowed to make patient referrals for their own financial gain. An exception was made for some fields because it's more convenient for patients, explains Dr. Sailesh Konda, a Mohs surgeon and professor at the University of Florida. "But that can be abused."

Step 3: Synergy

Now comes the cost-cutting. This is supposed to be the hallmark of private equity, and, done right, it can work to the benefit of doctors and patients. But there are pitfalls unique to medicine, where aggressive cuts can lead to problems, some of them merely inconvenient and some potentially dangerous.

A doctor at Advanced Dermatology says that waiting for corporate approvals means his office is routinely left without enough gauze, antiseptic solution, and toilet paper. Even before the great toilet paper shortage of 2020, he would travel with a few rolls in the trunk of his car, to spare patients when an office inevitably ran out. The company declined to comment.

At the country's second-biggest skin-care group, U.S. Dermatology Partners , a former doctor says a regional manager switched to a cheaper brand of needles and sutures without consulting the medical staff. The quality was so poor, she says, they would often break off in her patients' bodies. Mortified, she'd have to dig them out and start over. She complained to managers but couldn't get better supplies, she says. Paul Singh, U.S. Dermatology's CEO, says the company uses a "reputable, global vendor for medical supplies." "While our group may have standardized purchasing processes, individual providers have the autonomy to procure specific supplies that they need for a particular patient situation or patient population," he says in a statement.

Doctors who join a private equity-backed group generally sign contracts that state they'll never have to compromise their medical judgment, but some say that management began to intervene there, too. Dermatologists at most of the companies say they were pushed to see as many as twice the number of patients a day, which made them feel rushed and unable to provide the same quality of care. Others were forced to discuss their cases with managers or medical directors, who asked the doctors to explain why they weren't sending more patients for surgery. Multiple practices also encouraged doctors to send home Mohs surgery patients with open wounds and have them come back the next day for stitches -- or to have a different doctor do the closure the same day -- because that would allow the practice to collect more from insurers.

That's if doctors are performing the procedures at all. At Advanced Dermatology, several doctors say they were asked to claim that physician assistants, or PAs, were under their supervision when they weren't seeing patients in the same building, or even the same town. Because PAs are paid less than dermatologists, this allowed the company to keep costs low while growing the business. In a statement, Eric Hunt, Advanced's general counsel and chief compliance officer says that having PAs on staff enables the company to "provide access to quality dermatological care to more patients."

Step 4. Rolling Up the Roll-Up

Advanced Dermatology was sold in 2016 by Audax to Harvest Partners LP , following a pattern that's typical in the industry. At some point, after costs have been cut and profits maximized, most private equity-owned medical groups will be sold, often to another private equity firm, which will then try to somehow make the company even more profitable.

Having reduced most of the obvious costs, Advanced Dermatology began skimping on more important supplies, including Hylenex, according to doctors and other employees. The drug is an expensive reversal agent used when cosmetic fillers, which are supposed to make skin look plumper, go wrong. Not having enough is dangerous: Patients who get an injection that inadvertently blocks a blood vessel can be left with dead sections of skin or even go blind if they don't get enough Hylenex in a matter of hours. The company says that it stocks Hylenex in every office that performs cosmetic procedures, and that it "has no records of any provider being denied an order for this medication."

Advanced Dermatology also started giving even more authority to PAs, according to doctors and staff. Without enough oversight some were missing deadly skin cancers, they say. Others were doing too many biopsies and cutting out much larger areas of skin than necessary, leaving patients with big scars. Doctors who complained about the bad behavior say they saw PAs moved to other locations rather than fired or given more supervision. Hunt, the company's lawyer, says that all PAs get six months of training and are supervised by experienced doctors.

The staff coined a new medical diagnosis, "pre- pre- pre-cancer"

Advanced Dermatology also put more pressure on doctors to send biopsies to in-house labs. The move made sense financially, but some of the doctors didn't trust the lab. One of its two pathologists in Delray Beach, Fla., Steven Glanz, had a history of misdiagnosing benign tumors, which led patients to undergo surgeries that were later found to be unnecessary, according to doctors who worked with him. Dermatologists who warned that Glanz was a danger to patients say that their complaints to Dr. Matt Leavitt, the group's founder and CEO, were ignored. More procedures, doctors knew, brought in more money.

Glanz, who had been with the practice since its early days, was known to read slides under a microscope with a pistol on his desk. After he was arrested with a handgun, a folding knife, and a vial of methamphetamine crystals, he was fired and Florida's state medical board fined him $10,000, requiring him to complete a five-hour course on ethics before he could resume practicing. But his former colleagues were unsettled; they knew Glanz's signature was on years of reports that determined treatment for patients. Some slides were reevaluated, and pathologists noticed mistakes. Managers told some doctors and their staff that patients, even those who'd been misdiagnosed and had unnecessary procedures, were not to be told. Glanz pleaded guilty to stalking and a firearms violation and was sentenced to probation. When a reporter called his office and identified herself, the receptionist hung up. Further attempts to reach Glanz were unsuccessful. Advanced's Hunt says that he was "formally released from employment three years ago," but did not comment further.

Of course, some doctors pushed ethical boundaries long before private equity came into the picture. But critics of the industry, including doctors and investors, say management teams put in place by private equity firms tend to look the other way as long as a medical practice is profitable. Of the dermatologists with the highest biopsy rates in the country (between 4 and 11 per patient, per year), almost 25% were affiliated with private equity-backed groups, according to Dr. Joseph Francis, a Mohs surgeon and data researcher at the University of Florida.

Medical providers may have also been blurring ethical lines at U.S. Dermatology Partners, which was until recently on its second private equity owner, Abry Partners LLC . At four of the company's offices in Texas, a doctor and his PAs were doing more biopsies than necessary, according to employees. These employees say the staff routinely called patients with benign lichenoid keratosis, small brownish blotches that usually go away on their own, and told them the growths should be removed. Under instruction from the doctor, the staff coined a new medical diagnosis, "pre- pre- pre-cancer," and then talked patients into coming in for removal, employees say. Singh, the U.S. Dermatology CEO, says that the company trusts doctors to make the right decisions and that it monitors them through routine audits.

Step 5: Sell-Off

In some cases the cost-cutting either becomes impossible or leads to compromises in care too obvious to ignore. In 2016 a DermOne LLC office in Irving, Texas, had been using a faulty autoclave machine to sterilize surgical equipment -- the state and county health departments identified 137 patients that needed to get tested for blood-borne diseases such as HIV and hepatitis. By 2018, DermOne's backer, Westwind Investors, wanted out.

Westwind had been one of the earliest firms to build a big dermatology business -- with practices in five states -- but others had grown larger. After the debacle in Irving, the Nevada-based firm sold DermOne's medical records and patient lists, as well as some of its offices, to other groups. It dissolved the remaining offices, leaving some patients abruptly without care. Westwind did not respond to repeated requests for comment. Two other private equity-backed groups, TruDerm and Select Dermatology LLC, have also gone out of business in the past two years.

The surviving chains have been saddled with large piles of debt they're now struggling to repay. In January, U.S. Dermatology Partners defaulted on a $377 million loan, meaning the private equity backer, Abry Partners, had to hand over the keys to its lenders, Golub Capital , Carlyle Group , and Ares Management , which will now oversee a chain with almost 100 locations, receiving 1 million visits from patients a year. Abry did not respond to requests for comment .

For the medical groups that make it, the game plan is to eventually sell to the largest players, such as KKR , Blackstone Group , and Apollo Global Management . Pioneering investors, including Audax, are now buying practices in other fields -- a concerning development to critics who note that the areas that are currently attracting investment, such as urology, generally involve more invasive procedures. Should doctors performing vasectomies be thinking about the dollar-rate returns for KKR -- or any private investor?

"It's ultimately going to backfire," says Dr. Jane Grant-Kels, a veteran dermatologist and professor at the University of Connecticut School of Medicine. "There's a limit to how much money you can make when you're sticking knives into human skin for profit."

One paradox of the Covid-19 pandemic has been that even as the virus has focused the entire country on health care, it's been a financial disaster for the industry. And so, while emergency room doctors and nurses care for the sick -- comforting those who would otherwise die alone, and in some cases dying themselves -- private equity-backed staffing companies and hospitals have been cutting pay for ER doctors. These hospitals, like the big medical practices, make a large portion of their money from elective procedures and have been forced into wrenching compromises.

For investors with capital, on the other hand, the economic fallout from the virus is a huge opportunity. Stay-at-home orders have left small practices more financially strained than they've ever been. That will likely accelerate sales to private equity firms, according to Marc Cabrera, an investment banker focused on health-care deals at Oppenheimer & Co. Independent doctors or groups that previously rebuffed offers from deep-pocketed backers "will reconsider their options," he says.

Many doctors may ultimately come to regret cashing out, but it's hard to get out once you're in. As part of an acquisition, the private equity groups typically require doctors to sign yearslong contracts, with noncompete clauses that prevent them from working in the surrounding area.

As governors throughout the nation ease restrictions on businesses, Advanced Dermatology is opening its most profitable offices first. The company received an undisclosed sum under the Cares Act, as part of the government relief package intended for health-care workers. Hunt, Advanced's chief compliance officer, told employees in an email earlier this month that the money would be used for protective gear, such as masks, and to replace "millions of dollars" in lost revenue.

The group had closed most of its offices since the stay-at-home orders were issued in March, cutting pay for doctors and furloughing staff. With cities and states beginning to consider reopening, doctors and PAs say they've been told they should be prepared for a full schedule. Hunt says the company is following the appropriate safety measures, but employees fear it will be nearly impossible to keep patients apart in waiting rooms. Opening in a reduced capacity, they understand, is not an option.

Read more: Private Equity Ate Finance, and Now It's Taking Over the World

[May 24, 2020] Lung volume as an important factor in coronavirus progrnnsys

May 24, 2020 | www.moonofalabama.org

Jen , May 24 2020 23:13 utc | 41

I think lung volume is indirect indicator of how well trained the person is. Coach potatoes have low lung volume. Most sportsmen -- a high or even very high.

From WSJ article "The Healing Power of Proper Breathing" https://www.wsj.com/articles/the-healing-power-of-proper-breathing-11590098696

In the 1980s, researchers with the Framingham Study, a 70-year research program focused on heart disease, gathered two decades of data from 5,200 subjects, crunched the numbers and discovered that the greatest indicator of life span wasn't genetics, diet or the amount of daily exercise, as many had suspected. It was lung capacity. Larger lungs equaled longer lives. Because big lungs allow us to get more air in with fewer breaths. They save the body from a lot of unnecessary wear and tear.

Also a sedentary way of life with not enough movement during the day, especially during childhood and adolescence, along with poor sitting and standing postures can encourage shallow breathing instead of breathing with the whole body.

[May 24, 2020] It's the biggest question in the world right now: is Covid-19 a deadly disease that only a small fraction of our populations have so far been exposed to? Or is it a much milder pandemic that a large percentage of people have already encountered and is already on its way out?

May 24, 2020 | www.unz.com

Swedish Family , says: Show Comment May 21, 2020 at 8:39 pm GMT

New UnHerd interview up , this time with Sunetra Gupta, professor of theoretical epidemiology at Oxford. From their summary:

It's the biggest question in the world right now: is Covid-19 a deadly disease that only a small fraction of our populations have so far been exposed to? Or is it a much milder pandemic that a large percentage of people have already encountered and is already on its way out?

If Professor Neil Ferguson of Imperial College is the figurehead for the first opinion, then Sunetra Gupta, Professor of Theoretical Epidemiology at the University of Oxford, is the representative of the second. Her group at Oxford produced a rival model to Ferguson's back in March which speculated that as much as 50% of the population may already have been infected and the true Infection Fatality Rate may be as low as 0.1%.

Since then, we have seen various antibody studies around the world indicating a disappointingly small percentage of seroprevalence -- the percentage of the population has the anti-Covid-19 antibody. It was starting to seem like Ferguson's view was the one closer to the truth.

But, in her first major interview since the Oxford study was published in March, Professor Gupta is only more convinced that her original opinion was correct.

As she sees it, the antibody studies, although useful, do not indicate the true level of exposure or level of immunity. First, many of the antibody tests are "extremely unreliable" and rely on hard-to-achieve representative groups. But more important, many people who have been exposed to the virus will have other kinds of immunity that don't show up on antibody tests -- either for genetic reasons or the result of pre-existing immunities to related coronaviruses such as the common cold.

The implications of this are profound – it means that when we hear results from antibody tests (such as a forthcoming official UK Government study) the percentage who test positive for antibodies is not necessarily equal to the percentage who have immunity or resistance to the virus. The true number could be much higher.

Observing the very similar patterns of the epidemic across countries around the world has convinced Professor Gupta that it is this hidden immunity, more than lockdowns or government interventions, that offers the best explanation of the Covid-19 progression:

"In almost every context we've seen the epidemic grow, turn around and die away -- almost like clockwork. Different countries have had different lockdown policies, and yet what we've observed is almost a uniform pattern of behaviour which is highly consistent with the SIR model. To me that suggests that much of the driving force here was due to the build-up of immunity. I think that's a more parsimonious explanation than one which requires in every country for lockdown (or various degrees of lockdown, including no lockdown) to have had the same effect."

Asked what her updated estimate for the Infection Fatality Rate is, Professor Gupta says, "I think that the epidemic has largely come and is on its way out in this country so I think it would be definitely less than 1 in 1000 and probably closer to 1 in 10,000." That would be somewhere between 0.1% and 0.01%.

[ ]

https://www.youtube.com/embed/DKh6kJ-RSMI?feature=oembed

If she is right, antibody tests are a poor measure of the true virus spread, and the declining death rate Sweden and many other countries have seen this past month is from immunity -- not measures -- lowering the effective reproduction number. Time will tell.

[May 24, 2020] Coronafacts IFR 1%, Spread Low by Anatoly Karlin

May 24, 2020 | www.unz.com

Beckow , says: Show Comment May 21, 2020 at 11:24 am GMT

To summarise: corona infects less than 5-10% of people, more under ideal virus circumstances in cold, dumpy ski resorts or in NY-London tenements. Among infected it kills about 1%, almost all over 65, with those over 80 having a 10-20% chance of dying.

And they shut down the world, because ' corona '. This is a policy of 'do anything to protect the old' even if it means enslaving the young, a gerontocracy that would be unthinkable in the past.

It is dawning on even the most fanatical corona fans that the data won't change. Now we hear about a 'second wave' – why only one more? Or that the restrictions stopped a disaster – one of those 'what if' historical speculations. But the best one lately is that ' we didn't know anything, nobody knew '.

Right, who knew? One can justify anything by embracing ignorance: "I know nothing, but you must do what I say." This is one is better than WMDs, lier loans, or Putin personally flipping votes in Michigan in 2016 West is really growing intellectually. I can't wait for the next one

sudden death , says: Show Comment May 21, 2020 at 11:50 am GMT

To summarise: corona infects less than 5-10% of people, more under ideal virus circumstances in cold, dumpy ski resorts or in NY-London tenements

That is in 2-3 months since initial infections and it was enough to completely overwhelm organized healthcare in some places and strain very hard in most places, then all those loathed protective measures kick in and the spread slows because of it. If there were no such any measures taken anywhere in the world growth would become explosively exponential very soon and those 5% would increase tenfold.

Ludwig , says: Show Comment May 21, 2020 at 1:34 pm GMT
Thanks for a great list of resources! Incidentally ongoing studies from the COVID-19 stricken USS Roosevelt – a closed ecosystem like the Diamond Princess but with relatively young, fit crew members – should be interesting. ( https://www.washingtonpost.com/national-security/2020/04/23/roosevelt-coronavirus-epidemiology )

A couple of thoughts (and apologize if they may be in some of the links you mentioned):

While it's good to know what the "average" IFR is, IMO it's as important from a policy point of view to know what the conditions in which it varies and how much (based on current treatment options) it can vary by. Speaking purely statistically, a mean of 1% with a 95% CI of 0.9-1.1% is significantly different from one of 1% with a 95% CI of 0.01% to 2%.

Here are some factors that we already know significantly impact hospitalizations/mortality:

Inherent Factors:
– Age (easily the biggest known variable for impacting IFR, likely correlated with immune system response)
– Gender (men more susceptible than women (around 30% more?)
– Co-morbidity (correlates with pre-existing damage to tissues throughout the body and sensitivity of receptors/immune response)
– Prior coronavirus history (??? One paper claims that recent infection with coronavirus that causes the common cold may offer cross-reactive antibodies to SARS-Cov-2 https://www.lji.org/news-events/news/post/first-detailed-analysis-of-immune-response-to-sars-cov-2-bodes-well-for-covid-19-vaccine-development/ )
– Blood groups (??? Contradictory/not fully vetted data claiming for example those with ABO antigen type A more susceptible to infection progressing than type O, B, AB)

External Factors
– Early detection and treatment before severe symptoms
– Medical care availability
– Tailored treatment cocktails (evolving but reports that each country/region gaining experience on identifying optimal treatment regimens depending on patient)
– Optimal use of ventilators (reports that though low blood oxygen is first presented, automatic intubating may often make things worse)
– Lethality/Infectiousness of different strains (?? Non-peer reviewed studies claim for example at least three major strains that differ in infectiousness/severity which are found dominant in different regions.

There may be more (eg BCG vaccine (a theory I don't buy for reasons too long to go into here); past use of nicotine etc; ethnic genotypes etc).

But the point is, based on even current, rapidly evolving knowledge, IFR varies widely based on known/speculative factors, which should inform response policy from severity/types of lockdowns/social restrictions to medical responses in addition to efforts to prevent infection in the first place.

A123 , says: Show Comment May 21, 2020 at 1:36 pm GMT
@AP The interesting & important thing to note is that fatalities are heavily tied to the related factors of pre-existing conditions and advanced age. For example:

https://www.statista.com/statistics/1107913/number-of-coronavirus-deaths-in-sweden-by-age-groups/

With CQ/AZ/ZN available everywhere, the bulk of the economy could reopen immediately with or without masks. Given that psychology is important, odds are mask wearing will make the restart more effective. However, masks provide partial protection at most.

Znzn , says: Show Comment May 21, 2020 at 3:03 pm GMT
Let us talk about this again, basically, how much of international travel is really necessary, the cheap labor travel? White pedos vacationing in Thailand? A lot of mass tourism just leads to places like Queenstown, Kyoto, and Venice being trashed, driving the locals out, and losing their local culture, and 95 percent of business travel are really junkets that can be replaced by videoconferencing.
Znzn , says: Show Comment May 21, 2020 at 3:05 pm GMT
@james wilson Given that the current crap state of Western culture is that responsibility of SJW millennials and zoomer maybe it is they that should be sacrificed? How much will the world lose anyway? The world was much better off before they came here. They are the ones who are responsible for things going off the deep end the past decade or so. Look at how much better Star Trek the next generation was compared to the crap now by JJ Abrams.
utu , says: Show Comment May 21, 2020 at 3:18 pm GMT
I liked very much the paper by the Berkeley physicists: Modi, Chirag, Vanessa Boehm, Simone Ferraro, George Stein, and Uros Seljak. Epidemiologists and all kinds of statisticians could learn from them how to write transparently. One of the reason there are so many papers written poorly is that the authors often have to obfuscate as they do not really understand what they are doing. People can be taught how to use statistical software packages like SAS, SPSS, R w/o really understanding the underlying mathematical routines.

[May 24, 2020] Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak -- New York City, March 11 May 2, 2020 MMWR

May 24, 2020 | www.cdc.gov

During March 11–May 2, 2020, a total of 32,107 deaths were reported to DOHMH; of these deaths, 24,172 (95% confidence interval = 22,980–25,364) were found to be in excess of the seasonal expected baseline. Included in the 24,172 deaths were 13,831 (57%) laboratory-confirmed COVID-19–associated deaths and 5,048 (21%) probable COVID-19–associated deaths, leaving 5,293 (22%) excess deaths that were not identified as either laboratory-confirmed or probable COVID-19–associated deaths ( Figure ).

[May 23, 2020] Hydroxychloroquine After Action Report

May 23, 2020 | angrybearblog.com

Robert Waldmann | May 23, 2020 10:52 am

Healthcare Hot Topics I was a vehement advocate of prescribing hydroxychloroquine (HCQ) off label while waiting for the results of clinical trials. I wasn't all that much embarrassed to agree with Donald Trump for once. Now I feel obliged to note that my guess was totally wrong. I thought that the (uncertain) expected benefits were greater than the (relatively well known) costs.

The cost is that HCQ affects the heart beat prolonging the QT period (from when the atrium begins to contract to when the ventrical repolarizes and is read to go again). This can cause arrhythmia especially in people who already have heart problems. I understood that one might argue that all people with Covid 19 have heart problems but didn't consider that argument decisive (I probably should have).

The positive expected value of the uncertain benefits was based on strong in vitro evidence that HCQ blocks SARS Cov2 infection of human cells in culture. (this is a publication in the world's top general science journal).

Already in early May, there was evidence that any effect of HCQ on the rate of elimination of the virus must be small. In this controlled trial conducted in China , the null of no effect is not rejected. Much more importantly, the point estimates of the effects over time are all almost exactly zero. I considered the matter settled (although the painfully disappointed authors tried to argue for HCQ and that their study was not conclusive).

There are now four large retrospective studies all of which suggest no benefit from HCQ and two of which suggest it causes increased risk of death. I am going to discuss the two studies most recently reported.

One is a very large study (fairly big data goes to the hospital) published yesterday in The Lancet. In this study patients who received HCQ had a significantly higher death rate with a hazard of dying 1.335 times as high. The estimate comes from a proportional hazard model with a non parametric baseline probability and takes into account many risk factors including crucially initial disease severity. It is also important that only patients who were treated within 48 hours of diagnosis were considered.

I am, of course, dismayed by this result. I am also puzzled, because it is quite different from the result obtained in a smaller retrospective study published in JAMA

I think the practical lessons are that it seems unwise to give Covid 19 patients HCQ. Also maybe Robert Waldmann should be more humble. After the jump, I will discuss the two studies in some detail and propose an explanation of the difference in results.

[May 23, 2020] The more you know Over a third of Americans apprehensive about Covid-19 vaccine, citing rushed development trust issues -- RT

May 23, 2020 | www.rt.com

The more you know? Over a third of Americans apprehensive about Covid-19 vaccine, citing rushed development & trust issues 21 May, 2020 21:37 Get short URL The more you know? Over a third of Americans apprehensive about Covid-19 vaccine, citing rushed development & trust issues © Global Look Press / Fotostand / K. Schmitt Follow RT on RT As the Trump administration pushes for Covid-19 vaccine development on an ever-shrinking timetable and companies report lackluster early trials, 35 percent of Americans are less than thrilled about getting the shot. Operation Warp Speed, the Trump administration's unprecedented drive to create and roll out a vaccine for the coronavirus pandemic by the end of the year, may be doing more harm than good, at least where Americans' trust is concerned. Between the shockingly abbreviated timetable and the lack of long-term safety testing, almost one in four Americans (24 percent) said they were not interested in the shot, according to a Reuters poll published Thursday. An additional 11 percent were unsure about it.

Also on rt.com Study Trump cited in his latest attack on WHO does NOT EXIST, says editor-in-chief of prestigious medical journal

Compounding the distrust is the polarizing figure of President Donald Trump himself, who proudly announced the shortened timetable for vaccine development last week. Thirty-six percent of those polled by Reuters said they would be less likely to take a potential Covid-19 vaccine if it came recommended by Trump, while just 14 percent thought the president's seal of approval was a positive.

Trump's narrative flip-flops haven't helped his credibility on the vaccine front. From his early reassurances that the virus would vanish in weeks, to his public conflicts with his own health advisers over locking down and reopening the country, it's not hard to see why Americans are hesitant to fall in line behind him on this. But the problem isn't necessarily political. Nearly half of those uninterested in taking the vaccine said the speed of its development worried them, while over 40 percent said the vaccine would be riskier than actually contracting Covid-19 itself.

Read more Trump's WARP SPEED vaccine czar oversaw an infamously BOTCHED vaccination. Wonder why a THIRD of Americans want to dodge this one? Trump's WARP SPEED vaccine czar oversaw an infamously BOTCHED vaccination. Wonder why a THIRD of Americans want to dodge this one?

However, even 29 percent of those who said they were " not very interested " in the vaccine allowed they'd be willing to change their mind if the shot was approved by the Food and Drug Administration. The full approval process for vaccines usually takes over a decade, and even the most optimistic experts – including Dr. Anthony Fauci, who has become the public face of the US' Covid-19 policy – believe a shot won't be ready for another year to 18 months. Rushing a vaccine to market in the middle of a pandemic means sacrificing comprehensive safety checks for efficiency – a tradeoff that can be disastrous, as in the case of the 2009 swine flu shot Pandemrix, which caused permanent brain damage in over 1,000 British patients.

The parallels between Covid-19 and that epidemic are ominous – wildly inflated death predictions had spooked the UK government into approving Pandemrix without sufficient safety data – and it surely won't help Americans' trust in this vaccine that Trump's " vaccine czar " Moncef Slaoui ran GlaxoSmithKline's vaccine division during the swine flu debacle. Nor has it been especially heartening to discover Slaoui's extensive investments in not just Glaxo but many other drug companies working on potential vaccines.

Slaoui earned $3 million on Monday alone from Moderna, which is still considered the leading candidate in the vaccine race, even though the drug company has never brought a vaccine to market. After hyping up what were essentially meaningless preliminary results, Moderna's stock shot up 25 percent, bringing his holdings to over $10 million. He pledged to donate those earnings to " cancer research " after demands for him to divest reached a fever pitch. A vaccine produced at Oxford University hasn't fared much better, with all six rhesus monkeys who received the shot becoming infected anyway – despite a preliminary report that tried to spin the failure as representing " some " success.

Also on rt.com Define 'distribute'! Trump mobilizing MILITARY to deliver Covid-19 vaccine 'assuming we get it,' sparks conspiracy frenzy

Threats of mandatory vaccination have unsurprisingly not helped to soothe Americans' worries over a potentially unsafe vaccine. Fauci and other health officials have repeatedly warned the public that there will be no return to " normal " without a vaccine, even as lockdown restrictions are slowly lifted – a statement some have interpreted as a threat that the unvaccinated will be barred from crowded public places or travel. Harvard Law Professor Alan Dershowitz went further, declaring the government has " police power " to mandate Americans take a vaccine and claiming such power is " not debatable " constitutionally. And other experts downplayed the very real concerns voiced by poll respondents in favor of blaming the " very aggressive anti-vaccine movement ."

All this is bad news for the health experts Reuters cites, who say 70 percent of Americans would have to be immune in order to achieve " herd immunity " and stop the virus from spreading through the US, where upwards of 90,000 people have died since the pandemic began.

[May 22, 2020] The Remdesivir Study Is Finally Out Drug Only Helped Those On Oxygen, Finds Mortality Too High For Standalone Treatment Zero

May 22, 2020 | www.zerohedge.com

Remember when the market soared on several days in April on the Facui-touted Remdesivir study which, according to StatNews and various other unofficial sources of rumors, was a smashing success only for the optimism to fizzle as many questions emerged , and as the Gilead drug quietly faded from the public's consciousness and was replaced by various coronavirus vaccine candidates such as those made by the greatly hyped Moderna ( whose insiders just can't stop selling company stock ).

Meanwhile, those who were waiting for the official version of Remdesivir's effectiveness had to do so until 6pm on a Friday before a long holiday, and for good reason...

Friday 6 pm. Fking ridiculous. https://t.co/6Ze38BfVgN

-- Adam Feuerstein (@adamfeuerstein) May 22, 2020

... According to a pivotal study published in the New England Journal of Medicine late on Friday, Remdesivir, which was authorized to treat Covid-19 in a group of 1063 adults and children (split into two groups, one receiving placebo instead of remdesivir) who need i) supplemental oxygen, ii) a ventilator or iii) extracorporeal membrane oxygenation (ECMO), only significantly helped those on supplemental oxygen.

Meanwhile, and explaining the 6pm release on a Friday, the study also found no marked benefit from remdesivir for those who were healthier and didn't need oxygen or those who were sicker, requiring a ventilator or a heart-lung bypass machine.

The NEJM, almost apologetically, stated that "the lack of benefit seen in the other groups might have stemmed from a smaller number of patients in each group."

Still, as a result of the partial benefit for patients in the supplemental oxygen group, the study from the National Institute of Allergy and Infectious Diseases was evaluated early and led to the authorization of remdesivir before the full trial was completed.

Our findings highlight the need to identify Covid-19 cases and start antiviral treatment before the pulmonary disease progresses to require mechanical ventilation.

Some more details on the study, which was a "rank test of the time to recovery with remdesivir as compared with placebo, with stratification by disease severity":

The primary outcome measure was the time to recovery, defined as the first day, during the 28 days after enrollment, on which a patient satisfied categories 1, 2, or 3 on the eight-category ordinal scale. The categories are as follows:

  1. not hospitalized, no limitations of activities;
  2. not hospitalized, limitation of activities, home oxygen requirement, or both;
  3. hospitalized, not requiring supplemental oxygen and no longer requiring ongoing medical care (used if hospitalization was extended for infection-control reasons);
  4. hospitalized, not requiring supplemental oxygen but requiring ongoing medical care (Covid-19–related or other medical conditions);
  5. 5, hospitalized, requiring any supplemental oxygen;
  6. hospitalized, requiring noninvasive ventilation or use of high-flow oxygen devices;
  7. hospitalized, receiving invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); and
  8. death.

The results are summarized below, highlighting the only group that showed a statistically significant improvement in outcomes as a result of taking the drug vs placebo.

A visual representation of the outcomes is below; it shows that whereas there was a modest benefit only to patients who were receiving oxygen, the results were statistically insignificant vs placebo for patients not receiving oxygen, while in a surprising twist patients on high-flow oxygen or mechanical ventilator/ECMO did modestly better in the placebo group than those taking remdesivir. Also, the overall results showed a very modest, but not statistically significant improvement in the remdesivir group vs placebo (box A).

Another disappointment: the study found that overall "mortality was numerically lower in the remdesivir group than in the placebo group, but the difference was not significant ", in other words the alleged "miracle drug" has largely the same effect as a placebo in terms of overall disease mortality.

The study authors also note that the "findings in our trial should be compared with those observed in a randomized trial from China in which 237 patients were enrolled (158 assigned to remdesivir and 79 to placebo).... That trial failed to complete full enrollment (owing to the end of the outbreak), had lower power than the present trial (owing to the smaller sample size and a 2:1 randomization), and was unable to demonstrate any statistically significant clinical benefits of remdesivir. "

Finally, the study found that while mortality was modestly lower for the remdesivir arm, it was not significantly so, at 7.1% at 14 days on drug versus 11.9% on placebo.

In conclusion, while the "preliminary findings support the use of remdesivir for patients who are hospitalized with Covid-19 and require supplemental oxygen therapy" the study goes on to warn that " given high mortality despite the use of remdesivir, it is clear that treatment with an antiviral drug alone is not likely to be sufficient."

The study's recommendation:

Future strategies should evaluate antiviral agents in combination with other therapeutic approaches or combinations of antiviral agents to continue to improve patient outcomes in Covid-19.

So a generally disappointing outcome, one which would lead to a drop in the market. Nonsense: think of all the spin, and why this is in fact great news for stocks: Remdesivir may be a dud as a "silver bullet" to curing covid, leading to statistically significant improvement in only a very limited subset of infected patients and "high mortality" for those taking it, but at least the algos will have a whole lot of other "miracle drugs" to levitate them as optimism that the next remdesivir is just around the corner. In short: rinse, rumor, and repeat... and then save the bad news for 6pm on a Friday.

Oh, and for those asking about the "official" reason why the NE Journal of Medicine waited until just the right time to make sure nobody reads the results, here it is:

I asked NEJM spox to explain the Friday 6 pm release of the remdesivir study. Her response is below. pic.twitter.com/WjNGyUv7sH

-- Adam Feuerstein (@adamfeuerstein) May 22, 2020

The full study is available here .

[May 22, 2020] End New York City's lockdown now! by David Marcus

May 22, 2020 | turcopolier.typepad.com

Terence Gore , 21 May 2020 at 12:13 PM

long interview Robert Kennedy Jr

as left as you can get

against the left support of big Pharma

https://www.youtube.com/watch?time_continue=3164&v=QLi6ZrFp6vQ&feature=emb_logo

RFrancis , 21 May 2020 at 12:27 PM
The phrase "professional deformations" helped clarify a number of things for me! Thank you for your incisive words, Col. Lang.
CK , 21 May 2020 at 12:30 PM
But what about the snitches and the virtue signalers and the screamingly fearful faux celebrities, and how can you be so cruel to the currently essential who if we re-open have to return to being just another bunch of working stiffs. Have you not seen the vasty deep outpouring of love and affection we are currently piling on the Nurse Ratcheds and Dr. Evils of the world for their virtuous and self effacing tv commercials and the many glorious PSAs with paeans and "we're all in this together" sophistries from various health insurance companies and makers of very expensive symptom mollifiers?
I am sorry sir, but I must disagree. We must not only keep closed that which is currently closed, we must use the power of the IC and the various state and federal militaries and national guards to close down all the open and partially opened states and cities and towns and farms and counties and any other political subdivisions of this great nation until we are truly "all in this together".
Or
We could just open all of it, now.
If we did, we would be back to normal in about 60 days, some places would open with new management, some folks would enjoy continued unemployment until they were called back.
I, personally, expect that except for Ca and NY the country will be reopen about 90 days prior to the election.
Deap , 21 May 2020 at 12:38 PM
The liberal media and legislators applied the 100% solution to 1% of the population, if that much.

That was failed leadership; that was slavish "following orders". That was a loss of the maxim "trust, but verify" maxim. This powerful legacy of the Reagan era, must be put back at the forefront of any public decision process. Question authority needs repeating as well.

Our public education system failed us completely for too many decades. Teaching generations of Americans to be critical of America, is not teaching them critical thinking skills. We need to own up to that, from our local school boards on up.

These non-science , not thinking, hateful liberal media and politicians deserve the 100% solution - 100% voted out of office in 2020. Liberal media and legislators must get a new message. Voting and boycotting are the two primary tools we have. Some stunning upsets in primary races are already occurring. It will be morning in America again.

But may we never forget why so many were so willing to shoot ourselves in the foot. For what end purpose? Were we ever so collectively scared as a Nation in the past, that we were willing destroy ourselves as we witnessed happening these past few money - no nuance, no graduated response, no scalpel wiled with professional precision.

What happened to our true grit as Americans? How did we get into this devastatingly false dichotomy - total submission or we are all going to die.

Will there be a post mortem examination of the corpse of our once vibrant nation? This requires honest soul searching. I honestly don't think we have the tools to do this any longer. I hope I am wrong. In fact I would be greatly comforted to be proven wrong.

Will current national leadership rise to this challenge? Or has the Black Swan yet to arrive. Or do we start this soul-searching right here and right now, one by one. "Stronger together". Will the Karens stop demanding we go through their menopause danger years with them.

ancientarcher , 21 May 2020 at 02:02 PM
It is astonishing that no one is talking about the death profile from covid19 (or as it should have been named - the Wuhan coronavirus). Over there in the UK, the median age of death from covid is 83-84.

There has been a lot of talk about Children dying of covid. Only 2 (two) children under the age of 10 have died from covid since it started and they probably had other conditions. This is in a total population of 65million.

Fully 90% of the deaths from covid19 are in the ages of 65+ and that segment of the population doesn't, by and large, participate in production in the economy (of goods or services). While death is always sad and it will lead to grieving, we have to understand that people always die, especially the old and infirm. Anyways, no one is suggesting that they should be left to fend for themselves, the older people and those with conditions makes them high risk should be isolated.

The UK closed the massive Nightingale hospitals that were set up to handle thousands of patients. The one in London handled a total of 54 before shutting down. Clearly, we had over-provisioned for the outbreak (as we should) but very clearly we are past the worst.

Please OPEN UP THE ECONOMY. And do it NOW. The deaths being avoided are not worth keeping the economy shut down, not only in the UK but across the world.

People point towards the Spanish flu where most deaths happened in the 2nd wave. Well, most of those deaths would not have happened had antibiotics been invented then. The deaths were due to subsequent bacterial infections (usually pneumonia) after the virus weakened the immune system.

We need to start going back to normal and we need to do it now!

Fred , 21 May 2020 at 02:03 PM
Democrats - the Dream Killers. Meanwhile immigration is our strength, multi-national corporations may operate, private businesses may not - "for the common good" as Deborah Dingell, former GM lobbyist and now successor to John D's hold on power in Congress and the DNC, likes to repeat daily on her FB stream of concousness - along with exhortations to obedience.

"By prolonging the coronavirus shutdown long after its core mission was accomplished, Gov. Andrew Cuomo and Mayor Bill de Blasio have plunged tens of thousands of New Yorkers into poverty."

Poverty apparently doesn't kill anyone infected with this virus, but it sure is killing our freedoms and thanks to Cuomo and Whitmer it has killed thousands in nursing homes. The press is all praise for them, and tries to gin up stories about other governors, such as De Santis of Florida, or ignores them, as they are going with the story in Georgia.

Eric Newhill , 21 May 2020 at 02:05 PM
Sir,
I was a fence sitter/agnostic until the end of February or early March. Then there was enough data in to be able to understand that the elderly needed to be protected and the rest of should go about life as normal. When you first posted about panic, I wasn't seeing a panic as I would define it. Then a few days later lockdowns were announced. You had the jump on that one!

Just to summarize what I have been saying since the lockdown started, there are going to be more deaths (and many more years of life lost) from all of the people not able and/or too afraid to engage in regular healthcare services than there will be killed by the virus - and from the effects of economic destruction.

The Mayor of Ithaca, NY - not a conservative by any means - made an appeal to Cuomo to open the economy back up and to allow students to return to colleges. He says his college town (includes Cornell U) had the best economy in all of NY up to the lockdown (lowest unemployment, etc). Now he can't collect enough tax revenue to pay police and other public servants.

And that's what I don't get about this scheme to establish a new [socialist] normal. How do the socialists think they are going to generate revenues to pay for everything they want? It's almost as if they don't understand economics 101. Will they turn on their limousine faction and confiscate their wealth along with that of conservatives? Do they really imagine that no one is going to fight back (I mean with votes, pitchforks, guns...whatever)? For that matter, same goes for the non-scheming sincere useful science geek/idiots. They are supposed to be engineer types, but where are the sober calculations of costs and benefits? What are they thinking?

TedBuila , 21 May 2020 at 02:14 PM
Re:
A lot of people die every day of a variety of causes. This virus is a reaper that culls the population, eliminating the weak and the old. The great majority of healthy, productive people survive infection with little or no apparent effect.

The last or only time this brushed me was with polio in Detroit in the 50's. Following your "re-open the country, all of it" swimming pools and Belle Isle would never have been closed would have remained open in August and September to allow nature to thin-out Detroit's/the country's weakest.

That's your C19 call as I read it.

Keith Harbaugh , 21 May 2020 at 02:28 PM
On the damage the shutdowns and restrictions are causing,
this is a good account:

Doctors raise alarm about health effects of continued coronavirus shutdown: 'Mass casualty incident'

https://www.foxnews.com/politics/doctors-raise-alarm-about-health-effects-of-continued-coronavirus-shutdown

Laura Wilson , 21 May 2020 at 02:58 PM
Yeah, too bad about all those doctors and nurses dying. Easily replaced, I'm sure.

It's just math, folks. Epidemics are math...you can either go with the math or try to change the equation and the outcome of the math. I, personally, would rather try to change the equation.

turcopolier , 21 May 2020 at 03:40 PM
Laura Wilson

"The greater good ..." How many doctors and nurses really? How many? You should remember about me that I am accustomed to sacrificing people for the greater good. That is MY professional deformation.

turcopolier , 21 May 2020 at 03:44 PM
TedBuila

This plague actually kills few outside the legion of the old and infirm. Polio kills the youngest first. Yours is a false comparison.

turcopolier , 21 May 2020 at 03:50 PM
Eric Newhill

What were the Khmer Rouge thinking in the Year Zero when they systematically destroyed Cambodia and killed millions?

jerseycityjoan , 21 May 2020 at 04:07 PM
New York City is still getting hundreds of new cases and hospitalizations a day. How many people will want to go to crowded indoor places? If there is social distancing with lots of empty chairs and spaces, how many closed places could make any money if they opened?

There's been a lot of uncertainty and guesswork involved with this new virus and that will continue. We came through the first round with some hotspots but most places doing OK. I think we were right to shut down when we did and that we need to be careful in opening back up. I still trust Dr. Fauci and Dr. Birx.

Certainly it's time to start relaxing restrictions in most places. But we need to remember that this is a new virus with many unknowns and that we are all vulnerable because there's no proven ttestment that works, cure or vaccine.

I have to say that this crisis has taken on a symbolic importance for some. It has not for me. I think this will lead to a lot more disagreement about what should be done in the future, particularly if we have addition waves. That makes me feel uneasy -- very uneasy. I am not assuming we're going to have a very effective vaccine within a year so we may be living with this threat for a long time.

Deap , 21 May 2020 at 04:09 PM
Eric, socialists in California have one standard answer when confronted with funding for their schemes: They'll find the money. .

End of all practical discussion. When asked for details, they will invariably add .. "you had money for the Vietnam war .... the military etc. Just use that money."

Only two decades of total socialism in this state has this done to our fiscal literacy. "Just tax the rich" gets anything passed. Cruel fact in this state, the rich - just the top 1% in this state pay 50% of all state revenues. Only a handful of people pay half the bills.

Should any of this top 1% leave, like Musk recently threatened, shock waves will reach the state's executive suite. But this threat will fall on deaf ears in the state's Democrat super-majority legislature.

Voters finally are catching on - they lost their livelihood due to government actions, but government employees never missed a paycheck. How this translates at the ballot box remains to be seen. Two Democrats getting recently tossed out is a good start, but is it a trend?

My own local city council yesterday just gave all SEIU employees a raise; while our entire economy, much of it dependent on tourism, has been totally trashed. This is what a Democrat one party state looks like.

turcopolier , 21 May 2020 at 04:19 PM
jerseycityjoan

Timid. Will you like living in a dying metro area?

blue peacock , 21 May 2020 at 04:28 PM
"How do the socialists think they are going to generate revenues to pay for everything they want?"

Eric,

Simple. Print money. As they've been doing since the GFC at scale. The added benefit is that the biggest beneficiary of socialism - the titan of capitalism - Wall St - will get the lion's share as they're getting now with the Wuhan virus lockdown. Average Joe peon should be thankful they got $1,200.

Powell on 60 Minutes says there's no limit to the Fed printing money. He like Bernanke loves to click Print on the keyboard. And no pesky Congressional authorization either. MOAR & MOAR!!

BillWade , 21 May 2020 at 04:47 PM
It's feeling pretty normal here in SW Florida now, rumor is Jun 1st the bars will open up and that makes it 100% normal. I know of at least 6 restaurants in Port Charlotte/Punta Gorda that will not re-open. We go through the restaurant closings every year anyway, "Season" ended early this year with the lock down. Memorial Day usually is when we get the closings. But, they will reopen with new owners who have recently retired and "have always wanted to own a restaurant" not understanding that the restaurant business is for the younger, just as life is.

I feel awful when I see the little old ladies driving alone in their cars with their masks on, victims of the MSM that are truly a national security threat.

Eric Newhill , 21 May 2020 at 05:06 PM
Sir,
The fact of the Khmer Rouge and the mentality behind it (at bottom, same as Mao, same as Stalin same others that brought death, destruction and misery to their societies) is another reason to get back to normal in this country - and accept any casualties that might result. This has become a war for the heart and soul of the country. Actually, it's a war for everything; even material prosperity. Whatever the casualties might be in the short run, they will be far less than the long run if we allow the Khmer Rouge to continue (which, of course, is one of your key points).

One of my objectives on social media has been to try to gain insight into the Khmer Rouge and young pioneer psychology. I can now recognize it when I see it; even when it tries to disguise itself, but I truly don't understand such people. IMO it is some kind of twisted spiritual illness that seeks dominance as it replaces God with themselves. That much I can see. I guess it has to do with the battle between good and evil. Evil always seeks to control and manipulate and disrespects the sanctity of each soul. It seeks to enslave and cut off from freedom and recognition of divinity around each of us and in each of us. Its sycophants are attracted to the sense of power; false as it may truly be.

At least that is the way I best understand it.

Barbara Ann , 21 May 2020 at 05:15 PM
jerseycityjoan

Our natural capacity for threat perception and assessment is warped by the media's need to generate headlines. The virus is a gift to them which they have enthusiastically embraced. Most of us have a vanishing small chance of it killing us off, yet this single risk dominates the public discourse to the exclusion of almost all else.

Social media is particularly insidious, the effects of which far too few are prepared to counter. The feedback loops of hysteria it generates must be assessed as a threat in their own right - to our ability to make sound judgments.

A destroyed economy is not a direct threat to any one individual's survival, but it's collapse is an inevitable consequence if the lockdowns are allowed to continue. In this case many will die and very many more will experience a great deal of misery. Sadly the headlines carrying these stories will only come after it is far too late.

Turn off the Tee Vee news, treat social media 'news' with great skepticism and read the opinions of people who see the bigger picture. You are in the right place for the last of these.

Bobo , 21 May 2020 at 05:51 PM
Open it up-It never should of closed. What we have done is to prolong the inevitable. You either get it or you don't but it is still here waiting for those cowering in their homes. Prudent actions and awareness of your situation will get one through most of life's events.
The next thing we will here is Oh Folks, get out there and enjoy the summer while you can as it's coming back in the fall. No schools, Sheltering in Place, minimize the essentials, where are those ships and tent hospitals, we need PPE, start the printing etc etc cause the vaccine ain't ready Folks.

It will all be fine, don't worry. Keep in mind it has only taken a 100,000 out 330,000,000 a very low ratio.

rho , 21 May 2020 at 06:39 PM
"How do the socialists think they are going to generate revenues to pay for everything they want?"

https://www.zerohedge.com/markets/goldman-spots-huge-problem-fed

The US government will issue 3 trillion $ of new debt in this quarter alone. The banks will buy these bonds, then sell them back to the US Central Bank (that's called "quantitative easing", the quoted article talks about the expectation that the central bank will announce a new bond purchasing program soon because the current one is far too small to absorb all the new debt), and the cycle repeats.

That's not sustainable, but that's the only plan that exists. If the shutdown of the economy continues indefinitely, it will end in economic collapse by bankruptcy of the federal government, or hyperinflation, which is really just a different way to reach the same painful end point.

Same story here in Europe, just with the added complication that there are conflicts between the different national governments of the Eurozone when the European Central Bank does the very same thing.

Master Slacker , 21 May 2020 at 06:50 PM
You can open up the city when everyone starts to wear a mask . Covid-19 is proving to be an airborne killer... which simplifies things enormously. Consider it an instance of CBW. And of course the children's inflammatory syndrome is just collateral damage.
Laura Wilson , 21 May 2020 at 07:59 PM
Master Slacker--And now there is some evidence that the inflammatory syndrome is hitting teenagers and young adults, too.

turocpolier--The numbers aren't comprehensive (or even good) on the national toll of doctors and nurses and aides and CNAs, etc. in health care/hospitals. Too bad our government can't get everyone to report in a uniform manner!!!! (Not that any other administration has been successful with this either.) It certainly would be helpful in the middle of a novel pandemic to know if we were going to have enough front line responders to stay in the fight.

And I NEVER forget that you are a professional "sacrificer for the greater good." That is why I appreciate what you have to say...it is a worthy perspective and not one that I default to!

Fred , 21 May 2020 at 08:00 PM
Master slacker,

So "my body, my choice" is for abortion only now, because your fear is greater than my rights? "stay home, stay safe" negates my need to wear a gag in your presence. I reccomend Kevin Drum go out and drum up some antifa support for the socialist distancing policing. They ought to be well rested and ready for some agit-prop and agent provocateur actions by now.

"children's inflammatory syndrome" - is a miniscule risk to a minimal risk pool. It's like the CDC's mentioning legionaire's disease in their school opening guidlelines - meant to invoke fear. More civil servent "resistance". Trump should reform the civil service. Perhaps he should revoke EO 10988,
https://en.wikipedia.org/wiki/Executive_Order_10988
His initial order was upheld, I'm sure this one would be too.
https://www.politico.com/newsletters/morning-shift/2019/07/17/executive-orders-limiting-federal-employee-unions-reinstated-458951


[May 22, 2020] Global report: don't count on vaccine, US scientist warns, as cases pass 5m

May 22, 2020 | www.theguardian.com

A top US scientist has said that people should not count on a Covid-19 vaccine being developed any time soon...

William Haseltine, the groundbreaking cancer, HIV/AIDS and human genome projects researcher, has said the best approach to the pandemic is to manage the disease through careful tracing of infections and strict isolation measures whenever it starts spreading. He said that while a vaccine could be developed, "I wouldn't count on it", and urged people to wear masks, wash hands, clean surfaces and keep a distance.

[May 22, 2020] Washington officials admit to counting GUNSHOT DEATHS in Covid-19 tally, say virus death toll likely underreported despite lapses

Yes, gunshot wounds are clearly the ffect of the new coronavirus.
May 22, 2020 | www.rt.com

Health officials in Washington state said they are reassessing their Covid-19 fatality data, warning of underreported deaths.

Even after noting that five people who died of gunshot wounds were inexplicably included in the figures.

[May 22, 2020] Washington State conned out of a likely 'hundreds of millions of dollars' by Nigerian scammers

If Nigerian hackers can steal that much money, Israel, Chinese, and Russian, intel agencies probably are in the most Fed information systems doing what they want ;-)
Notable quotes:
"... officials in Washington State may have lost "hundreds of millions of dollars" to fraudsters filing bogus unemployment claim ..."
May 22, 2020 | www.rt.com
officials in Washington State may have lost "hundreds of millions of dollars" to fraudsters filing bogus unemployment claim s – all the way from Nigeria.

[May 22, 2020] Mortality due to COVID-19 in the USA

May 22, 2020 | www.unz.com

TRM , says: Show Comment Next New Comment May 21, 2020 at 10:53 pm GMT

Connecticut and North Carolina are missing some weeks in 2020 (5 weeks & 3 weeks respectively). Pennsylvania is also negative but not missing any weeks. Interesting, I'll have to look into that.

The entire USA is about 4.5% higher than the 4 year average.

In some online discussions some were suggesting using "excess deaths" to see what effect the covid-19 disease is having and I thought that would be a reasonable approach as it gets past the deaths "with/from" issue.

State 2016-19-Av 2020 Diff
-- -- -- -- -- -- -- -- -- -- -- -- -
Entire USA 915946 956410 40464

California 88731 91453 2722
Florida 65372 68427 3055
Georgia 26955 27649 694
Illinois 35539 38088 2549
Massachusetts 19074 21800 2726
Michigan 31957 35598 3640
New Jersey 24525 32600 8075
New York State 33187 39267 6079
New York City 17614 35524 17910
Pennsylvania 44275 37383 -6892

All the data is from this CDC page:
https://gis.cdc.gov/grasp/fluview/mortality.html

The script and all related files are here if you want to kick the tires:
https://www.dropbox.com/sh/fh9x5fngmfbeiiu/AAAH-OtOMqiY_R9qqG6YccCRa?dl=0

The script generates data for all 50 states plus DC and New York City (CDC treats it separately from New York State).

I follow the advice of Ken Thompson, "When in doubt use brute force". The script is nothing fancy and dumps to file a lot as that is how I like to debug.

I will be doing up a Powershell script for this as well so the Windows folks can run it natively if they don't have WSL2 or a Linux system around.

[May 22, 2020] Survey finds 87% of America's nurses forced to reuse protective equipment

www.smh.com.au

The vast majority of America's nurses say they have not been tested for Covid-19, are reusing personal protective equipment (PPE), or have exposed skin or clothing while caring for Covid-19 patients, a new survey has shown.

The nationally representative survey finds that "dangerous healthcare workplace conditions have become the norm" since Covid-19 spread widely in the US, said the union which conducted the survey. More than 100 nurses have died since the beginning of the pandemic .

"We've known for years we're behind," said Jean Ross, president of National Nurses United. "Not because we couldn't have what we needed – because we are the richest country on the planet – but because of greed, because of the profit system that doesn't really look out for the welfare of patients. Therefore it couldn't possibly look out for the welfare of workers." ...

The survey asked more than 23,000 nurses across all 50 states and Washington DC about their working conditions since the pandemic began. The survey represents the period between 15 April and 10 May, and was conducted by National Nurses United. It included both union and non-union nurses.

In it, surveyors found 84% of nurses had not been tested for Covid-19, 87% are forced to reuse personal protective equipment designed to be single-use, such as N95 masks and face shields, and 72% of nurses have exposed skin or clothing while treating coronavirus patients.

[May 21, 2020] Smokers are at a lower risk of contracting covid19 infections

May 21, 2020 | www.moonofalabama.org

J Norwich , May 19 2020 5:43 utc | 108

Prior infection with other coronavirus strains appears to confer an enhanced immune response to covid19. Smokers are at a lower risk of contracting covid19 infections. Perhaps the two observations are related? Smokers generally have poorer lung health and may be more likely to acquire lung infections such as those caused by other varieties of coronavirus and to develop antibody protection. So maybe their vulnerability to such infections has proved an advantage in this case?

Hoarsewhisperer , May 19 2020 6:05 utc | 109

"Immune warriors known as T cells help us fight some viruses, but their importance for battling SARS-CoV-2, the virus that causes COVID-19, has been unclear. Now, two studies reveal infected people harbor T cells that target the virus -- and may help them recover. Both studies also found some people never infected with SARS-CoV-2 have these cellular defenses, most likely because they were previously infected with other coronaviruses."

Thanks for drawing attention to this, b.

The T cell/Common Cold factor may help to explain why children are less likely to be infected by COVID-19 than adults. I can recall that when each of my own offspring went through that miserable, snotty-nosed toddler phase, there seemed to be no upside for them or their parents. In retrospect, maybe it was producing a hidden benefit?

[May 21, 2020] Is nikotin effective against COVID-19

May 21, 2020 | www.moonofalabama.org

gm , May 19 2020 16:13 utc | 129

With respect to highly addictive nicotine, it is not hard to find any number of "healthful" justifications for continuing with the (disgusting, imho) smoking habit.

Why, there is already an extensive body of scientific "evidence" one can latch onto that nicotine is beneficial in Parkinson's disease:

https://scholar.google.com/scholar?q=smoking+parkinson%27s+disease&hl=en&as_sdt=0&as_vis=1&oi=scholart

And of course, one can also find numerous reports nicotine also helps schizophrenics to manage their symptoms:

https://scholar.google.com/scholar?q=smoking+schizophrenia+benefits&hl=en&as_sdt=0&as_vis=1&oi=scholart

But with regard to anecdotal/unverified [touch'e] claims of nicotine benefits in covid, one should not reflexively ignore the evidence to the contrary that conflict with one's pro-nicotine bias/belief system:}

"Smokers more likely to express ACE2 protein that SARS-COV-2 uses to enter human cells"
https://medicalxpress.com/news/2020-05-smokers-ace2-protein-sars-cov-human.html

and

"Tobacco smoking increases lung entry points for COVID-19 virus"
https://medicalxpress.com/news/2020-04-tobacco-lung-entry-covid-virus.html

"They looked at the expression of ACE2, the molecule in the respiratory tract that the COVID-19 virus uses to attach to and infect human cells. They also looked at the expression of FURIN and TMPRSS2, human enzymes known to facilitate COVID-19 virus infection.

The researchers report in the American Journal of Respiratory and Critical Care Medicine a 25 percent increase in the expression of ACE2 in lung tissues from ever-smokers, people who have smoked at least 100 cigarettes during their lives, when compared with nonsmokers. Smoking also increased the presence of FURIN, but to a lower extent compared to ACE2 . TMRPSS2 expression in lungs was not associated with smoking. They also found that smoking remodeled the gene expression of cells in the lungs so that the ACE2 gene was more highly expressed in goblet cells, cells that secrete mucus in order to protect the mucous membranes in the lungs ."

But if you are totally bent on using a non-addictive feel-good drug that Israelis say may prevent/fight against the Corona-chan, try CANNABIS:

https://news.google.com/search?for=marijuana%20covid%20israel&hl=en-US&gl=US&ceid=US%3Aen

[May 21, 2020] An MD wrote this op/ed dealing with the hypoxia caused by the coronavirus and provides evidence in support of Dr. Bush's video interview

May 21, 2020 | www.moonofalabama.org

karlof1 , May 19 2020 20:56 utc | 137

An MD wrote this op/ed dealing with the hypoxia caused by the coronavirus and provides evidence in support of Dr. Bush's video interview that can be reached through the link @135 above.

Yes, the op/ed's a month old, but the dynamics of the virus haven't changed nor have the frequency of deaths within the Outlaw US Empire.

Based on the doctor's first hand testimony and other studies, the initial treatment approach advocated by Dr. Bush and its reasoning seem quite pragmatic and logical.

Comparison with Malaria yields almost no correlation aside from the malaria parasite's use of red blood cells as nurseries and lairs, which may explain why anti-malaria drugs used against COVID-19 in its initial stages have some positive results.

[May 21, 2020] Our FLCCC Working Group currently believes that, if hydroxychloroquine proves to have any benefit, it will most likely be in the earliest stage of infection, while the virus replicates and the patient is still at home, before breathing difficulties or low oxygen levels necessitate a trip to the hospital.

May 21, 2020 | www.moonofalabama.org

Richard Steven Hack , May 19 2020 4:45 utc | 106

The Front-Line COVID-19 Critical Care Working Group (EVMS is part of that group) has this to say about HCQ:
Some have asked why our initial protocol included hydroxychloroquine, the anti-viral drug that was widely touted as a cure for the COVID-19 disease that is caused by the virus. Almost all ER and ICU physicians tried it before a study published in the New England Journal of Medicine showed it to have no effect on mortality in patients with severe cases of the disease. Our FLCCC Working Group currently believes that, if hydroxychloroquine proves to have any benefit, it will most likely be in the earliest stage of infection, while the virus replicates and the patient is still at home, before breathing difficulties or low oxygen levels necessitate a trip to the hospital.

A shortened version of their current treatment protocol (PDF):
https://tinyurl.com/y836kmpc

Dr. Kory Senate Testimony before the Homeland Security and Government Affairs Committee Hearing (Vimeo video)
https://vimeo.com/415698366

Dr. Kory is Pierre Kory, M.D., M.P.A., Medical Director, Trauma & Life Support Center, Critical Care Service Chief, Associate Professor of Medicine Univ. of Wisconsin School of Medicine & Public Health - one of eight medical professionals on the FLCCC team.

Note: I do *not* explicitly endorse any of this. I am not a doctor, nor do I play one on MoA. But I find their arguments reasonable to the degree I can comprehend them.

Richard Steven Hack , May 19 2020 6:26 utc | 110

Just watched Dr. Kory's testimony before the Senate Committee I referenced above... Link again: https://vimeo.com/415698366

I recommend it to everyone. Again, I can't speak to the medicine, but I think you'll find him highly persuasive, if rather desperate to fit his arguments into the time allotted him (which he overran.)

At least we got a number for the patients treated with their complete MATH+ Protocol - merely 100 (at the time of his testimony.) That's not a high number that persuades me. But he also cites a number of other doctors around the country and in Italy who have tried corticosteroids and apparently they consider it a "game-changer" in treatment, in that it massively reduces the number of people needing to be put on ventilators. He emphasizes that the treatment is safe, physiologically sound, well-recognized as useful for the conditions caused by the virus for years, and although "off-label" for this disease it is not unusual to do "off-label" and that is supported by all the medical association ethical standards.

But he emphasizes that the treatment needs to be started as soon as respirator symptoms develop and he is concerned that too many people are avoiding going to the hospital until it's too late. This of course raises the question as to whether this is another treatment - like HCQ - that "only" works at early stages and therefore is not necessarily proven by trials, but is only supported by "observation" in the hospital.

Of course, the solution to that is run the bloody trial. Or at least use the treatment on a greater number of treatments and see how it washes out. He's concerned that they can't get the White House to listen - big surprise, there.

[May 21, 2020] Do Lockdowns Work Mounting Evidence Says No

May 21, 2020 | www.zerohedge.com

Authored by Ryan McMaken via The Mises Institute,

The coerced economic "shutdowns" - enforced with fines, arrests, and revoked business licenses - are not the natural outgrowth of a pandemic. They are the result of policy decisions taken by politicians who have suspended constitutional institutions and legal recognition of basic human rights. These politicians have instead imposed a new form of central planning based on an unproven, theoretical set of ideas about police-enforced "social distancing."

Suspending the rule of law and civil rights will have enormous consequences in terms of human life counted in suicides, drug overdoses, and other grave health problems resulting from unemployment , denial of "elective" medical care , and social isolation.

None of that is being considered, however, since it is now fashionable to have governments determine whether or not people may open their businesses or leave their homes. So far, the strategy for dealing with the resulting economic collapse is no more sophisticated than record-breaking deficit spending , followed by debt monetization via money printing. In short, politicians, bureaucrats, and their supporters have insisted a single policy goal -- ending the spread of a disease -- be allowed to destroy all other values and considerations in society.

Has it even worked? Mounting evidence says no.

In The Lancet , Swedish infectious disease clinician (and World Health Organization (WHO) advisor) Johan Giesecke concluded:

It has become clear that a hard lockdown does not protect old and frail people living in care homes - a population the lockdown was designed to protect. Neither does it decrease mortality from COVID-19, which is evident when comparing the UK's experience with that of other European countries.

At best, lockdowns push cases into the future, they do not lower total deaths. Gieseck continues:

Measures to flatten the curve might have an effect, but a lockdown only pushes the severe cases into the future -- it will not prevent them. Admittedly, countries have managed to slow down spread so as not to overburden health-care systems, and, yes, effective drugs that save lives might soon be developed, but this pandemic is swift, and those drugs have to be developed, tested, and marketed quickly. Much hope is put in vaccines, but they will take time, and with the unclear protective immunological response to infection, it is not certain that vaccines will be very effective.

As a public policy measure, the lack of evidence that lockdowns work must be balanced with the fact that we have already observed that economic destruction is costly in terms of human life.

Yet in the public debate, lockdown enthusiasts insist that any deviation from the lockdown will result in total deaths far exceeding those places where there are lockdowns. So far, there is no evidence of this.

In a new study titled "Full Lockdown Policies in Western Europe Countries Have No Evident Impacts on the COVID-19 Epidemic," author Thomas Meunier writes , "total deaths numbers using pre-lockdown trends suggest that no lives were saved by this strategy, in comparison with pre-lockdown, less restrictive, social distancing policies." That is, the "full lockdown policies of France, Italy, Spain and United Kingdom haven't had the expected effects in the evolution of the COVID-19 epidemic." 1

The premise here is not that voluntary "social distancing" has no effect. Rather, the question is to whether "police-enforced home containment" works to limit the spread of disease. Meunier concludes it does not.

Meanwhile a study by polititical scientist Wilfred Reilly compared lockdown policies and COVID-19 fatalities among US states. Reilly writes:

The question the model set out to ask was whether lockdown states experience fewer Covid-19 cases and deaths than social-distancing states, adjusted for all of the above variables. The answer? No. The impact of state-response strategy on both my cases and deaths measures was utterly insignificant. The "p-value" for the variable representing strategy was 0.94 when it was regressed against the deaths metric, which means there is a 94 per cent chance that any relationship between the different measures and Covid-19 deaths was the result of pure random chance.

Overall, however, the fact that good-sized regions from Utah to Sweden to much of East Asia have avoided harsh lockdowns without being overrun by Covid-19 is notable.

Another study on lockdowns -- again, we're talking about forced business closures and stay-at-home orders here -- is this study by researcher Lyman Stone at the American Enterprise Institute. Stone notes that areas where lockdowns were imposed either had already experienced a downward trend in deaths before the lockdown could have possibly shown effects or showed the same trend as the year prior. In other words, lockdown advocates have been taking credit for trends that had already been observed before lockdowns were forced on the population.

Stone writes:

Here's the thing: there's no evidence of lockdowns working. If strict lockdowns actually saved lives, I would be all for them, even if they had large economic costs. But the scientific and medical case for strict lockdowns is paper-thin.

Experience increasingly suggests that a more targeted approach is better for those who actually want to limit the spread of disease among the most vulnerable. The overwhelming majority -- nearly 75 percent -- of deaths from COVID-19 occur in patients over sixty-five years of age. Of those, approximately 90 percent have other underlying conditions . Thus, limiting the spread of COVID-19 is most critical among those who are already engaged with the healthcare system and are elderly. In the US and Europe , more than half of COVID-19 deaths are occuring in nursing homes and similar institutions.

This is why Matt Ridley at The Spectator quite reasonably observes that testing, not lockdowns, appears to be the key factor in limiting deaths from COVID-19 . Those areas where testing is widespread have performed better:

Yet it is not obvious why testing would make a difference, especially to the death rate. Testing does not cure the disease. Germany's strange achievement of a consistently low case fatality rate seems baffling -- until you think through where most early cases were found: in hospitals. By doing a lot more testing, countries like Germany might have partly kept the virus from spreading within the healthcare system. Germany, Japan and Hong Kong had different and more effective protocols in place from day one to prevent the virus spreading within care homes and hospitals.

The horrible truth is that it now looks like in many of the early cases, the disease was probably caught in hospitals and doctors' surgeries. That is where the virus kept returning, in the lungs of sick people, and that is where the next person often caught it, including plenty of healthcare workers. Many of these may not have realised they had it, or thought they had a mild cold. They then gave it to yet more elderly patients who were in hospital for other reasons, some of whom were sent back to care homes when the National Health Service made space on the wards for the expected wave of coronavirus patients.

We could contrast this with the policies of Governor Andrew Cuomo in New York, who mandated that nursing homes accept new residents without testing . This method nearly ensures that the disease will spread quickly among those who are most likely to die from it.

Meanwhile, Governor Cuomo saw fit to impose police-enforced lockdowns on the entire population of New York, ensuring economic ruin and ruined health for many non-COVID patients who were then cut off from vital treatments. Yet, disturbingly, lockdown fetishists like Cuomo are hailed as wise statesmen who "acted decisively" to prevent the spread of disease.

But this is the sort of regime we now live under. In the minds of many, it is better to abolish human rights and consign millions to destitution in the name of pursuing trendy unproven policies. The prolockdown party has even turned basic fundamentals of policy debate upside down. As Stone notes:

At this point, the question I usually get is, "What's your evidence that lockdowns don't work?"

It's a strange question. Why should I have to prove that lockdowns don't work? The burden of proof is to show that they do work! If you're going to essentially cancel the civil liberties of the entire population for a few weeks, you should probably have evidence that the strategy will work. And there, lockdown advocates fail miserably, because they simply don't have evidence.

With economic output crashing worldwide and unemployment soaring to Great Depression levels, governments are already looking for a way out. Don't expect to hear any mea culpas from politicians, but we can already see how governments are quickly moving toward a voluntary social-distancing, nonlockdown strategy. This comes even after politicians and disease "experts" have been insisting that lockdowns must be imposed indefinitely until there's a vaccine .

The longer the lockdown-created economic destruction continues, the greater will be the threat of social unrest and even economic free fall. The political reality is thst the current situation cannot be sustained without threatening the regimes in power themselves. In an article for Foreign Policy titled " Sweden's Coronavirus Strategy Will Soon Be the World's ," authors Nils Karlson, Charlotta Stern, and Daniel B. Klein suggest that regimes will be forced to retreat to a Swedish model:

As the pain of national lockdowns grows intolerable and countries realize that managing -- rather than defeating -- the pandemic is the only realistic option, more and more of them will begin to open up. Smart social distancing to keep health-care systems from being overwhelmed, improved therapies for the afflicted, and better protections for at-risk groups can help reduce the human toll. But at the end of the day, increased -- and ultimately, herd -- immunity may be the only viable defense against the disease, so long as vulnerable groups are protected along the way. Whatever marks Sweden deserves for managing the pandemic, other nations are beginning to see that it is ahead of the curve.

[May 21, 2020] On the necessity and the duration of quarantine

May 21, 2020 | www.unz.com

likbez , says: Show Comment May 21, 2020 at 9:20 pm GMT

Hi The Kremlin Stooge,

Don't forget 'Covidiots'. The frontline-worker-lovin', government-narrative-believin' social-distance welcomin' simpletons are endlessly inventive when it comes to coining contemptuous nicknames for those who don't buy into their embrace of madness. I am happy to be able to say I thought the virus was bogus from the first, and said so to anyone who would listen.

That's too simplistic. You should agree that religious nuts who attend the church in large groups despite the risk can and should be called "Covidiots". Because they are. And the people who are trying to preserve their meager income generally should not.

Why religious nuts can't move to outdoors for the same purpose like first Chirstians did, is unclear to me ;-). Not sure about Orthodox Jews, which is pretty closed sect in any case so if they want to infect each other, be my guest.

The virus causes specific for it virus pneumonia which is no joke. People who recovered still have fibroses in this lungs of different degree. That's why people who were hospitalized with COVID-19 are ineligible to serve in US army. So for those unlucky who get virus pneumonia that's a crippling disease. You can't deny this.

For around 15-20% of people over 65 infected with COVID-19 it means the death sentence -- they will never recover and either die in hospital or soon after. Men over 65 are two third of those so for old men the risk can't be discounted.

So the question is what forms and length of quarantine was optimal, not whether it should or should not be enforced. I doubt that you want to argue that night clubs should remain open. Or that wearing masks in closed spaces is redundant (in open spaces they generally are redundant, unless you are standing in line, etc)

You also need some timeout to collect the vital information about the disease using first cases, enhance the protection of medical personnel, and access the level of actual risk to the population and the economy (the USA generally wasted it and Trump was inapt; so the effect of quarantine is more questionable for this particular country).

It was not that clear in March that the risk is generally low, although we can't deny that Fauci and Co were caught without pants (or, for some sinister reason were intended to be caught this way as if they waited until epidemic got to a certain point that masks something else )

That does not excuse incompetence of Trump administration and very strange behaviors of Fauci, who spent two months and then woke up and suddenly start crying Wolf, Wolf, but the USA is very mysterious country and in no way Canadians can understand it

[May 21, 2020] More than 80% of Americans support closing non-essential businesses. Support for limiting restaurants, closing schools, canceling sporting and entertainment events, and group gatherings exceeds 90%.

May 21, 2020 | www.moonofalabama.org

Richard Steven Hack , May 19 2020 6:47 utc | 111

The Argument Against the Argument Against Facemasks
Resistance rooted in liberty clashes with the unalienable right of life
https://tinyurl.com/yctjydmx

Masks help stop the spread of coronavirus – the science is simple and I'm one of 100 experts urging governors to require public mask-wearing
https://tinyurl.com/yah8orzo

THE STATE OF THE NATION: A 50-STATE COVID-19 SURVEYUSA, April 2020
https://tinyurl.com/yaf58h27

Key takeaways:


More than 80% of Americans support closing non-essential businesses. Support for limiting restaurants, closing schools, canceling sporting and entertainment events, and group gatherings exceeds 90%. A total of 94% strongly or somewhat approve asking people to stay home and avoid gathering in groups; 92% support canceling major sports and entertainment events; 91% approve closing K-12 schools; 91% approve limiting restaurants to carry-out only; 83% approve closing businesses other than grocery stores and pharmacies. There are some partisan differences on these items -- Republicans are somewhat less supportive, but even among Republicans large majorities support all of these measures; and, as summarized below, support is largely consistent across every state.

A bipartisan consensus opposes a rapid "reopening" of the economy. Only 7% support immediate reopening of the economy, and the median respondent supports waiting four to six weeks. There is a bipartisan consensus on waiting (89% of Republicans as compared to 96% of Democrats opposed immediate re-opening), and Republicans support a somewhat faster re-opening of the economy than Democrats, where the median Republican supports waiting two to four weeks versus median Democrat six to eight weeks. As discussed below, even in those Republican-led states which are moving toward re-opening, few people support reopening immediately
Generally, Americans report adhering to social distancing, indicating that they had minimal social interactions with people outside of their households. That said, 56% reported encountering at least one person from outside of their home in the preceding 24 hours (and 7% reported encountering 10 or more persons); the survey did not contain information on the circumstances of those encounters (e.g., was it at grocery stores? were the individuals wearing masks?). Generally, there were not large differences with respect to age, gender, race, income, partisanship or education. An exception was that Asian Americans were substantially less likely to encounter other individuals, and more likely to avoid contact with other people. There were significant racial differences reported in wearing face masks outside of the home, with 51% of whites reporting following recommendations very closely, along with 62% of Hispanics, 64% of African Americans, and 68% of Asian Americans. There was also an age gradient in this regard, ranging from 50% face mask wearing for 18-24 year olds to 60% of those aged 65 or higher. There were also partisan differences: 51% of Republicans, compared to 64% for Democrats, reported wearing face masks outside the home.

I find the racial differences interesting, especially since in my observation fewer blacks are wearing masks. However, since I was specifically looking at blacks (due to the disproportionate number of blacks dying) in my walks, I may have under counted the number of whites not wearing masks. Also I suspect it varies between cities, states and more suburban or rural areas.

In any event, not enough people are wearing masks to re-open the economy - and we damn sure don't have enough testing, tracing and isolating capability and probably won't until September, according to one report I read.

A number of other interesting results. Check it out.

[May 21, 2020] The most recent CDC COVID-19 mortality data

May 21, 2020 | www.moonofalabama.org

Don Bacon , May 19 2020 18:05 utc | 134

From the most recent CDC COVID-19 mortality data report, Feb 1 to May 16:
> US deaths 62,515 [which are inflated, and yet comparable to annual flu deaths]
> US deaths from all causes – 97% of expected deaths. [i.e. no 'excess' deaths] . . here
> The media currently reports 90,694 deaths which they get from Johns Hopkins. That's an organization which ought to be examined. CDC data is not used by the media, but CDC doesn't have a great record either:
> CDC estimates that, from October 1, 2019, through March 28, 2020, there have been 24,000 – 63,000 flu deaths . . here
> For 2017-2018, the CDC first estimated 80,000 flu deaths, then later reduced the estimate (their word) to 61,000.
> In the news now: San Diego County California public health first reported 194 Covid deaths out of a population of 3.3 million. After autopsies and testing of tissue, health department reported only 6 of the 194 actually died of Covid.
> Meanwhile the lives of millions of people of all ages have been adversely affected.
> But hey, the banks have more money.

[May 21, 2020] New York Times continues to prop up the vaccine hype

May 21, 2020 | www.moonofalabama.org

vk , May 21 2020 0:49 utc | 55

New York Times continues to prop up the vaccine hype:

Coronavirus Live Updates: Scientists See Progress in Path to Vaccine by Next Year

In addition to this Home Page highlight, there's an opinion piece as a side dish:

What to Expect When a Coronavirus Vaccine Finally Arrives

Buried a little bit more at the bottom, there's this borderline pseudoscientific, definitely reckless article:

Prototype Vaccine Protects Monkeys From Coronavirus

There is a statistical possibility a vaccine comes out next year. But his possibility is remote. The key here is that a vaccine must be tested to the exhaustion before being ok'd by any government for mass use. Any mistake can result in a number of deaths that will make this pandemic look like child's play. My opinion is that the NYT is feeding too much enthusiasm to its readers.

Circe , May 19 2020 12:05 utc | 119

The Moderna Vaccine the media is touting as a promising, miracle breakthrough that has only been tested on a limited group of 45 people, aged 18 to 55 has Grade 3 adverse effects in 100 and 250 microgram dosage.

So they're going to lower dosage to 50 micrograms and test it on the 56 to 70 and over 70 age groups. What about the group most Americans are in: the KFC, McDonald's, IHOP group?

[May 21, 2020] It is worth reminding of criticism of the untrustworthiness of modern medical science from the editors of some of the top medical journals

Notable quotes:
"... There are some who parrot Big Pharma vested interests in ridiculing and denigrating hydroxychloroquine, despite the very notable positive results several countries such as China, Russia, Iran and Turkey have had with it, while vainly spouting the benefits of smoking despite complete lack of quality research papers supporting it and abundant quality papers against. ..."
"... Research is not created equal. There is good research (some, not so much) and there is bad research (bundles of it), mostly funded by vested interests, who where necessary direct the desired results. In general, research from China and Russia arguably tends to be higher quality and more reliable because those countries place the emphasis on health for society, not on profits for the corporations. ..."
May 21, 2020 | www.moonofalabama.org

BM , May 20 2020 6:17 utc | 146

But with regard to anecdotal/unverified [touch'e] claims of nicotine benefits in covid, one should not reflexively ignore the evidence to the contrary that conflict with one's pro-nicotine bias/belief system:}
"Smokers more likely to express ACE2 protein that SARS-COV-2 uses to enter human cells"
"Tobacco smoking increases lung entry points for COVID-19 virus"
Posted by: gm | May 19 2020 16:13 utc | 129

Touché again gm!

It is indeed desperate grasping at straws to believe that smoking will protect against Covid-19 when far higher quality research clearly indicates increased risk from smoking that the disease will be more severe (the latter also being the more plausible result).

As I commented the last time B raised this issue, there is one genuine effect of a past history of smoking that statistically reduces risk of death from Covid-19 - namely smoking significantly reduces expected lifespan, and therefore reduces the risk of living long enough to reach the highest risk age groups for severe Covid-19. Alternatively expressed - smoking kills you off first before you get a chance to be killed by Covid, if that is what you want. Post-hoc nicotine patches at a late stage deny you even that advantage.

There are some who parrot Big Pharma vested interests in ridiculing and denigrating hydroxychloroquine, despite the very notable positive results several countries such as China, Russia, Iran and Turkey have had with it, while vainly spouting the benefits of smoking despite complete lack of quality research papers supporting it and abundant quality papers against.

At this point it is worth reminding of criticism of the untrustworthiness of modern medical science from the editors of some of the top medical journals:

Skeptical of medical science reports?

"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as editor of The New England Journal of Medicine"
Angell M. Drug Companies & Doctors: A Story of Corruption. The New York Review of Books magazine.

More recently, Richard Horton, editor of The Lancet, wrote that "The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness"
Horton R. Offline: What is medicine's 5 sigma? www.thelancet.com.

The first of these two commentaries on clinical research publications appeared in 2009, the second in April of this year. These statements are being taken seriously, coming as they do from the experiences of editors of two of the world's most prestigious medical journals. The first article showed how the relationships between pharmaceutical companies and academic physicians at prestigious universities impacted certain drug-related publications and the marketing of prescription drugs. Potential conflicts of interest seemed to abound: millions of dollars in consulting and speaking fees to physicians who promoted specific drugs, public research dollars being used by a researcher to test a drug owned by a company in which the researcher held millions of dollars in shares, failure of university researchers to disclose income from drug companies, company subsidies to physician continuing education, publishing practice guidelines involving drugs in which the authors have a financial interest, using influential physicians to promote drugs for unapproved uses, bias in favor of a product coming from failure to publish negative results and repeated publication of positive results in different forms. The author, Marcia Angell, cited the case of a drug giant that had to agree to settle charges that it deliberately withheld evidence that its top-selling anti-depressant was ineffective and could be harmful to certain age groups. ...

Richard Horton's statement was part of his comments on a recent symposium on reliability and reproducibility of research in the biomedical sciences and addresses a broader area of concern. Some of the problems he identified are seen in the veterinary literature. They include inadequate number of subjects in the study, poor study design, and potential conflicts of interest. He notes that the quest for journal impact factor is fuelling competition for publication in a few high reputation journals. He warns that "our love of 'significance' pollutes the literature with many a statistical fairy-tale" ...

Research is not created equal. There is good research (some, not so much) and there is bad research (bundles of it), mostly funded by vested interests, who where necessary direct the desired results. In general, research from China and Russia arguably tends to be higher quality and more reliable because those countries place the emphasis on health for society, not on profits for the corporations.

@Flatulus @16 "sources"
Christian Drosten, chief virologist Charité Berlin in his podcast no 31. Available with transcript here.
Posted by: b | May 18 2020 16:42 utc | 32

B, have you looked into the Big Pharma vested interests of Drosten yet? I suggest you do so.

[May 20, 2020] Adding insult to injury Spike in Covid-19 robocalls fraud

Few things can be more annoying than answering the phone while you're in the middle of something -- and then being greeted by a recording. If you receive a robocall trying to sell you something (and you haven't given the caller your written permission), it's an illegal call. You should hang up. Then, file a complaint with the FTC and the National Do Not Call Registry.
May 20, 2020 | www.rt.com

From phony positive Covid-19 test results to deceptive offers of financial relief, robocalls have proliferated amid the pandemic, separating Americans from millions of precious dollars at a time when few can afford to lose money.

One particularly nasty scam sees the target receive a text or phone call warning them they've been exposed to the virus, tricking them into providing personal information while in a state of panic. Another cruel variant dangles the possibility of virus-related financial relief if they just give up their bank account details or wire the scammer a small " fee " – a tempting prospect at a time when half of American workers are unlikely to see a paycheck this month and upwards of 36 million have filed for unemployment since the pandemic began. Phony treatments – in which the target orders a miracle cure, only to never receive it – comprise some 22 percent of coronavirus-related robocalls, making them the most common pandemic scam.

Even those who haven't been personally scammed by a robocaller have experienced stress because of them, Provision found; 70 percent of millennials are concerned a parent or grandparent will be preyed upon by the automated scammers, who frequently impersonate government authorities like the Social Security Administration or the Internal Revenue Service in order to con their targets out of bank account information or other personal data. In fact, nearly two in five robocalls (39 percent) claim to be the SSA, with 38 percent impersonating the IRS and 33 percent pretending to be debt collectors.

The Covid-19 scams are apparently quite effective, robbing Americans of over $13.4 million of their hard-earned cash in the first three months of 2020 alone, according to the Federal Trade Commission. That number doesn't include scams that haven't been discovered by their victims, or those that go unreported to the FTC – meaning the real figure is likely much higher.

[May 20, 2020] Beware of fake contact tracers, N.J. officials warn

May 20, 2020 | www.nytimes.com

Beware of fake contact tracers, N.J. officials warn.

New Jersey officials warned residents on Wednesday to be wary of fraudsters identifying themselves as contact tracers in order to obtain financial information.

In recent weeks, as health departments have hired legitimate tracers to track the spread of the coronavirus, fake tracers have been sending people text messages looking for insurance information and bank account and social security numbers, said Judith Persichilli, the state health commissioner.

Real contact tracers do not ask for such things, the state said.

A legitimate tracer will call, identify themselves as part of a local health department, and explain to the person on the phone that they may have come into contact with someone who tested positive for the virus.

Scams around the virus, unemployment benefits and stimulus checks have proliferated nationwide , the authorities say.

Gov. Philip D. Murphy said "there is a special place in hell" for people who would scam others during the pandemic.

Mr. Murphy also reported the state's daily virus fatalities: 168, bringing the overall death toll to 10,747.

[May 20, 2020] Due to Coronavirus the Grim Reaper was deprived of his seasonally adjusted mortality quota missing 21K in 12 weeks by David Stockman

Highly recommended!
Apr 28, 2020 | ronpaulinstitute.org

According to the CDC's long established mortality models, 687,000 Americans were supposed to die during the 12 weeks between February 1 and April 18.

But only 666,000 actually complied. So the Grim Reaper was deprived of his seasonally adjusted mortality quota, even as 21,000 families were spared, at least temporarily, of the loss and grief which accompanies the passing of a loved one.

Either way, how in the hell does that square with Lockdown Nation -- an unprecedented government ordered economic heart attack purportedly designed to prevent a Black Plague of illness and death?

To be sure, a better than garden variety recession was already due after a record 129- month long business expansion. But it was the sudden, virulent eruption of the Covid Death Hysteria in the halls of government that turned a scheduled business cycle contraction into a monumental catastrophe.

[May 20, 2020] Breakthrough South Korean Study Finds Recovered COVID Patients Who Test Positive Aren't Infectious

May 19, 2020 | www.zerohedge.com
In what appears to be yet another strike against public officials like LA County's Barbara Ferrer - that is, Democrats and others who insist that lockdowns should continue perhaps until a vaccine has been discovered and that police should punish anyone who dares violate these orders - a study from the Korean Centers for Disease Control and Prevention has found that patients who test positive for COVID-19 after recovering from the illness appear to be shedding dead copies of the virus. That would suggest that these patients are not infectious, the scientists said, which helped dispel fears that some patients can remain infectious for months after being infected. While the study doesn't answer every question about the virus's longevity - such as patients who almost appear to have developed a "chronic" form of the illness because their symptoms have persisted for so long.

But still, the finding was greeted as a major relief, and, if anything, should encourage economies to reopen more quickly, as a potential trigger for reinfection that had panicked some experts appears to be a non-issue.

The research also undermines the reliability of 'antibody' tests like the ones NY Gov Andrew Cuomo insisted would be 'critical' for NY's reopening.

The results mean health authorities in South Korea will no longer consider people infectious after recovering from the illness. Research last month showed that so-called PCR tests for the coronavirus's nucleic acid can't distinguish between dead and viable virus particles, potentially giving the wrong impression that someone who tests positive for the virus remains infectious.

The research may also aid in the debate over antibody tests, which look for markers in the blood that indicate exposure to the novel coronavirus. Experts believe antibodies probably convey some level of protection against the virus, but they don't have any solid proof yet. Nor do they know how long any immunity may last.

A recent study in Singapore showed that recovered patients from severe acute respiratory syndrome, or SARS, are found to have "significant levels of neutralizing antibodies" nine to 17 years after initial infection, according to researchers including Danielle E. Anderson of Duke-NUS Medical School.

Other scientists have found higher levels of IgM, an antibody that appears in response to exposure to an antigen, in children, according to an article published on medRxiv. That suggests younger populations have the potential to produce a more potent defense against Covid-19. The study has not been certified by peer review.

Bloomberg offers a succinct review of some of the research into the infectious qualities of the virus, and the efficacy of antibodies in keeping patients safe from reinfection. As BBG shows, studies of SARS, which is related to the virus that causes COVID-19, suggest that antibodies keep patients safe for years, undermining warnings about a possible second wave, or worries that the virus might become endemic, which were recently raised by the WHO.

The research may also aid in the debate over antibody tests, which look for markers in the blood that indicate exposure to the novel coronavirus. Experts believe antibodies probably convey some level of protection against the virus, but they don't have any solid proof yet.

Nor do they know how long any immunity may last.

A recent study in Singapore showed that recovered patients from severe acute respiratory syndrome, or SARS, are found to have "significant levels of neutralizing antibodies" nine to 17 years after initial infection, according to researchers including Danielle E. Anderson of Duke-NUS Medical School.

Other scientists have found higher levels of IgM, an antibody that appears in response to exposure to an antigen, in children, according to an article published on medRxiv. That suggests younger populations have the potential to produce a more potent defense against Covid-19. The study has not been certified by peer review.

The study's findings are apparently convincing enough for South Korean health authorities to no longer require patients to be re-tested after they've recovered from COVID-19 and all symptoms have subsided.

As a result of the findings in the South Korea study, authorities said that under revised protocols, people should no longer be required to test negative for the virus before returning to work or school after they have recovered from their illness and completed their period of isolation.

"Under the new protocols, no additional tests are required for cases that have been discharged from isolation," the Korean CDC said in a report. The agency said it will now refer to "re-positive" cases as "PCR re-detected after discharge from isolation."

Some coronavirus patients have tested positive again for the virus up to 82 days after becoming infected. Almost all of the cases for which blood tests were taken had antibodies against the virus.

If nothing else, this study is just the latest reminder of how much we don't know about the virus.

[May 20, 2020] Here's a source of excellent n95 masks. They are 3m 8210 PLUS

May 20, 2020 | www.unz.com

Alden , says: Show Comment May 10, 2020 at 2:53 pm GMT

@Al t from wood like cherry and walnut Unlike the medical masks with the 3 flapping edges, dust doesn't come in through the seal.

The medical masks are 6 inch long rectangles that are open at the bottom and 2 sides. According to the 2 Drs I saw , they're useless for preventing germs and viruses coming in.

The 3m 8210 PLUS n95 masks work to keep the finest softest dust out if you think you need a mask. And you can use them for days if you're not sanding and using dangerous materials.

The only reason I looked at was after I used a really strong toxic paint stripper all day long. The stripper was orange. I saw that the outside of the mask was orange from the fumes. But the inside was still white, no orange. So that mask prevented the fumes going through to my nose and mouth.

[May 20, 2020] Men's Blood Contains High Levels of Enzyme That Helps COVID-19 Infect Cells Study

May 20, 2020 | www.unz.com

vot tak , says: Show Comment May 12, 2020 at 12:22 am GMT

Men's Blood Contains High Levels of Enzyme That Helps COVID-19 Infect Cells – Study

https://sputniknews.com/science/202005111079275898-mens-blood-contains-high-levels-of-enzyme-that-helps-covid-19-infect-cells -- study/

"A new study published in the European Heart Journal on Monday has provided scientific evidence that men have higher concentrations of ACE2 in their blood than women. ACE2, which is found in organs such as the heart, kidney, intestines and others, is the receptor required for cellular entry of SARS-CoV-2, the virus that causes COVID-19.

While the ACE2 receptor is normally helpful to the human body, as it stabilizes one's blood pressure and regulates blood vessel dilation, it is also the target of SARS-CoV-2's spike protein. Once the spike protein has attached itself to the receptor, the novel coronavirus is able to invade the human cell and infect an individual.

"When we found that one of the strongest biomarkers, ACE2, was much higher in men than in women, I realised that this had the potential to explain why men were more likely to die from COVID-19 than women," said Iziah Sama, a doctor at University Medical Center (UMC) Groningen who co-led the study.

Findings from the recent study further advanced scientists' presumption that the ACE2 is a key component to how COVID-19, the respiratory disease caused by the novel coronavirus, creeps to the lungs.

"ACE2 is a receptor on the surface of cells. It binds to the coronavirus and allows it to enter and infect healthy cells after it has been modified by another protein on the surface of the cell, called TMPRSS2," explained Dr. Adriaan Voors, a professor of cardiology at UMC Groningen who led the study. "High levels of ACE2 are present in the lungs and, therefore, it is thought to play a crucial role in the progression of lung disorders related to COVID-19."

The study, which relied on blood samples from several thousand participants, also found that heart failure patients prescribed drugs that target the renin-angiotensin-aldosterone system, like angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), did not have higher concentrations of ACE2 in their blood.

"ACE inhibitors and ARBs are widely prescribed to patients with congestive heart failure, diabetes or kidney disease," Reuters noted.

"Our findings do not support the discontinuation of these drugs in COVID-19 patients as has been suggested by earlier reports," explained Voors."

[May 20, 2020] If 20% recovered enough for herd immunity?

May 20, 2020 | www.unz.com

Alfred , says: Show Comment May 9, 2020 at 3:29 pm GMT

@KA From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the H1N1pdm09 virus

This is interesting.

The population of the USA in 2010 was 308 million. The number of infected was 60.8 million. That suggests that herd immunity was reached when 19.7% of the population was infected.

That magical number of 20% has been repeated by me in a number of comments here. I don't claim to have originated it.

[May 20, 2020] There are several papers on pubmed suggesting the use of doxycycline to treat COVID-19

May 20, 2020 | www.unz.com

Harold Smith , says: Show Comment May 6, 2020 at 9:15 pm GMT

@Anon Speaking of antibiotics, there are several papers on pubmed suggesting the use of doxycycline to treat COVID-19 (and the ARB drug telmisartan is apparently another off-the-shelf treatment possibility).

In silico modeling shows that doxycycline might inhibit SARS-CoV-2 PLpro and 3CLpro; plus it has an anti-inflammatory effect. Doxy is highly bioavailable and crosses the blood brain barrier.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102550/

Apparently some clinical trials with doxycycline for COVID-19 are in the works.

https://clinicaltrials.gov/ct2/show/NCT04371952

[May 19, 2020] Politics is altering clinical practice.

May 19, 2020 | www.moonofalabama.org

oldhippie , May 18 2020 18:15 utc | 48

Analysis begins with close reading.

The BMJ article in top post refers to mild and moderate cases. All cases are hospitalized cases. What exactly does it mean to hospitalize a mild case? Is that standard practice for covid? The article has some discussion on this point but it basically makes no sense. Patients excluded from study does not begin to include all those who would ordinarily be contraindicated for HCQ. Then dosages of 1200mg per day to start are flat twice what is recommended by Raoult. After 3 days dosage cut to 800mg, which is still high. Dosage continued for two to three weeks where others would end after ten days.

The Economist article from top post is so badly in need of basic copy editing it just makes no sense at all. Perhaps the publication has given up on editing since that interferes with the constant right wing propaganda onslaught. Currently owned by Rothschilds.

I could give some notes here on actual clinical practice as given to me by those treating patients but old friends and HIPPAA have a lot of conflicts. Suffice it to say that politics is altering clinical practice. Which reminds of the article above about Utah. Utah is a theocracy. A theocracy of cranks and cultists. No, that does not mix with science.

If this comment is not yet suitable for deletion some notes on the pandemic as seen from Cook County (Chicago). The current case count is up to 62,000, deaths nearing 3000. There is no panic in the streets. A heavy blanket of fear uncertainty and doubt covers the city, there is no panic. More than 1% of the population is supposedly positive but everyone is asking each other "Do you know anyone who is sick? Do you know anyone positive?" And most do not know a soul who is sick. Fatalities I know of are in NYC. Most lack even that sort of connection. One friend lives in zip 60639 where 2-1/2% of residents are positive and he hasn't heard a thing from neighbors. Supposedly there is a cluster of six deaths centered right around his house (neighborhood of single-family residences) and no one is talking about it

Finally I do personally know a case. Our mailman had it. Postal employees can be tested, most of us still can't. He was sick ten days. First retest at two weeks showed positive even though he felt fine.Second retest at three weeks was negative, immediately allowed to return to work. Wife and daughter also got sick, also recovered easily. No tests available for them so no stats. No medical treatment but stay home and rest. On his own he took high doses of Vitamin C plus some zinc, but he does that for any cold or flu. After discussing symptoms with him am fairly certain that my wife and I had it back in January but will never know for sure. An antibody test would be interesting and even helpful at this point, no expectation one will ever be offered.

[May 19, 2020] Does COVID-19 attack hemoglobin cells?

May 19, 2020 | www.moonofalabama.org

karlof1 , May 18 2020 22:57 utc | 85

What if the virus causing COVID-19 is first doing great injury to hemoglobin which then allows bacteriological infections to do their work? People are showing hypoxia, not all, just what become the worst cases. Those factors are part of an hypothesis developed by Dr. Zach Bush, a physician specializing in internal medicine, endocrinology and hospice care, that gets presented during this 1 hour 20 minute interview that covers more than just the COVID-19 issue. When finished, you'll have a completely different appreciation for the term Environmental Science.

[May 19, 2020] A team of doctors in Bangladesh claims success in treating patients with COVID-19 using doxycycline and ivermectin:

May 19, 2020 | www.moonofalabama.org

Jen , May 19 2020 2:59 utc | 104

A team of doctors in Bangladesh claims success in treating patients with COVID-19 using doxycycline and ivermectin:

Kamal Kant Kohli, "Doxycycline And Ivermectin Combo May Be New Effective Covid 19 Treatment"

Doxycycline is an anti-malarial drug that was patented in 1957, became commercial in 1967 and is now a generic drug. Ivermectin , used to treat parasitic infestations, is available in the US as a generic prescription drug. Both drugs do have side effects. It will be interesting to see if either drug gets much attention in the global press beyond the medical literature if the Bangladeshi doctors continue to have success in treating their patients.

Jim , May 19 2020 3:28 utc | 106

https://www.evms.edu/media/evms_public/departments/internal_medicine/Marik-Covid-Protocol-Summary.pdf

Eastern Virginia Medical school covid treament protocol
Pretty recent update (may 14th)

[May 18, 2020] Donald Trump says Americans won't stand for stay-at-home orders anymore

May 18, 2020 | www.washingtontimes.com

me name=

President Trump said Wednesday the coronavirus crisis is worse than the 9/11 terrorist attacks, and Americans won't allow it to go on any longer.

"I don't think people will stand for it," Mr. Trump told reporters in the Oval Office. "The country won't stand for it. It's not sustainable."

He said the pandemic "is worse than Pearl Harbor."

...Asked about soaring unemployment being a potential liability for him in an election year, the president replied, "Nobody's blaming me for that. I built the greatest economy and I'm going to rebuild it again. This was an artificially induced unemployment."

[May 16, 2020] FDA Halts Bill Gates-Backed COVID-19 Testing Program

Notable quotes:
"... SCAN is backed by The Bill and Melinda Gates Foundation and the University of Washington Medicine. The testing program was sending free test kits to participants' homes in the Seattle Metropolitan Area, with the goal of testing people in the region to get a sense of how the virus was spreading through the community. ..."
May 16, 2020 | www.zerohedge.com

About a month after Bill Gates criticized President Trump's decision to suspend funding to the World Health Organization (WHO), the federal government has just halted a Seattle-based COVID-19 testing program backed by Gates.

What are the odds, right?

"Please discontinue patient testing and return of diagnostic results to patients until proper authorization is obtained," the Food & Drug Administration (FDA) wrote in a memo, addressed to the Seattle Coronavirus Assessment Network (SCAN), according to The New York Times .

SCAN posted an update on its website on Thursday (May 14) describing how the FDA had asked it to "pause" testing while it receives further guidance on new procedures for its COVID-19 test kits that collect samples at home.

The FDA "recently clarified its guidance for home-based, self-collected samples to test for COVID-19. We have been notified that a separate federal emergency use authorization (EUA) is required to return results for self-collected tests," the post read.

"The FDA has not raised any concerns regarding the safety and accuracy of SCAN's test, but we have been asked to pause testing until we receive that additional authorization."

An FDA spokesperson told The Times, the home collection test kits raised some concerns about "safety and accuracy that required the agency's review."

The issue in the Seattle case appears to be that the test results are being used not only by researchers for surveillance of the virus in the community but that the results are also being returned to patients to inform them.

The two kinds of testing — surveillance and diagnostic — fall under different F.D.A. standards. In a pure surveillance study, the researchers may keep the results just for themselves. But coronavirus testing has largely revolved around getting results returned to doctors who can share the results with patients.

"We had previously understood that SCAN was being conducted as a surveillance study," the spokesperson said.

SCAN is backed by The Bill and Melinda Gates Foundation and the University of Washington Medicine. The testing program was sending free test kits to participants' homes in the Seattle Metropolitan Area, with the goal of testing people in the region to get a sense of how the virus was spreading through the community.

[May 16, 2020] Side effect of untested vassine can be crippling

May 16, 2020 | www.moonofalabama.org

juliania , May 16 2020 13:41 utc | 88

As there have been some comments relating to the development of a vaccine against the virus, I made a search this morning relating to the Bill and Melinda Gates foundation's record in funding such developments. I tried to stay away from the articles that seemed to be inflammatory but did find this article dated today at indianexpress.com: "Can't penalise US NGO for violating drug trial norms" related to a previous drug trial involvement of the foundation. Here are the opening paragraphs:
The NDA government Friday told the Supreme Court that no specific penalties could be imposed on the Bill and Melinda Gates Foundation-funded Programme for Appropriate Technology in Health (PATH) for violating norms in conducting the vaccination trials on tribal girls in Andhra Pradesh and Gujarat.

Pointing out that the current legal regime had no provision of penalties, the Ministry of Health and Family Welfare has expressed its inability to proceed against the NGO PATH despite a parliamentary panel recommending strict actions.

The article would seem to advise caution in urging such trials on the part of the US government with respect to a vaccine for the covid virus, as they also have taken place in other countries, with unforseen complications for some of the participants. It is often the case that strong medicinal remedies are available to poor people on a trial basis. These days I'm remembering the John Le Carre novel, "The Constant Gardener". If my library were open I'd be rereading it.

The old saying 'haste makes waste' needs to be kept in mind.

Trailer Trash , May 16 2020 14:25 utc | 96

> I made a search this morning relating to the Bill and Melinda Gates
>Posted by: juliania | May 16 2020 13:41 utc | 88

Thank you for this. I've been wondering about the noise swirling around Gates and vaccine shenanigans and how much of it is true. I would not be surprised to learn that he really did harm many people with his PATH project.

It's well understood in the computer industry that Gates was an abusive bully to his employees while wrecking every company he crossed paths with, whether they were the competition or a partner. No reason to think it would be different with his new projects.

I'll take my chances with the evil virus before I'll take a dose of a Gates' vaccine.

[May 16, 2020] Any drugs out of patent will be discredited by big pharma lobbyists. It seems a number of drugs do have an impact on the covid-19 set of symptoms.

May 16, 2020 | www.moonofalabama.org

Peter AU1 , May 16 2020 11:18 utc | 73

Any drugs out of patent will be discredited by big pharma lobbyists. It seems a number of drugs do have an impact on the covid-19 set of symptoms.

At one point in time, I was diagnosed with 'chronic fatigue syndrome'. It is a bullshit diagnosis, basically the scrap heap for undiagnosed disease. I looked up research on the subject at the the time. There was a couple of interesting contrasts.

One research project simply took in a mob that had been diagnosed with chronic fatigue syndrome, and of course found nothing in various trials.

Another project took in a cohort with exactly the same symptoms, and found that a pathogen was indeed causing their problems.

A number of drugs on anecdotal evidence (and perhaps the observations of Chinese doctors unencombered by lobbyists are anecdotal) do help certain patients.
Each drug may not be a cure all for all people with COVID-19, but it seems these do help various patients depending on their symptoms and the way the virus is attacking them.

With that in mind, I would be keeping an eye on China rather than US big pharma.
Big pharma may well come up with a you beaut cure all, but in the mean time I would be looking at doctors unencombered by big pharma for something that will help.


BM , May 16 2020 13:59 utc | 91

WaPo: Drug promoted by Trump as coronavirus 'game changer' increasingly linked to deaths
Posted by: b | May 16 2020 9:39 utc | 61

b,
do you have any conception of the lobbying methods used by Big Pharma?
Do you have any conception of the financial clout they have available for protecting their interests?
Do you have any conceptions of the influence they have, of the revolving doors between Big Pharma, pharmaceutical regulatory bodies, medical schools and every single level of the medical industry?
Do you have any conception of the way pharmaceutical registration works, and of the corrupt and fraudulent practices used to obtain authorisation for drugs?

It is one gigantic spaghetti pot of corruption and deception. Boeing/FAA is miniscule and almost angelic by comparison (and far less deadly also).


Coincidentally I have direct first-hand experience of both sides of the activities of Big Pharma concerning one specific highly effective cancer drug that the world's biggest Pharma corporations have tried for the last 40 years to eradicate (finally almost successful by 2014, unfortunately). I have direct first-hand experience of the highest praise they share amongst their own top elites of the efficacy of that competitor's medicine against all known types of cancer. I also have close 2nd hand inside knowledge of their efforts to purchase the patents for that same medicine for vast sums of money. I also personally know the proprietor and developer of that same medicine, and have witnessed and experienced first hand some of the fraudulent and criminal methods Big Pharma have used non-stop for 40 years to try to force my friend out of business, together with the lies and deception they have used publicly falsely alleging its "danger" and "inefficacy", together even with using police to illegally force parents to stop using it for their seriously ill children who had already dramatically benefited from its use, and forcing doctors to stop using it for treatment. I also have extensive 2nd hand knowledge of their activities to that effect, and have good reason to believe they are true. I have also used that medicine myself, to great effect, and closely know a medical practice which has used it with considerable medical success, and of the coercion they also experienced not to use it.

The way the Western medical establishment has handled the question of the use of chloroquine and closely related drugs for Covid-19 is in every single respect and at every level 100% typical of Big Pharma disinformation projects .

The very fact that the US medical establishment approved use of hydroxychloroquine under specific conditions that ensure it is used exclusively at a very late stage after the virus has ceased to replicate guarantees that all or almost all major Western hydroxychloroquine trials will be negative - because it is a specific and known requirement of hydroxychloroquine therapy that the therapy is conducted early whilst the virus is stil replicating - later it is known to be useless. The approval of its use under such conditions is the specific result of Big Pharma influence . That is how they operate all the time.

Big Pharma is no more honest about either the safety or the efficacity of its products than are the White Helmets about their activities in Syria. Many of the most dangerous drugs sold by the biggest companies are approved on the basis of very small, improperly balanced trials, sometimes fraudulently conducted. Trials which give the wrong result are routinely hidden. Research on toxicity and dangerous side-effects are routinely inadequate, frequently fraudulent or knowingly misleading, and legal requirements for drug authorisations are frequently waived on the basis of influence campaigns. This is especially so for new chemotherapy drugs, which are intrinsically highly toxic and are normally used at very close to the fatal dose. There is no level playing field at all, quite the contrary.

Big Pharma do not profit from cures - they profit from selling very expensive drugs, and they are far more ruthless than the White Helmets in destroying any potential threat to their profits. There is no more effective threat to the World-View of Big Pharma - as I know from first hand experience - than effective cures, especially where they are cheap and unpatentable, or the patents are owned outside the cabal. Any such cure must be destroyed at all costs.

Several of the Big Pharma companies in recent years have been given multi-billion dollar fines for the fraud and subversion they have utilised in obtaining authorisation for drugs which are dangerous to the patient, and for their marketing of drugs known to be dangerous.

The patent for chloroquine and its derivatives has expired. It has been widely used for many years, its hazards and limitations are thoroughly documented, and it is in this respect - under proper supervision with respect to its known hazards and limitations and qualified by them - incomparably safer than any new and barely tested pharmaceutical drug or vaccine such as Remdesivir. It is cheaply produced around the world. Therefore, no full-scale well-controlled randomised clinical trial of hydroxychloroquine treatment for Covid-19 will ever be conducted in a major Western country. Big Pharma will ensure that.

BM , May 16 2020 16:24 utc | 112
One does have to wonder whether it is simply a matter that the difficulty in the US concerning early diagnosis is the real problem that makes use of the drug impractical here. Perhaps we just don't have the resources, teams of testers and physicians and nurses, for the accuracy and careful monitoring of patients in early stage infection required when using this drug.
Posted by: juliania | May 16 2020 15:17 utc | 103

I'm afraid it's not anything to do with early diagnosis, it is only about profit. As Blue Dotterel said, it is about profit, not curing patients. For Big Pharma the very last thing they want is for the patient to be cured - a dead patient is far more profitable. No wonder Gilead holds the more promising GS-441524 off the market, because they can make more profit from a more expensive useless drug that will be in patent for far longer.

Big Pharma expects to make many trillions of dollars profit per year on Covid-19, as they do on cancer. The more Covid cases, the more profits. The less effective the efforts to reduce infections, the more profits. The less availability of PPE, the more profits. The more chaotic and irrational the government policies, the more profit. Big Pharma profits at every step.

They will stop at nothing to block proper trials of hydroxychloroquine - including bribery, coercion, and sabotage, not just massive disinformation. They will spend billions just to block
proper trials, using myriad different methods of subterfuge and subversion. That is just small change compared to the profits they want and expect.

The entire philosophy of Western medicine is a dying patient - it is corrupt, it is dishonest, its entire foundations are fraudulent. There is an urgent need for a whole new paradigm for medicine that is based on maximising the health of society, not on maximising profit.

There is a story I heard on television several decades ago - I think it was true, but I am not certain - about an old Chinese tradition. Villagers would pay a regular monthly fee to the doctor, as long as they stay healthy. As soon as they fall sick they stop paying, and the doctor has to cure them (without charge). Only when they get better will they resume the normal regular payments. Think about it, what is the best interest of the doctor towards his patient? He has an investment in their good health. Now compare the Western system. What interest does the doctor have in the patient's health? If the patient is sick for 4 times as long and then dies, is the doctor richer or poorer? If the doctor gives drugs with side effects, which need more drugs against the side effects, will he be richer or poorer? If there are two drugs available, one cheap, one expensive, which one does the doctor prefer?

Think about it Juliana, the last time you went to a hospital, how much did it cost? How many useless medicines did the doctor give you, versus how many basic essential medicines?

Western medicine is a big scam. It is a business. The second biggest business in the world after war.

That is why I reject Western medicine. For 20 years I have used only non-Western medicine.

[May 16, 2020] WaPo: for a certain type of patients hydroxychloroquine promoted by Trump as coronavirus 'game changer' increasingly linked to deaths

May 16, 2020 | www.moonofalabama.org

b , May 16 2020 9:39 utc | 61

@fairleft

You want to continue to promote Trump's wonder medicine? Than leave this place and go elsewhere.

You are obviously not well informed about the issue anyway.

WaPo: Drug promoted by Trump as coronavirus 'game changer' increasingly linked to deaths

Clinical trials, academic research and scientific analysis indicate that the danger of the Trump-backed drug is a significantly increased risk of death for certain patients. Evidence showing the effectiveness of hydroxychloroquine in treating covid-19 has been scant. Those two developments pushed the Food and Drug Administration to warn against the use of hydroxychloroquine outside of a hospital setting last month, just weeks after it approved an emergency use authorization for the drug.

Alarmed by a growing cache of data linking the anti-malaria drug to serious cardiac problems, some drug safety experts are now calling for even more forceful action by the government to discourage its use. Several have called for the FDA to revoke its emergency use authorization, given hydroxychloroquine's documented risks.

"They should say, 'We know there are harms, and until we know the benefits, let's hold off,' " said Joseph Ross, a professor of medicine and public health at Yale University, who added that the original authorization may have been warranted but new evidence has emerged about the drug's risks.

"I'm surprised it hasn't been revoked yet," said Luciana Borio, who served as director for medical and biodefense preparedness of the National Security Council and was acting chief scientist at the FDA.
...
Yogen Kanthi, assistant professor in the division of cardiovascular medicine at the University of Michigan, said that it has been clear that the combination of hydroxychloroquine and azithromycin -- used to treat bacterial infections -- could lead to cardiac arrhythmias, which cause the heart to beat irregularly or too fast or slow. Many patients hospitalized for covid-19 had underlying cardiovascular disease that put them at higher risk for arrhythmias, "so it shouldn't be surprising we saw an increase in death," he said.
AD

"The question has been answered that if you have the infection and it's significant enough to be in the hospital, the drug doesn't seem to do anything for you," he said. "It may be the horse is out of the barn."

Many hospitals have stopped using the drug outside of clinical trials.

"We no longer are keeping large quantities and have returned most of it," said Nishaminy Kasbekar, director of pharmacy for the Penn Presbyterian Medical Center in Philadelphia. "I think they should revoke the EUA because clearly based on the data it is no longer considered a treatment for covid."
...
A study of Veterans Affairs patients hospitalized with the coronavirus found no benefit and higher death rates among those taking hydroxychloroquine, researchers said last month.

More than 27 percent of patients treated with hydroxychloroquine died, and 22 percent of those treated with the combination therapy died, compared with an 11.4 percent death rate in those not treated with the drugs, the study said.


fairleft , May 16 2020 13:13 utc | 82

Posted by: b | May 16 2020 9:39 utc | 61

This is what I thought, you've been damaged by Trump Derangent Syndrome (TDS), so you insult with a childish phrase like "Trump's wonder medicine." You actually erased a medical doctor's respectful and evidence-laden disagreement with your 'line'. In any case, I'm not participating in the childish Trump/antiTrump, pro-hydroxychloroquine/anti-hydroxychloroquine, pro-lockdown/anti-lockdown discourse. The evidence is split on all of these issues. You cite your evidence, those who disagree with you cite theirs. Believe it or not, neither side in the disagreement are demons.

I don't have a strong opinion on Hydroxychloroquine, but it's just that it had been widely and uncontroversially used in China from early on in the fight against Covid-19. Then, after Trump mentioned it positively, it became controversial. A classic TDS timeline doesn't mean anything factually, but it naturally raises a rational person's skepticism about the extremely negative claims suddenly appearing in places like the Washington Post and other classic TDS places. I'm not expert enough to weigh the evidence, and neither are you, b, but even a brief internet search shows China-produced scientific studies of Hydroxychloroquine showing positive results:

Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial
https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v3

"But for TTCR, the body temperature recovery time and the cough remission time were significantly shortened in the HCQ treatment group. Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 31) compared with the control group (54.8%, 17 of 31)."

Chinese study finds hydroxychloroquine useful in controlling Covid mortality

"The mortality rate in the HCQ group stood at 18.8 percent against 43.5 percent in the non-HCQ group, the study noted.

"'Hydroxychloroquine treatment is significantly associated with a decreased mortality in critically-ill Covid-19 patients,' the researchers wrote. ...

"The Chinese researchers, however, also suggest that despite their findings, the randomized double-blind-control study was needed to provide stronger evidence."

So there is evidence on both sides, as contributors more expert than you or me have told you repeatedly. Non-experts don't know who's right, or if this disagreement will reach some nuanced "you're both partly right" conclusion. I will humbly continue to be open to both sides of the argument. Get well soon from TDS, b.

BM , May 16 2020 13:59 utc | 91
WaPo: Drug promoted by Trump as coronavirus 'game changer' increasingly linked to deaths
Posted by: b | May 16 2020 9:39 utc | 61

b,
do you have any conception of the lobbying methods used by Big Pharma?
Do you have any conception of the financial clout they have available for protecting their interests?
Do you have any conceptions of the influence they have, of the revolving doors between Big Pharma, pharmaceutical regulatory bodies, medical schools and every single level of the medical industry?
Do you have any conception of the way pharmaceutical registration works, and of the corrupt and fraudulent practices used to obtain authorisation for drugs?

It is one gigantic spaghetti pot of corruption and deception. Boeing/FAA is miniscule and almost angelic by comparison (and far less deadly also).


Coincidentally I have direct first-hand experience of both sides of the activities of Big Pharma concerning one specific highly effective cancer drug that the world's biggest Pharma corporations have tried for the last 40 years to eradicate (finally almost successful by 2014, unfortunately). I have direct first-hand experience of the highest praise they share amongst their own top elites of the efficacy of that competitor's medicine against all known types of cancer. I also have close 2nd hand inside knowledge of their efforts to purchase the patents for that same medicine for vast sums of money. I also personally know the proprietor and developer of that same medicine, and have witnessed and experienced first hand some of the fraudulent and criminal methods Big Pharma have used non-stop for 40 years to try to force my friend out of business, together with the lies and deception they have used publicly falsely alleging its "danger" and "inefficacy", together even with using police to illegally force parents to stop using it for their seriously ill children who had already dramatically benefited from its use, and forcing doctors to stop using it for treatment. I also have extensive 2nd hand knowledge of their activities to that effect, and have good reason to believe they are true. I have also used that medicine myself, to great effect, and closely know a medical practice which has used it with considerable medical success, and of the coercion they also experienced not to use it.

The way the Western medical establishment has handled the question of the use of chloroquine and closely related drugs for Covid-19 is in every single respect and at every level 100% typical of Big Pharma disinformation projects .

The very fact that the US medical establishment approved use of hydroxychloroquine under specific conditions that ensure it is used exclusively at a very late stage after the virus has ceased to replicate guarantees that all or almost all major Western hydroxychloroquine trials will be negative - because it is a specific and known requirement of hydroxychloroquine therapy that the therapy is conducted early whilst the virus is stil replicating - later it is known to be useless. The approval of its use under such conditions is the specific result of Big Pharma influence . That is how they operate all the time.

Big Pharma is no more honest about either the safety or the efficacity of its products than are the White Helmets about their activities in Syria. Many of the most dangerous drugs sold by the biggest companies are approved on the basis of very small, improperly balanced trials, sometimes fraudulently conducted. Trials which give the wrong result are routinely hidden. Research on toxicity and dangerous side-effects are routinely inadequate, frequently fraudulent or knowingly misleading, and legal requirements for drug authorisations are frequently waived on the basis of influence campaigns. This is especially so for new chemotherapy drugs, which are intrinsically highly toxic and are normally used at very close to the fatal dose. There is no level playing field at all, quite the contrary.

Big Pharma do not profit from cures - they profit from selling very expensive drugs, and they are far more ruthless than the White Helmets in destroying any potential threat to their profits. There is no more effective threat to the World-View of Big Pharma - as I know from first hand experience - than effective cures, especially where they are cheap and unpatentable, or the patents are owned outside the cabal. Any such cure must be destroyed at all costs.

Several of the Big Pharma companies in recent years have been given multi-billion dollar fines for the fraud and subversion they have utilised in obtaining authorisation for drugs which are dangerous to the patient, and for their marketing of drugs known to be dangerous.

The patent for chloroquine and its derivatives has expired. It has been widely used for many years, its hazards and limitations are thoroughly documented, and it is in this respect - under proper supervision with respect to its known hazards and limitations and qualified by them - incomparably safer than any new and barely tested pharmaceutical drug or vaccine such as Remdesivir. It is cheaply produced around the world. Therefore, no full-scale well-controlled randomised clinical trial of hydroxychloroquine treatment for Covid-19 will ever be conducted in a major Western country. Big Pharma will ensure that.

Blue Dotterel , May 16 2020 14:17 utc | 94
Turkey uses Chloroquine as well
"Koca explained that unlike the other countries, in Turkey doctors do not advise people with symptoms such as fever, store throat and coughing to take antipyretics and stay at home, but invite them to hospital and immediately start treatment by administering chloroquine to the people in suspicious cases without waiting for the results from the test results.

Another difference between the methods Turkey and other countries use is that in addition to chloroquine, an antibiotic, called azithromycin, is used in the early stages of the treatment, Koca noted."
https://www.hurriyetdailynews.com/turkish-model-proves-effective-in-covid-19-treatment-154220

So one has to wonder

Blue Dotterel , May 16 2020 14:17 utc | 94
Turkey uses Chloroquine as well
"Koca explained that unlike the other countries, in Turkey doctors do not advise people with symptoms such as fever, store throat and coughing to take antipyretics and stay at home, but invite them to hospital and immediately start treatment by administering chloroquine to the people in suspicious cases without waiting for the results from the test results.

Another difference between the methods Turkey and other countries use is that in addition to chloroquine, an antibiotic, called azithromycin, is used in the early stages of the treatment, Koca noted."
https://www.hurriyetdailynews.com/turkish-model-proves-effective-in-covid-19-treatment-154220

So one has to wonder

Hoarsewhisperer , May 16 2020 14:46 utc | 98
...
The very fact that the US medical establishment approved use of hydroxychloroquine under specific conditions that ensure it is used exclusively at a very late stage after the virus has ceased to replicate guarantees that all or almost all major Western hydroxychloroquine trials will be negative-
...
Posted by: BM | May 16 2020 13:59 utc | 91

I'm calling bullshit on that claim.
Whoever made it is an ignoramus with no knowledge, or understanding, of what Clinical Trials involve, how many variables have to be tested, nor why it takes so long for such trials to reach a 'safe' set of recommendations. If ever...

Trailer Trash , May 16 2020 15:36 utc | 105
>I'm calling bullshit on that claim.

Unfortunately the poster doesn't state what is wrong with the claim. Assertions that another poster is ignorant are not relevant. Neither are appeals to authority.

BM , May 16 2020 16:24 utc | 112
One does have to wonder whether it is simply a matter that the difficulty in the US concerning early diagnosis is the real problem that makes use of the drug impractical here. Perhaps we just don't have the resources, teams of testers and physicians and nurses, for the accuracy and careful monitoring of patients in early stage infection required when using this drug.
Posted by: juliania | May 16 2020 15:17 utc | 103

I'm afraid it's not anything to do with early diagnosis, it is only about profit. As Blue Dotterel said, it is about profit, not curing patients. For Big Pharma the very last thing they want is for the patient to be cured - a dead patient is far more profitable. No wonder Gilead holds the more promising GS-441524 off the market, because they can make more profit from a more expensive useless drug that will be in patent for far longer.

Big Pharma expects to make many trillions of dollars profit per year on Covid-19, as they do on cancer. The more Covid cases, the more profits. The less effective the efforts to reduce infections, the more profits. The less availability of PPE, the more profits. The more chaotic and irrational the government policies, the more profit. Big Pharma profits at every step.

They will stop at nothing to block proper trials of hydroxychloroquine - including bribery, coercion, and sabotage, not just massive disinformation. They will spend billions just to block
proper trials, using myriad different methods of subterfuge and subversion. That is just small change compared to the profits they want and expect.

The entire philosophy of Western medicine is a dying patient - it is corrupt, it is dishonest, its entire foundations are fraudulent. There is an urgent need for a whole new paradigm for medicine that is based on maximising the health of society, not on maximising profit.

There is a story I heard on television several decades ago - I think it was true, but I am not certain - about an old Chinese tradition. Villagers would pay a regular monthly fee to the doctor, as long as they stay healthy. As soon as they fall sick they stop paying, and the doctor has to cure them (without charge). Only when they get better will they resume the normal regular payments. Think about it, what is the best interest of the doctor towards his patient? He has an investment in their good health. Now compare the Western system. What interest does the doctor have in the patient's health? If the patient is sick for 4 times as long and then dies, is the doctor richer or poorer? If the doctor gives drugs with side effects, which need more drugs against the side effects, will he be richer or poorer? If there are two drugs available, one cheap, one expensive, which one does the doctor prefer?

Think about it Juliana, the last time you went to a hospital, how much did it cost? How many useless medicines did the doctor give you, versus how many basic essential medicines?

Western medicine is a big scam. It is a business. The second biggest business in the world after war.

That is why I reject Western medicine. For 20 years I have used only non-Western medicine.

[May 16, 2020] Remdesivir is a drug looking for a disease

May 16, 2020 | www.moonofalabama.org

abierno , May 15 2020 19:34 utc | 10

Deep thanks for the comment on Remdesivir. I've seen this appraisal in the medical community but not in any public commentary. It was developed to address Ebola and failed miserably. Tagged "a drug looking for a disease."

[May 15, 2020] The games cats play: a cat which went out of the house and met a cat already infected with Covid-19 comes back home and infects its own human servant

May 15, 2020 | www.moonofalabama.org

oldhippie , May 15 2020 22:32 utc | 27

The New England Journal of Medicine (NEJM)has a correspondence about cats:

Transmission of SARS-CoV-2 in Domestic Cats

Cats can get infected with the SARS-CoV-2 virus and do replicate it strongly in their respiratory system. But the cats do not get sick and show no symptoms. During the study three infected cats were each put into the same cage as a not-infected cat. They transmitted the disease to the previously non-infected ones. The researchers tested if the viruses the cats produce are still able to grow on human tissues. Unfortunately they are.

This means that a cat which went out of the house and met a cat who's owner has Covid-19 might come back home and infect its own human servant. Household cats may also play a role in the infection chain between household members. Any cat owner who goes into lockdown or is quarantined at home must also quarantine the cat. So far COVID lives in cats, Siberian tigers, bats, pangolins, raccoon dogs, ferrets. Only commonality here is they are all mammals. There have been a couple reports that it lives in dogs as well. If conclusions can be drawn from this it would seem to be a simple and indiscriminate virus. And we must mask our dogs, mask our cats, make them wear diapers if they go outside.

[May 15, 2020] French researchers High temperatures ineffective against coronavirus TheHill

May 15, 2020 | thehill.com

The novel coronavirus can survive in high temperatures, researchers said, casting doubt on suggestions that the threat will subside in the summer.

Researchers from the University of Aix-Marseille in France, led by Remi Charrel and Boris Pastorino, found that the virus survived in 140-degree Fahrenheit temperatures typically used to disinfect research labs, The Jerusalem Post reported .

It took 15 minutes of exposure to 197.6-degree temperatures to kill the virus, the newspaper noted, adding that the study had yet to be peer-reviewed.

Researchers did say the lower temperature should be sufficient to deactivate the virus in samples with smaller loads but added that the higher temperature was necessary for larger loads and concluded that disinfecting chemicals were a better option.

Earlier research has reached similar conclusions.

A National Academies of Sciences (NAS) panel told the White House in early April that previous research suggesting a connection between temperature and the virus's transmissibility was flawed. "There is some evidence to suggest that [the coronavirus] may transmit less efficiently in environments with higher ambient temperature and humidity; however, given the lack of host immunity globally, this reduction in transmission efficiency may not lead to a significant reduction in disease spread" without efforts such as social distancing, the NAS report stated, noting that SARS and MERS are not seasonal.

[May 15, 2020] Uncovering Why the COVID-19 Virus Is So Infectious and Efficiently Evades Immune Responses

May 15, 2020 | scitechdaily.com

SARS-CoV-2 , the virus that causes COVID-19 , is highly infectious. Curiously, in many patients, it triggers poor immune responses, which prolongs illness. This helps the virus spread widely, exacerbating the global pandemic. In a new study published in the Proceedings of the National Academy of Sciences , researchers at the University of Minnesota identified the biochemical mechanism that may explain how the virus infects people efficiently while evading their immune responses.

This study, led by Fang Li, a professor in the College of Veterinary Medicine, examined the mechanism by which SARS-CoV-2 enters cells. Specifically, the team of scientists investigated how the virus "unlocks" human cells using a surface spike protein as the "key." They made three important findings:

"Typically when a virus develops mechanisms to evade immune responses, it loses its potency to infect people," said Li. "However, SARS-CoV-2 maintains its infectivity using two mechanisms. First, during its limited exposure time, the tip of the viral key grabs a receptor protein on human cells quickly and firmly. Second, the pre-activation of the viral key allows the virus to more effectively infect human cells."

Li says that recognizing the evasiveness of SARS-CoV-2 is important for designing antibody drugs and vaccines. Antibody drugs would need to overpower the tip of the hidden viral key by latching onto it very quickly and tightly during its limited exposure time. Alternatively, drugs can target other parts of the viral key that are more exposed.

Li recommends that successful antiviral strategies will need to consider both the potency of the virus and its evasiveness.

Reference: "Cell entry mechanisms of SARS-CoV-2" by Jian Shang, Yushun Wan, Chuming Luo, Gang Ye, Qibin Geng, Ashley Auerbach and Fang Li, 6 May 2020, Proceedings of the National Academy of Sciences .
DOI: 10.1073/pnas.2003138117

The study is coauthored by postdoctoral researchers Jian Shang, Yushun Wan, and Chuming Luo, graduate students Gang Ye and Qibin Geng, and junior scientist Ashley Auerbach. The National Institutes of Health funded the study.

[May 15, 2020] Dirty games of big pharma

Notable quotes:
"... I've seen this appraisal in the medical community but not in any public commentary. It was developed to address Ebola and failed miserably. Tagged "a drug looking for a disease." ..."
May 15, 2020 | www.moonofalabama.org

Stonebird , May 15 2020 20:46 utc | 14

The remdesivir drug by the company Gilead gets hyped as a potential useful drug against the Covid-19 disease. This even after a serious study from China published in Lancet found it useless:

Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial

The result:

In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits.

A not completed Adaptive COVID-19 Treatment Trial (ACTT) by the National Institute of Allergy and Infectious Diseases also found that remdesivir does not change the mortality of serious Covid-19 cases. But it found that the drug may lead to a faster recovery. That has led to run on the hard to produce drug and confusion about its distribution .

But the real scandal behind this is that Gilead has a second drug, GS-441524, that is more promising and much easier to produce. STAT published a strong call on Gilead to release it immediately:

Gilead should ditch remdesivir and focus on its simpler and safer ancestor

The authors have the suspicion that Gilead has an ignoble motive for holding back the better drug as its patent will run out sooner:

The attractive profile of GS-441524 from both manufacturing and clinical perspectives raises this question: Why hasn't Gilead opted to advance this compound to the clinic? We would be remiss for not mentioning patents, and thus profits. The first patent on GS-441524 was issued in 2009, while the first patent for remdesivir was issued in 2017.
...
Given GS-441524's optimal properties, we -- along with the millions of people awaiting an effective treatment for Covid-19 -- are left to wonder why Gilead isn't giving it the same attention it is giving remdesivir. The world can only hope it isn't for the sake of protecting its intellectual property.
Surely it is profit that Gilead is after? I have heard quoted that one dose of remdesivir is about $1'000 so a "full" cure (whatever that may be) is $30'000. The second drug is almost certainly much cheaper.

They may think about reducing the cost if they find it is being given to the cat.

abierno , May 15 2020 19:34 utc | 11

Deep thanks for the comment on Remdesivir. I've seen this appraisal in the medical community but not in any public commentary. It was developed to address Ebola and failed miserably. Tagged "a drug looking for a disease."

[May 15, 2020] I don't think we should coerce people to go back to work. But once people are given accurate information and this hysteria calms down, people will just go back to their lives as normal. No coercion will be needed.

May 15, 2020 | crookedtimber.org

Anthony T 05.11.20 at 11:53 am 1 ( 1 )

Hello Chris,

I certainly don't think that people should be coerced back to work if they don't want to, though I do think we need to end these lockdowns as soon as possible. What we need is more clear public messaging, from the government: making it clear to people that this disease isn't actually that dangerous and that unless they are in an at risk group they really have very little to be concerned about. Cards should be sent out with green, red, amber marking where people can fill it out with their BMI, their underlying health conditions, chronic diseases etc. and this will give them a picture for whether or not they and their household is actually at risk.

People are talking about this disease like its the black death; as though it threatens everyone and kills indiscriminately. This way of talking has created a completely unfounded mass hysteria in the population. We are talking about a disease which has a case fatality rate of 0.3% (according to the most detailed serological studies, such as the one carried out in Gangelt) so it's a little more deadly than the flu. Of course, it will be a significant killer for the next couple of years – but so is influenza, and nobody panics like this and announces crackers lockdowns during a bad flu season.

Part of the problem has been the medias failure to adequately contextualise the data they are presenting, so people just hear a large number of deaths and don't know what to make of that number. Reporters need to be more clear about the fact that 800,000 people die every year in the UK and that deviations of 5% on either side of this are not uncommon. We need to be reminded that at 43,000 the number of excess deaths in the UK is about the same as the number of excess deaths during the 2014/15 flu season – and still falls short of the number of excess deaths during the 2017/18 flu season (excess deaths then were around 50,000). That context allows people to make sense of the data they read about without panicking – how scared were you of going to work during the 17/18 flu season? Most people probably didn't even notice.

The other problem is that the government has completely failed to give a serious explanation for the lockdown to the public. They are spouting rubbish about "save lives" without actually explaining why the lockdown would "save lives". As a result the public have been given the wrong impression that just extending the lockdown on and on will save lives. This is nonsense. Eventually the lockdown will be lifted and then the same people who would have died before would die a bit later – so no lives would be saved apart from for a few months. There are two explanations that could have been given for why we were implementing the lockdown. Firstly, it could be to ensure that hospitals don't get overfilled as happened in Wuhan and Northern Italy. If that was the aim, then a short lockdown (or a local lockdown in London and some of the other cities with severe outbreaks) would have been sufficient. It has been clear for at least the last three weeks that the government has overestimated ICU needs, most hospitals around the country – including the Nightingale in London – are completely empty. There are no more concerns about shortages of ventilators as it is now clear they are not actually a good way to treat most cases. If there is another severe outbreak in another city in the UK we can always just announce a small local lockdown of that city. Secondly, it could be argued that lockdowns save lives because they give us time to build up a testing capactiy so we can trace down cases and stop really severe outbreaks from happening; but at 500,000 or so tests per week the UK is now testing a lot of people and has the capacity to test even more. Apart from that I can't really think of any other reason why a lockdown would "save lives".

So, no I don't think we should coerce people to go back to work. But once people are given accurate information and this hysteria calms down, people will just go back to their lives as normal. No coercion will be needed.

[May 14, 2020] About the distinction "of COVID-19" and "with COVID-19"

May 14, 2020 | crookedtimber.org

Hidari 05.06.20 at 4:22 pm 9 ( 9 )

@8

The distinction between 'with' and 'of' is self-evident bullshit, if you just think about HIV and how it acts and what it does.

You just need to think it through: how could you possibly tell the difference?

Lots of semi-educated, semi-smart people are drawing this tenuous distinction vis a vis Covid-19 that they would not dare to do with any other disease ('Oh no the real cause of his illness was Kaposi sarcoma. It just happened to be an unfortunate coincidence that the patient was HIV positive as well'.)

In any case, there was an actuary in a twitter thread I have now lost the addy for, who pointed out that actuaries make decisions about this 'distinction' all the time, it is literally their job. And the reality is that even for very old Covid-19 sufferers who die, they are still losing a non-trivial number of years in terms of their lifespan, maybe up to 8 or 9 years.

hix 05.06.20 at 5:20 pm ( 10 )
Just look at excess death rates – they are at least as bad as the covid numbers, there is no overcounting whatsoever going on in the UK. What is going on is very slow reporting of non hospital covid death.
Anarcissie 05.06.20 at 5:37 pm ( 11 )
@4 -- or more directly, https://existentialcomics.com/comic/259
Jim Harrison 05.06.20 at 5:51 pm ( 12 )
Just for the record, has the Department of Public Health ever taken the lead or even participated significantly in the establishment of a despotic regime? First they told us to eat more broccoli; and next thing you know, they're telling us we're going to be deloused.
Alex 05.06.20 at 11:17 pm ( 13 )
@Quentin The "dying with, not of" is pretty much moot given that all-cause mortality in England and Wales is twice normal. The Financial Times has a write up, but there's no way to explain that away as mislabeling existing deaths. There's a lot of people who live 50 years or more with high blood pressure or diabetes. They didn't just all die this month for no reason.
Moz in Oz 05.07.20 at 12:04 am ( 14 )

The UK is generous with its death figures

But it does not test all deaths and only counts those who had a positive test result. I've seen more complaints about likely undercounting than overcounting.

Vahid Friedrich 05.07.20 at 12:41 am ( 15 )
Here is a great example of the freedom to work. https://www.10tv.com/article/reopened-restaurant-told-workers-dont-wear-face-masks-or-dont-work-2020-may
Collin Street 05.07.20 at 2:13 am ( 16 )
The UK is generous with its death figures: it counts those who die with Coronavirus, not those who die of it. That's a nice but important distinction.

Not many car accidents in the respiratory ER, I thought.

The distinction between "with" and "of" matters very much for chronic conditions. A lot of cancers are extremely slow-growing, for example; a 90-yo with early stage prostate cancer is statistically likely to die of something fast-acting -- a car accident, a lung infection -- years before the prostate cancer becomes a problem. The thing-that-kills-you has to be faster-acting than the thing-that-will-kill-you-if-you-live-long-enough. But COVID-19 is an acute condition, actually pretty fast-acting: there's not a huge lot that kills you faster than a lung infection. Major trauma? Septicemia, dehydration? If you're working at a meatworks and you have COVID-19 and you get decapitated, that's "with not of", but that looks to me like we're talking about tiny numbers, and you've just claimed that that's an important distinction.

I don't think that that distinction is important. It's potentially non-zero, a source of error that might potentially be significant but on the face of it that potential is so small as to be ludicrous rather than important. You think otherwise, strongly enough to bother to write a comment: please, explain to me what lead you to think that. Show me I'm wrong.

hix 05.07.20 at 9:18 am ( 17 )
Regarding over/undercounting in general. There are just no standardiced rules for counting. Every nation, sometimes every region does it´s own thing, with a wild mix of aspects that under and overcount, or just delay reporting of some death. Overall overcounting (compared to excess death rates, there is no objective rule whom to count anyway) seems to be very rare, maybe Belgium?
Here is a nice graphic tool with weekly excess mortality data, they sure look particular ugly in the UK:
https://www.euromomo.eu/graphs-and-maps#excess-mortality
bianca steele 05.07.20 at 1:36 pm ( 18 )
If the infection rate in big cities and institutions is as high as some studies have suggested (1/3 by some reports), counting "deaths by Covid-19" as "presumed deaths" + "positive tests at death" will obviously be inaccurate. There are other reasons to count asymptomatic infections.

If people like the form of argument "basically P, but it's more complicated than that, for reason A, and B, and I think that's enough reasons, may as well just assert that P," I guess I'm not going to stop them. Maybe they're right and I'm wrong. It's not like anyone's willing to pay me to do it my way.

Collin Street 05.07.20 at 2:40 pm ( 19 )
If the infection rate in big cities and institutions is as high as some studies have suggested (1/3 by some reports), counting "deaths by Covid-19" as "presumed deaths" + "positive tests at death" will obviously be inaccurate

I am forced to admit that I was approaching this problem with the perspective of the situation we have in australia, where the disease is still very rare.

[which is to say much of what I said and implied is wrong, for which I apologise.]

[May 14, 2020] What you *deliberately* have ignored and continue to ignore is the number of people who *are* at risk from re-opening the economy too soon.

May 14, 2020 | www.moonofalabama.org

Richard Steven Hack , May 14 2020 2:26 utc | 254

Posted by: fairleft | May 14 2020 0:35 utc | 253 So because you didn't read the word "healthy" in my description of the truth about Covid-19 (which I note you do not deny), you've stupidly decided I'm a troll.

No, you've been pushing this "only the elderly are at risk" *crap* since forever. *Of course* healthy people are at limited risk. That's been known since almost day one from China. As soon as the first statistics came out, we knew that *most* people don't die from it.

What you *deliberately* have ignored and continue to ignore is the number of people who *are* at risk from re-opening the economy too soon. I have cited the *millions* of people who are at risk several times in these threads. The numbers aren't hard to find. And every expert who has written about risk factors since the first statistics came out have pointed that out.

But it doesn't fit your agenda, so you ignore it.

"And I'm not writing about Amerikkka moron."

Nice try. You were referring to the Galbraith piece in the top post which is explicitly referring to the US. Moron.

Typical troll behavior. Deflect, deny, make counter accusations, continually re-assert the same positions no matter how many times they are debunked.

Why b hasn't kicked your ass to the curb is beyond me. Few people here are posting more nonsense than you - and you have even less actual evidence.

[May 14, 2020] Stephan Kohn (who was fired immediately of course) assesses the German reaction as "Fehlalarm" (false alarm), claims that the lockdown has charged/will charge many more deaths than the virus itself. It was a grotesque overreaction, not only in Germany, but in many other countries.

May 14, 2020 | www.moonofalabama.org

mk , May 13 2020 19:40 utc | 241

In Germany a huge scandal is growing. I'm surprised that this didn't emerge here yet (as far as I can see).

An official in the Ministry for Interior has blown the whistle. After trying to forward a study about the effect of the lockdown measures to his superiors, including Minister for Interior Horst Seehofer, and being ignored, he leaked the study to a non-mainstream online magazine. The study has reached the mainstream meanwhile.

Stephan Kohn (who was fired immediately of course) assesses the German reaction as "Fehlalarm" (false alarm), claims that the lockdown has charged/will charge many more deaths than the virus itself. It was a grotesque overreaction, not only in Germany, but in many other countries.

I will just take one point, which the majority here, AFAICS, has never taken into account: collateral damage. In Germany, in March/April 2020, 90% of important, in part life-saving operations have not been conducted because the beds were reserved for the expected giant Corona wave that didn't arrive. This means between 1,5 Million and 2,5 Million people are affected, and it is only a matter of statistics how many lives have been lost or shortened due to the delayed operations. Cohn estimates between 5000 and 125000 premature deaths which easily outweigh the 7000 Corona deaths.

And this is just one point.

Like so many virologists, he says Corona is not worse than a strong flu.

Here's the document:

https://ichbinanderermeinung.de/Dokument93.pdf

[May 14, 2020] The virus may mostly kill older people - but it's because of the co-morbidities which almost *half* of US adults suffer from it his most age groups

May 14, 2020 | www.moonofalabama.org

Richard Steven Hack , May 13 2020 9:14 utc | 216

Here's Who's Dying From Covid-19 in the United States
Data and new research reveal all age groups are at risk, from children to middle age and beyond
https://tinyurl.com/y8ch67qk
"We estimated that 45.4% of U.S. adults are at increased risk for complications from coronavirus disease because of cardiovascular disease, diabetes, respiratory disease, hypertension, or cancer," according to a new analysis from the CDC. Those at elevated risk include 19.8% of people age 18 to 29 and 80.7% for people over age 80.

As I've pointed out before, the virus may mostly kill older people - but it's because of the co-morbidities which almost *half* of US adults suffer from. More than 25 million Americans have asthma. This is 7.7 percent of adults and 8.4 percent of children. Currently, there are about 6.2 million children under the age of 18 with asthma. Granted, most of them probably never will get this virus - but those who do...


Separately, a new study of children with Covid-19 admitted to pediatric intensive care units in the United States and Canada concludes that while the overall severity of symptoms in the children was "far less than that documented in adults Covid-19 can result in a significant disease burden in children." According to the research, published in JAMA Pediatrics, 40 of the 48 children, ranging in age from four to 16, had underlying medical conditions. Two of them died, and three remain on ventilators. /BLOCKQUOTE> Assuming the three on ventilators die, that's five out of 48 - ten percent.

So much for the "we can let the old people die" meme. No one wants to claim a willingness to let kids die to re-open the economy.

[May 14, 2020] Interesting *opinion* piece supporting HCQ over remdesivir.

May 14, 2020 | www.moonofalabama.org

Richard Steven Hack , May 13 2020 6:29 utc | 213

Interesting *opinion* piece supporting HCQ over remdesivir. I take no position on this argument - unlike many here - except that as I've said before, we need a *good* set of studies on both (and every other treatment, which includes the EVMS treatment I discuss above) and then a decent review study to interpret the results for us laymen. Perhaps that's another case of "good luck with that" any time before, say, five or ten years from now...

A Tale of Two Drugs: Money vs. Medical Wisdom
https://tinyurl.com/yadpyktu


Richard Steven Hack , May 13 2020 6:39 utc | 214

Ah, the same doctor referenced above as author of the "A Tale of Two Drugs" has another *opinion* article on the same topic - HCQ. Again, I have no idea whether her statements are factual, although presumably her quoting the CDC on HCQ is accurate, which in itself is interesting if true.

Doctors and Patients Are Pawns in a Dangerous Political Brinkmanship
https://tinyurl.com/ycpxcjry


On duration of use: "CDC has no limits on the use of hydroxychloroquine for the prevention of malaria. When hydroxychloroquine is used at higher doses for many years, a rare eye condition called retinopathy has occurred. People who take hydroxychloroquine for more than five years should get regular eye exams."

NOTE: CDC guidelines for use in malaria do not even mention the "fatal heart arrhythmia" hyped in the fear-mongering articles in the media. Rheumatology guidelines for HCQ in lupus and rheumatoid arthritis (RA) do not require a baseline EKG to check heart rhythm, although doctors might order one before prescribing HCQ if needed for a patient with heart disease. SARS-CoV-2 itself, which can damage to the heart, may be responsible for some heart problems now blamed on HCQ.

Hausmeister , May 13 2020 13:35 utc | 223
@ b
Did you read what you linked here?
https://www.nejm.org/doi/full/10.1056/NEJMoa2012410?query=featured_home

„Conclusions

In this observational study involving patients with Covid-19 who had been admitted to the hospital, hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death. Randomized, controlled trials of hydroxychloroquine in patients with Covid-19 are needed. (Funded by the National Institutes of Health.)"

According to what we learnt in the meantime the use of HCQ at a quite late stadium of this illness is as meaningless as most likely the use of Remdisivir (another kind of pure antiviral medicament) would have been. The only thing what one can learn from this study isthat HCQ apparently did not damage people. So your sentence „...to be as false as the promotion of the useless but potentially dangerous Hydroxychloroquine as a therapy for Covid-19." is just nonsense.

[May 14, 2020] UCSF Health Hospital Epidemiology and Infection Prevention COVID-19 Global Clinical Knowledge Base

May 14, 2020 | www.moonofalabama.org

Richard Steven Hack , May 13 2020 6:13 utc | 212

People might find this resource useful...

UCSF Health Hospital Epidemiology and Infection Prevention COVID-19 Global Clinical Knowledge Base
https://tinyurl.com/y9qu3qs6


The goal of this site is to compile a comprehensive but curated directory of publicly-available practice guidelines, clinical protocols, and other resources related to COVID-19. We hope this resource will encourage clinicians and medical organizations to share knowledge and compare practices with peers.

Submitted resources are reviewed by a team of medical professionals for accuracy and relevance. We do not specifically endorse any resource posted on this site.

[May 13, 2020] Prager The Worldwide Lockdown May Be The Greatest Policy Mistake In History

Notable quotes:
"... The forcible prevention of Americans from doing anything except what politicians deem "essential" has led to the worst economy in American history since the Great Depression of the 1930s. It is panic and hysteria, not the coronavirus , that created this catastrophe. And the consequences in much of the world will be more horrible than in America. ..."
"... That would be enough to characterize the worldwide lockdown as a deathly error. But there is much more. If global GDP declines by 5%, another 147 million people could be plunged into extreme poverty, according to the International Food Policy Research Institute. ..."
"... Foreign Policy magazine reports that, according to the International Monetary Fund, the global economy will shrink by 3% in 2020, marking the biggest downturn since the Great Depression, and the U.S., the eurozone and Japan will contract by 5.9%, 7.5% and 5.2%, respectively. Meanwhile, across South Asia, as of a month ago, tens of millions were already "struggling to put food on the table." Again, all because of the lockdowns, not the virus. ..."
May 13, 2020 | www.zerohedge.com

Prager: The Worldwide Lockdown May Be The Greatest Policy Mistake In History by Tyler Durden Wed, 05/13/2020 - 13:15 Authored by Dennis Prager via PJMedia.com,

The idea that the worldwide lockdown of virtually every country other than Sweden may have been an enormous mistake strikes many - including world leaders; most scientists, especially health officials, doctors and epidemiologists; those who work in major news media; opinion writers in those media; and the hundreds of millions, if not billions, of people who put their faith in these people - as so preposterous as to be immoral.

Timothy Egan of The New York Times described Republicans who wish to enable their states to open up as "the party of death."

That's the way it is today on planet Earth, where deceit, cowardice and immaturity now dominate almost all societies because the elites are deceitful, cowardly and immature.

But for those open to reading thoughts they may differ with, here is the case for why the worldwide lockdown is not only a mistake but also, possibly, the worst mistake the world has ever made. And for those intellectually challenged by the English language and/or logic, "mistake" and "evil" are not synonyms. The lockdown is a mistake; the Holocaust, slavery, communism, fascism, etc., were evils. Massive mistakes are made by arrogant fools; massive evils are committed by evil people.

The forcible prevention of Americans from doing anything except what politicians deem "essential" has led to the worst economy in American history since the Great Depression of the 1930s. It is panic and hysteria, not the coronavirus , that created this catastrophe. And the consequences in much of the world will be more horrible than in America.

The United Nations World Food Programme, or the WFP, states that by the end of the year, more than 260 million people will face starvation -- double last year's figures. According to WFP director David Beasley on April 21:

"We could be looking at famine in about three dozen countries...

There is also a real danger that more people could potentially die from the economic impact of COVID-19 than from the virus itself " (italics added).

That would be enough to characterize the worldwide lockdown as a deathly error. But there is much more. If global GDP declines by 5%, another 147 million people could be plunged into extreme poverty, according to the International Food Policy Research Institute.

Foreign Policy magazine reports that, according to the International Monetary Fund, the global economy will shrink by 3% in 2020, marking the biggest downturn since the Great Depression, and the U.S., the eurozone and Japan will contract by 5.9%, 7.5% and 5.2%, respectively. Meanwhile, across South Asia, as of a month ago, tens of millions were already "struggling to put food on the table." Again, all because of the lockdowns, not the virus.

In one particularly incomprehensible act, the government of India, a poor country of 1.3 billion people, locked down its people. As Quartz India reported on April 22, "Coronavirus has killed only around 700 Indians a small number still compared to the 450,000 TB and 10,000-odd malaria deaths recorded every year."

One of the thousands of unpaid garment workers protesting the lockdown in Bangladesh understands the situation better than almost any health official in the world:

"We are starving. If we don't have food in our stomach, what's the use of observing this lockdown?"

But concern for that Bangladeshi worker among the world's elites seems nonexistent.

The lockdown is " possibly even more catastrophic (than the virus) in its outcome : the collapse of global food-supply systems and widespread human starvation" (italics added).

That was published in the left-wing The Nation, which, nevertheless, enthusiastically supports lockdowns. But the American left cares as much about the millions of non-Americans reduced to hunger and starvation because of the lockdown as it does about the people of upstate New York who have no incomes, despite the minuscule number of coronavirus deaths there. Or about the citizens of Oregon, whose governor has just announced the state will remain locked down until July 6. As of this writing, a total of 109 people have died of the coronavirus in Oregon.

An example of how disinterested the left is in worldwide suffering is made abundantly clear in a front-page "prayer" by a left-wing Christian in the current issue of The Nation: "May we who are merely inconvenienced remember those whose lives are at stake."

"Merely inconvenienced" is how the Rev. Dr. William J. Barber II, a Protestant minister and president of the North Carolina NAACP, describes the tens of millions of Americans rendered destitute, not to mention the hundreds of millions around the world rendered not only penniless but hungry. The truth is, like most of the elites, it is Barber who is "merely inconvenienced." Indeed, the American battle today is between the merely inconvenienced and the rest of America.

Michael Levitt, professor of structural biology at Stanford Medical School and winner of the 2013 Nobel Prize in chemistry, recently stated, "There is no doubt in my mind that when we come to look back on this, the damage done by lockdown will exceed any saving of lives by a huge factor."

To the left, anyone who questions the lockdown is driven by preference for money over lives. Typical of the left's moral shallowness is this headline on Salon this week:

"It's Time To Reject the Gods of Commerce: America Is a Society, Not an 'Economy,'" with the subhead reading, "America Is About People, Not Profit Margins."

And, of course, to smug editors and writers of The Atlantic, in article after repetitive article, the fault lies not with the lockdown but with President Donald Trump. The most popular article in The Atlantic this week is titled "The Rest of the World Is Laughing at Trump." The elites can afford to laugh at whatever they want. Meanwhile, the less fortunate -- that is, most people -- are crying.

[May 13, 2020] The Chilling Return of 'Papers Please'

May 13, 2020 | www.theamericanconservative.com

The Chilling Return of 'Papers Please'

So-called immunity passports would bring back the worst civil liberties abuses of the past and result in a crime wave. Credit: M.Moira/Shutterstock

May 13, 2020

|

12:01 am

Bill Wirtz The coronavirus lockdown drags on, yet only a few fringe fanatics (and France, but I repeat myself) support continuing complete shutdowns of the world's economies. However, even those countries that have opted to end forced quarantines still present a range of worrying responses. One of these ongoing debates surrounds the so-called "Corona apps," with which authorities intend to track and trace the movements of their own citizens. In Poland, the government is mandating that those infected with COVID-19 install an app and use it to send a selfie on a regular basis. If they do not comply, they face a visit from the law enforcement.

The nightmarish infringements on civil liberties are set to continue with "immunity passports." The German Robert Koch Institute, along with other researchers and blood donation services, is working on a large-scale study to establish immunity in COVID-19 patients. Those found to have built immunity, either because they've already had the disease or through antibody testing, could be issued paperwork that exempts them from lockdown restrictions.

CNN's medical analyst Saju Mathew counts himself as convinced by the concept, and quotes a noted beacon of human freedom to back it up: "In China, for example, QR codes have been used to loosen restrictions in Wuhan, where the pandemic originated. People assessed to be healthy have been given a green QR code, indicating they can travel within the province."

From a law enforcement level, the existence of immunity passports would extend indefinitely the practice of questioning citizens without reasonable suspicion at any time. "Papers please" wouldn't be experienced only because one is crossing a border, but merely because one is outside. If you were worried about rogue police abusing power before, wait until stop and frisk becomes the norm all across the United States, at any time of the day.

In the United Kingdom, Professor Peter Openshaw, a member of the government's new and emerging respiratory virus threats advisory group, told The Guardian that "people granted the passports would have to be kept under close observation to ensure they were not becoming reinfected." In practice, this would amount to daily identification checkpoints and mandatory home visits. Any pretense of individual liberty and fundamental rights would go out the window.

But beyond that, on a more practical level, the measure would be inoperable. In a scientific brief published at the end of April , the World Health Organization (WHO) -- known to be warm on authoritarian measures such as those used by China -- preliminarily rejected the idea of these passports. Current antibody tests, the WHO warned, could confuse immunity with one of the six existing coronaviruses, four of which cause the common cold. The WHO also noted that such paperwork would give citizens the impression that they do not need to abide by social distancing guidelines, giving them a false sense of security. Professor Openshaw adds that immunity passports would incentivize people to try and deliberately catch coronavirus, which could end up overwhelming the health sector, exactly the scenario that the lockdowns are meant to prevent.

There's also a massive opportunity for crime under such a proposal. In 2015, 50 million travel documents were either lost or stolen. In 2014, the UK recorded a five-year high of counterfeit passport seizures. Fake passports fuel organized crime and have long been available on the black market. Immunity passports would be far more valuable, since they would grant not just the ability to go to other countries, but other basic freedoms of movement, going into shops or meeting friends. The idea that people would pay a pretty price for their freedom would be an understatement. In turn, the government could only react to such a flood of false documentation by becoming more authoritarian, casting us into yet another spiral of increasing state control.

There is no instance in which the systematic control of citizens has not ended in police abuse, or plain and simple authoritarianism. There is a genuine fear about the coronavirus. That said, we cannot allow such fear to rid us completely of our fundamental rights. States of emergency were and are designed to be temporary, and in that, to be short.

If the debate is over whether to radically overturn the Bill of Rights and human rights conventions, then let us have that debate. Let us talk about rewriting the rules, instead of just plain ignoring them.

Bill Wirtz comments on European politics and policy in English, French, and German. His work has appeared in Newsweek , the Washington Examiner , CityAM, Le Monde , Le Figaro , and Die Welt .

[May 13, 2020] 92% Of Cook County COVID-19 Victims Had Pre-Existing Condition

Notable quotes:
"... The medical examiner's database showed COVID-19 as the primary cause of death for 2,303 people. Of those, 2,112 were shown to have at least one underlying condition as a secondary cause of death. Those conditions, also known as comorbidities, included hypertension, diabetes, obesity and heart disease. There were no secondary causes reported for 191 deaths. ..."
"... For months, Illinois residents have lived in fear, a fear that has been exacerbated by a lack of transparency and open reporting from the state. ..."
May 13, 2020 | www.zerohedge.com

Authored by Ted Dabrowski and John Klingner via Wirepoints.org,

A Wirepoints analysis of COVID-19 deaths from the Cook County Medical Examiner's office reveals that 92 percent of victims from the virus had pre-existing medical conditions.

The medical examiner's database showed COVID-19 as the primary cause of death for 2,303 people. Of those, 2,112 were shown to have at least one underlying condition as a secondary cause of death. Those conditions, also known as comorbidities, included hypertension, diabetes, obesity and heart disease. There were no secondary causes reported for 191 deaths.

... ... ...

Hypertension affected 1,070 victims, or more than 46 percent of all deaths. Diabetes impacted 973 victims, or 42 percent of the total. Pulmonary disease was part of 397 deaths, or 17 percent. And 215 of those deaths, about 9 percent, were accompanied by obesity or morbid obesity.

Yet others had conditions including cancer and cardiovascular and kidney diseases. The numbers above add up to more than 100 percent because many victims had more than one pre-existing condition.

,,, ,,, ,,,

What’s stark about the Cook comorbidity data is just how few young adults die from COVID-19 in the absence of some pre-existing condition. Just 3 of the 15 deaths in the 20-29 age bracket had no comorbidities. Same goes for the 30-39 and 40-49 age brackets, where just 26 of the 132 deaths were accompanied with no underlying causes.

Even more, almost 50 percent of all Illinois deaths have been tied to long-term care facilities, the subject of an upcoming Wirepoints piece. That means nearly 1,600 deaths occurred outside the general public.

For months, Illinois residents have lived in fear, a fear that has been exacerbated by a lack of transparency and open reporting from the state.

[May 12, 2020] Deadly Medicines and Organized Crime

May 12, 2020 | www.moonofalabama.org

Pft , May 12 2020 23:01 utc | 186

Interesting book "Deadly Medicines and Organized Crime " published in 2013 by PETER C GØTZSCHE

He points out "Science philosopher Karl Popper in "The Open Society and Its Enemies" depicts the totalitarian, closed society as a rigidly ordered state in which freedom of expression and discussion of crucial issues are ruthlessly suppressed. Most of the time, when I have tried to publish unwelcome truths about the drug industry, I have been exposed to the journal's lawyers, and even after I have documented that everything I say is correct and have been said before by others, I have often experienced that important bits have been removed or that my paper was rejected for no other reason than fear of litigation. This is one of the reasons I decided to write this book, as I have discovered that I have much more freedom when I write books. Popper would have viewed the pharmaceutical industry as an enemy of the open society.

Rigorous science should put itself at risk of being falsified and this practice should be protected against those who try to impede scientific understanding, as when the industry intimidates those who discover harms of its drugs. Protecting the hypotheses by ad hoc modifications, such as undeclared changes to the measured outcomes or the analysis plan once the sponsor has seen the results, or by designing trials that make them immune to refutation, puts the hypotheses in the same category as pseudoscience.

In healthcare, the open democratic society has become an oligarchy of corporations whose interests serve the profit motive of the industry and shape public policy, including that of weakened regulatory agencies. Our governments have failed to regulate an industry, which has become more and more powerful and almighty, and failed to protect scientific objectivity and academic curiosity from commercial forces."

Thats about it in a nutshell. Too bad the good scientists are all muzzled. Only the politicized fraudsters get the good press.

[May 12, 2020] PHARMA: Greed, Lies, and the Poisoning of America

May 12, 2020 | www.moonofalabama.org

karlof1 , May 12 2020 16:01 utc | 125

Renegade Inc interview with Gerald Posner the author of PHARMA: Greed, Lies, and the Poisoning of America is lively, timely, revealing, and very informative! An excellent 25 minute investment of your time today. In the book which was written well before the COVID-19 breakout, Posner did address the issue of pandemic which this article reported on along with other aspects of PHARMA . And there's much more at his website.

[May 12, 2020] How coronavirus attacks the human body - The Washington Post

May 12, 2020 | www.washingtonpost.com

How coronavirus attacks the human body - The Washington Post It mostly spares the young. Until it doesn't: Last week, doctors warned of a rare inflammatory reaction with cardiac complications among children that may be connected to the virus. On Friday, New York Gov. Andrew M. Cuomo (D) announced 73 children had fallen severely ill in the state and a 5-year-old boy in New York City had become the first child to die of the syndrome. Two more children had succumbed as of Saturday.

That news has shaken many doctors, who felt they were finally grasping the full dimensions of the disease in adults. "We were all thinking this is a disease that kills old people, not kids," Reich said.

Mount Sinai has treated five children with the condition. Reich said each started with gastrointestinal symptoms, which turned into inflammatory complications that caused very low blood pressure and expanded their blood vessels. This led to heart failure in the case of the first child who died.

"The pattern of disease was different than anything else with covid," he said.

"We were all thinking this is a disease that kills old people, not kids," said David Reich, president of Mount Sinai Hospital in Manhattan. (Jeenah Moon/Reuters)

Of the millions, perhaps billions, of coronaviruses, six were previously known to infect humans.

Four cause colds that spread easily each winter, barely noticed. Another was responsible for the outbreak of severe acute respiratory syndrome that killed 774 people in 2003. Yet another sparked the outbreak of Middle East respiratory syndrome in 2012, which kills 34 percent of the people who contract it. But few do.

SARS-CoV-2, the bad seed of the coronavirus family, is the seventh. It has managed to combine the infectiousness of its cold-causing cousins with some of the lethality of SARS and MERS. It can spread before people show symptoms of disease, making it difficult to control, especially without widespread and accurate testing. At the moment, social distancing is the only effective countermeasure .

It has infected 4 million people around the globe, killing more than 280,000, according to the Johns Hopkins University Coronavirus Resource Center. In the United States, 1.3 million have been infected and more than 78,000 have died.

Had SARS or MERS spread as widely as this virus, Rasmussen said, they might have shown the same capacity to attack beyond the lungs. But they were snuffed out quickly, leaving only a small sample of disease and death.

Paramedics bring home a woman with covid-19 who underwent an emergency C-section because she was gravely ill. After extensive care, including time on a ventilator, she was released from a hospital in Stamford, Conn., and she has a healthy newborn. (John Moore/Getty Images)

Trying to define a pathogen in the midst of an ever-spreading epidemic is fraught with difficulties. Experts say it will be years until it is understood how the disease damages organs and how medications, genetics, diets, lifestyles and distancing impact its course.

"This is a virus that literally did not exist in humans six months ago," said Geoffrey Barnes, an assistant professor at the University of Michigan who works in cardiovascular medicine. "We had to rapidly learn how this virus impacts the human body and identify ways to treat it literally in a time-scale of weeks. With many other diseases, we have had decades."

In the initial days of the outbreak, most efforts focused on the lungs. SARS-CoV-2 infects both the upper and lower respiratory tracts, eventually working its way deep into the lungs, filling tiny air sacs with cells and fluid that choke off the flow of oxygen.

But many scientists have come to believe that much of the disease's devastation comes from two intertwined causes.

The first is the harm the virus wreaks on blood vessels, leading to clots that can range from microscopic to sizable. Patients have suffered strokes and pulmonary emboli as clots break loose and travel to the brain and lungs. A study in the Lancet, a British medical journal, showed this may be because the virus directly targets the endothelial cells that line blood vessels.

The second is an exaggerated response from the body's own immune system, a storm of killer "cytokines" that attack the body's own cells along with the virus as it seeks to defend the body from an invader.

Research and therapies are focused on these phenomena. Blood thinners are being more widely used in some hospitals . A review of records for 2,733 patients, published Wednesday in the Journal of the American College of Cardiology, indicates they may help the most seriously ill.

"Things change in science all the time. Theories are made and thrown out. Hypotheses are tweaked. It doesn't mean we don't know what we are doing. It means we are learning," said Deepak Bhatt, executive director of interventional cardiology at Brigham and Women's Hospital in Boston.

Inflammation of those endothelial cells lining blood vessels may help explain why the virus harms so many parts of the body, said Mandeep Mehra, a professor of medicine at Harvard Medical School and one of the authors of the Lancet study on how covid-19 attacks blood vessels.

Subtitle Settings Font Font Size Font Edge Font Color Background The novel coronavirus is a master of disguise: Here's how it works Skip

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That means defeating covid-19 will require more than antiviral therapy, he said.

"What this virus does is it starts as a viral infection and becomes a more global disturbance to the immune system and blood vessels -- and what kills is exactly that," Mehra said. "Our hypothesis is that covid-19 begins as a respiratory virus and kills as a cardiovascular virus."

The thinking of kidney specialists has evolved along similar lines. Initially, they attributed widespread and severe kidney disease to the damage caused by ventilators and certain medications given to intensive-care patients, said Daniel Batlle, a professor of medicine at Northwestern University Feinberg School of Medicine.

Then they noticed damage to the waste-filtering kidney cells of patients even before they needed intensive care. And studies out of Wuhan found the pathogen in the kidneys themselves, leading to speculation the virus is harming the organ.

"There was nothing unique at first," Batlle said. But the new information "shows this is beyond the regular bread-and-butter acute kidney injury that we normally see."

Like other coronaviruses, SARS-Cov-2 infiltrates the body by attaching to a receptor, ACE2, found on some cells. But the makeup of the spikes that protrude from this virus is somewhat different, allowing the virus to bind more tightly. As a result, fewer virus particles are required to infect the host. This also may help explain why this virus is so much more infectious than SARS, Rasmussen said.

Other factors can't be ruled out in transmission, she said, including the amount of virus people shed and how strictly they observe social distancing rules.

Once inside a cell, the virus replicates, causing chaos. ACE2 receptors, which help regulate blood pressure, are plentiful in the lungs, kidneys and intestines -- organs hit hard by the pathogen in many patients. That also may be why high blood pressure has emerged as one of the most common preexisting conditions in people who become severely ill with covid-19.

A colorized scan of a cell (shown in red) infected with SARS-COV-2 virus particles (shown in yellow), isolated from a patient sample. (National Institute of Allergy and Infectious Diseases)

The receptors differ from person to person, leading to speculation that genetics may explain some of the variability in symptoms and how sick some people become.

Those cells "are almost everywhere, so it makes sense that the virus would cause damage throughout the body," said Mitchell Elkind, a professor of neurology at Columbia University's College of Physicians and Surgeons and president-elect of the American Heart Association.

Inflammation spurs clotting as white blood cells fight off infection. They interact with platelets and activate them in a way that increases the likelihood of clotting, Elkind said.

Such reactions have been seen in severe infections, such as sepsis. But for covid-19, he said, "we are seeing this in a large number of people in a very short time, so it really stands out."

"The virus can attack a lot of different parts of the body, and we don't understand why it causes some problems for some people, different problems for others -- and no problems at all for a large proportion," Elkind said.

Coughlin, in critical condition at a hospital in Connecticut, deteriorated quickly after she reached the emergency room. Her fever shot up to 105 and pneumonia developed in her lungs.

On Wednesday, she called her six daughters on FaceTime, telling them doctors advised she go on a ventilator.

"If something happens to me, and I don't make it, I'm at peace with it," she told them.

The conversation broke daughter Coleman's heart.

"I am deciding to help her go on a ventilator, and she may never come off," she said. "That could have been my last phone conversation with her."

Illustrations from iStock. Edited by Carol Eisenberg . Photo editing by Nick Kirkpatrick . Copy-edited by Jennifer Anderson and Thomas Floyd. Design and development by Tyler Remmel.

Read more:

Coronavirus destroys lungs. But doctors are finding its damage in kidneys, hearts and elsewhere.

Young and middle-aged people, barely sick with covid-19, are dying of strokes

Children are falling ill with perplexing inflammatory syndrome thought to be linked to covid-19

A mysterious blood-clotting complication is killing coronavirus patients

Frostbite' toes and other peculiar rashes may be signs of hidden coronavirus infection, especially in the young

[May 12, 2020] https://www.newsbiella.it/2020/04/28/leggi-notizia/argomenti/speciale-coronavirus-4/articolo/idrossiclorochina-vs-covid-19-una-terapia-considerata-efficace-ma-controversa-il-parere-dellinfet-4.html

May 12, 2020 | www.newsbiella.it

Posted by: cirsium | May 11 2020 23:44 utc | 43

[May 11, 2020] Do you need a personal oximeter to fight coronavirus? by By Jane Ridley

Vital for old people who live alone. Especially for those with hypertension
Apr 08, 2020 | nypost.com

ver since coronavirus survivor Andy Cohen told listeners of "Andy Cohen Live" March 30 that owning a pulse oximeter provided a source of relief for him, interest in the humble medical device has soared.

The small, handheld units, which normally attach to your finger or toe, monitor your oxygen-saturation level -- which, if that level dips below 90%, can be an indicator that you have COVID-19.

"Oximeters measure how efficient the lungs are at getting the blood filled with oxygen," Dr. Eric Cioe-Pena, director of global health at Northwell Health , tells The Post. "Most healthy people's reading of oxygen in the blood is 100%.

"We are seeing lower levels in coronavirus patients because the virus impedes their ability to oxygenate the blood. There is fluid, instead of air, in their lungs, and so, when the blood passes through those organs, it doesn't get oxygen."

The doctor, based in New Hyde Park, LI, adds that he has treated COVID-19 sufferers with blood-oxygen levels as low as 55% and even 27%.

Speaking on his radio show, Cohen, 51, said, "You could scare yourself and think: 'Oh my God, my lungs don't feel right,' but you could use this pulse oximeter and see, OK, actually, you're fine, you're within the range." CNN host Chris Cuomo, 49, who currently has the coronavirus , has also been testing his oxygen levels daily using an oximeter, according to his wife, Cristina, who shared an extensive update on Cuomo's health earlier this week.

No wonder people are scrambling to purchase their own oximeters, which can be found at pharmacies and online for anywhere from $20 to $50.

see also Andy Cohen reveals what it was like to have coronavirus His symptoms included a fever, tightness in his chest, a...

But Cioe-Pena maintains that healthy people don't need them. Not only that, a rush on the devices could cause problems at hospitals and other emergency facilities that require them, similar to the situation that played out over N95 masks and other gear for essential medical workers .

"The issue is supply and demand," explains Cioe-Pena, adding that the information given by an oximeter about oxygen is really "only good if you have the ability to supply supplementary oxygen, like you can in a hospital." He notes as well that folks with "underlying conditions such as diabetes, hypertension or chronic lung disease" might need to have access to oximeters more than the average healthy person with fears of contracting the coronavirus.

[May 10, 2020] I wonder if the average age of our government was say 30, do you think they would have chosen to lock down the country? No.. Its because the average age of our government is more like 68.

Notable quotes:
"... "Our outcomes are similar to the state of Pennsylvania, where the median age of death from COVID-19 is 84 years old. ..."
"... "COVID-19 is a disease that ravages those with preexisting conditions – whether it be immunosenescence of aging or the social determinants of health. We can manage society in the presence of this pathogen if we focus on these preexisting conditions. ..."
May 10, 2020 | www.moonofalabama.org

jack lockwood , May 10 2020 9:36 utc | 52

This lock down stupidity needs to end now.

i wonder if the average age of our government was say 30, do you think they would have chosen to lock down the country? No.. Its because the average age of our government is more like 68.. We are sacrificing ourselves to protect the old, the least productive part of our society.
Im 33, i have had the virus, it was mild.i have had worse colds. Im running out of money! unlike pensioners who get there cash regardless i need to earn it. Furthermore the pension these people currently draw i will never see, we realise now that pensions as they were cannot be sustained, but yet they still have them. If they are like my grandparents they retired over 20 years ago.. 2/3 of my life, and have drawn private/public pensions since, they consume the vast majority of the NHS resources so they can stay alive another day and continue drawing pensions. The old people of my country also own the majority of the property, i rent my house of a couple in there 70s, i pay them over £1000 per month to live here. i cannot afford to buy.

When i do get a little bit of work at the moment i head out to find the roads and shops populated with fucking pensioners, all driving around in there stupid tall and narrow cars doing 40mph in a 60 oblivious to the world and economy that is around them paying them their pensions and protect them.

my attitude is simple.. if you dont want to catch it, dont go out.. no need to lockdown everybody, just the ones who fear this.. like you B. Its my right to live or die as i chose, not under the kosh of the fucking gray mafia.

ive already given up following the 'rules' fuck em all.


fairleft , May 10 2020 10:05 utc | 54

"Our outcomes are similar to the state of Pennsylvania, where the median age of death from COVID-19 is 84 years old. The few younger patients who died all had significant preexisting conditions. Very few children were infected and none died. Minorities in our communities fared equally as well as others, but we know that this is not the case nationally. In sum, this is a disease of the elderly, sick and poor. ...

"COVID-19 is a disease that ravages those with preexisting conditions – whether it be immunosenescence of aging or the social determinants of health. We can manage society in the presence of this pathogen if we focus on these preexisting conditions.

"What we cannot do, is extended social isolation. Humans are social beings, and we are already seeing the adverse mental health consequences of loneliness, and that is before the much greater effects of economic devastation take hold on the human condition."

- Dr. Steven Shapiro, University of Pennsylvania Medical Center chief medical and scientific officer

https://inside.upmc.com/shapiro-economy-roundtable/

Richard Steven Hack , May 10 2020 12:03 utc | 61
@Circe | May 10 2020 11:07 utc | 57

"people with proven underlying conditions not returning to work yet"

You mean the...

William Gruff , May 10 2020 12:21 utc | 62
Pretty easy to spot the tattoo-sleeved, cranial-pierced, hipster baristas with no productive skills in here as they are manically demanding that everyone else go to work. After all, they cannot go back to slinging idiot-proof pre-measured lattes until real working people are out and about, so they shriek for everyone else to go back to normal.

But isn't the current situation just a huge basket of opportunities for real bold entrepreneurs? If one is some hero type like the guy above who has "given up following the 'rules'" , then the marketplaces are theirs for the taking, what with all of the competition shut down. If one wants the capitalists' economy to be "re-opened" , then they need to be like the fabled entrepreneurs that worked for their wealth and take the initiative oneself instead of demanding that others do it for them.

Or are the whiners demanding that the economy be "re-opened" really just kids wishing their parents would go back to work because that is who actually pays the rent on their hipster apartments?

Something these individuals will have to confront is that things are never "going back to normal" . A new normal is being born, and it ain't very normal.

[May 10, 2020] Can pulse oximeters detect coronavirus How they work and more by Dale Smith

Notable quotes:
"... According to the Mayo Clinic, a normal pulse oximeter oxygen level reading is between 95% and 100% , and anything less than 90% is considered dangerously low, or hypoxic. Some doctors have reported COVID-19 patients entering the hospital with oxygen levels at 50% or below . ..."
May 08, 2020 | www.cnet.com

Some doctors are recommending these small, inexpensive devices to help monitor symptoms.

A pulse oximeter attaches to a finger and uses light to detect the level of oxygen in your blood.

As coronavirus testing efforts continue to ramp up and face masks are now a part of everyday life, a small diagnostic tool that clips to the tip of your finger is fast becoming a must-have gadget in the fight against the coronavirus . It's called a pulse oximeter, and it painlessly checks your blood oxygen level, which can be affected by lung diseases such as COVID-19.

The device was already starting to surge in popularity as word got around that people with the coronavirus frequently arrive at the hospital with abnormally low oxygen levels . After an op-ed piece in The New York Times recommended the use of pulse oximeters to detect a frightening condition called "silent hypoxia," sales of the devices skyrocketed . Many models are sold out or on lengthy backorder online. Same with brick-and-mortar drug stores, supermarkets and box stores.

[May 10, 2020] Monoclonal antibodies Drug inspired by an old treatment could be 'next big thing for Covid-19' - CNN

May 10, 2020 | www.cnn.com

At least five US teams have cloned antibodies to Covid-19, paving the way for cutting-edge treatments that could be what one researcher calls "an immunity bridge" before a vaccine comes along. The treatment is monoclonal antibody therapy, and the antibodies come from people who have recovered from the novel coronavirus. Researchers then take the blood, select the most potent antibodies, and make them into a drug. One company, Regeneron Pharmaceuticals, hopes to have a treatment available to patients as early as the end of the summer. "I think monoclonal antibody therapy has enormous promise as the next big thing for Covid-19," said Dr. Peter Hotez, a vaccine specialist at Baylor University School of Medicine who is not involved in the research. Monoclonal antibody therapy is a modern take on convalescent plasma, where someone who has recovered from coronavirus donates blood to someone who is currently ill. Read More Even if convalescent plasma is effective -- it's still being studied -- it has two shortcomings. First, one person can only give so much blood. Second, the donor might not have enough strong antibodies for the blood donation to be effective. To develop a monoclonal antibody treatment, researchers cull through thousands of antibodies to find the best ones, and then clone them potentially in unlimited amounts. Many other illnesses are treated with monoclonal antibodies, such as various forms of cancer, HIV, asthma, lupus, multiple sclerosis and various forms of cancer, but of course there's no guarantee it could work for Covid-19. What happens if a coronavirus vaccine is never developed? It has happened before <img alt="What happens if a coronavirus vaccine is never developed? It has happened before" src="//cdn.cnn.com/cnnnext/dam/assets/200428210047-coronavirus-new-york-0320-large-169.jpg"> What happens if a coronavirus vaccine is never developed? It has happened before "One of the things about the search is it's a little bit like finding a needle in a haystack. We're all searching for the magical antibody that's a silver bullet," said Dr. James Crowe, who's leading the Covid-19 monoclonal antibody effort at Vanderbilt University Medical Center. Regeneron is hoping to start clinical trials for an antibody treatment for coronavirus in humans as soon as next month, and if everything goes right, perhaps have a treatment ready for widespread distribution by the end of the summer. "We generated thousands of [antibodies] and then selected the most powerful and potent ones to grow up into an antibody cocktail," said company president Dr. George Yancopoulos. Like any treatment under development, it might not pan out. But if it does, it could treat coronavirus and possibly also prevent infection for a period of time. A vaccine would likely offer longer lasting immunity, but that would likely take longer to develop, with the earliest estimates set at January. "I think antibodies will be finished first, and will be the bridge toward longer immunity, which will be conferred by vaccines," said Crowe, director of the Vanderbilt Vaccine Center at Vanderbilt University Medical Center. 'A guided nuclear warhead' In mid-January, researchers at the Rockefeller University in New York City heard from the National Institutes of Health: Get to work because we hope to have coronavirus antibodies cloned by the spring. About two months later, Rockefeller researcher Jill Horowitz found herself handing out fliers outside a supermarket in New Rochelle, New York, inviting people who'd recovered from coronavirus to learn more about the Rockefeller study. They won the fight against coronavirus. Here&#39;s what life looks like on the other side <img alt="They won the fight against coronavirus. Here&amp;#39;s what life looks like on the other side" src="//cdn.cnn.com/cnnnext/dam/assets/200416042613-03-coronavirus-recovery-large-169.jpg"> They won the fight against coronavirus. Here's what life looks like on the other side The city -- and in particular one synagogue -- had been hit hard by a coronavirus outbreak. "I'm Jewish, and I'm Orthodox, and I know people at Young Israel. I have friends in New Rochelle. Our kids went to school together, so I could go into the community and make my case," said Horowitz, executive director of strategic operations in the immunology laboratory at Rockefeller. In all, more than 100 people donated blood for the study, many of them from the New Rochelle community. Some of their stories will be told in an upcoming documentary, " Rebel Blood The Race to Cure Covid-19 ." The lead scientist in Rockefeller's monoclonal antibody effort compares it to battle, noting that convalescent plasma has been used for more than a century. "If you're thinking about a war, and you're fighting a war with a drug that came out of the early part of the 20thcentury, the monoclonal antibody is like a guided nuclear warhead in comparison," said Dr. Michel Nussenzweig, a professor at Rockefeller. Research by several US teams Several other US teams also say they've cloned antibodies, including Vanderbilt, Regeneron, Lilly Pharmaceuticals and Distributed Bio. Regeneron anticipates starting clinical trials next month and hopes to provide "hundreds of thousands of doses" to patients by the end of the summer, Yancopoulos said. The company already makes monoclonal antibodies for several illnesses, including cancer, arthritis and asthma. "We're using the same exact technology now to come up with a specific tailored approach against Covid-19," Yancopoulos said. Get CNN Health's weekly newsletter Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team. Other companies gave a longer timeline. For example, Crowe, the doctor at Vanderbilt, said he anticipates it will be around the first quarter of next year before his team might have a Covid monoclonal antibody treatment ready to distribute. He said it's a good sign that several teams are working on monoclonal antibodies. "I think the more groups we have working on it, all the better, and the more shots on goal we have for getting an effective prevention or treatment," he said.

CNN's Dr. Minali Nigam, Devon Sayers and Wes Bruer contributed to this report.

[May 09, 2020] Is Fauci corrupt? The story of Remdesevir approval suggest that YES.

Does Dr Fauci enjoy indirect financial ties to Gilead? Does he own the stock?
Notable quotes:
"... Basically, this was a negative trial. Of the 255 patients screened, 237 met the eligibility criteria, and 158 were assigned to the remdesivir group, with 79 assigned to placebo control. Unfortunately, remdesivir treatment was not associated with a shorter time to clinical improvement, and mortality was not different between the two groups. ..."
"... It does look very fishy to me. Endpoint or outcome switching, particularly late in a clinical trial is a huge red flag. ..."
"... There are also other reasons to question this trial, including how no confidence intervals were reported, that not even an abstract was published, just a press release with, as Heathers put it, "two results in four lines": ..."
"... I remain very suspicious that the NIH study was announced the same day that a negative study out of China of remdesivir was published. It just seems too convenient. Maybe I'm being overly suspicious. Maybe I'm too suspicious. Maybe I'm falling prey to conspiracy mongering. However, in the Trump era, when the Trump administration has politicized previously (mostly) apolitical government agencies as never before, it's hard not to wonder. ..."
"... He was unimpressed by remdesivir's modest benefit. "It was expected to be a whopping effect," Topol added. "It clearly does not have that." ..."
"... Indeed, given that the pre-test probability of remdesivir having a significant effect was low, meaning that this trial is probably just noise: ..."
"... But Gilead will make billions and billions of dollars ..."
"... Could Anthony Fauci explain why the investigators of the NIAID remdesivir trial did change the primary outcome during the course of the project (16th April)? Removing "death" from primary outcome is a surprising decision. ..."
"... The most common adverse effects in studies of remdesivir for COVID-19 include respiratory failure and blood biomarkers of organ impairment, including low albumin, low potassium, low count of red blood cells, low count of platelets that help with clotting, and yellow discoloration of the skin. Other reported side effects include gastrointestinal distress, elevated transaminase levels in the blood (liver enzymes), and infusion site reactions. ..."
"... So, if it does shorten duration, is it worth potential liver damage, respiratory failure and organ impairment? In other words is the cure potentially as bad as the disease. ..."
"... For yet another drug that was supposed to be a game changer, I am unimpressed by its results. The whole mechanism is wrong. A drug with this mechanism would need to be almost a prophylactic for it to be hugely effective. ..."
"... Fauci didn't seem to have any problem cautioning against unwarranted optimism for CQ/HCQ even while DJT was championing the stuff. What is different about this? . ..."
"... So, what did Fauci say about chloroquine? ""We've got to be careful that we don't make that majestic leap to assume that this is a knockout drug. We still need to do the kinds of studies that definitely prove whether any intervention is truly safe and effective," Fauci, who is also a member of the White House coronavirus task force, said during an interview on "Fox & Friends. . . "We don't operate on how you feel, we operate on what evidence and data is," Fauci said, adding that it was "not a very robust study" or "overwhelmingly strong."" (Concha, 2020 Apr 3) ..."
"... Now, what did he say about Remdesivir: "Speaking to reporters from the White House, Fauci said he was told data from the trial showed a "clear-cut positive effect in diminishing time to recover." Fauci said the median time of recovery for patients taking the drug was 11 days, compared with 15 days in the placebo group. He said the mortality benefit of remdesivir "has not yet reached statistical significance." ..."
"... Disappointingly, the lock down seems to have made a number of people irrational. Just a quick post to expound on my Fauci post for those who see the world as binary – ie: black or white. These people think you either support Fauci 100% or 0% and a single criticism of any Fauci statement means 0% support of Fauci. I do not happen to worship at the altar of Fauci or any scientist and recognize all are subject to errors – including myself. I view the world in a more nuanced manner than those with the black/white delusion. I find I can disagree with some things a person says or stands for and agree with some other things they say or do. ..."
"... I am of the opinion that Fauci made a mistake here. The evidence for Remdesiver is nowhere near good enough for it to become the standard of care. ..."
"... On the other hand, watching the White House performance from afar, I can see the administration is dysfunctional and is run by a narcissistic bully, who will publicly turn on anyone who disagrees with them. ..."
"... I believe that is the main thrust of this Orac article – that the evidence for Remdesiver efficacy is sorely lacking. ..."
May 09, 2020 | respectfulinsolence.com
Remdesivir: Gilead wins with unimpressive results announced by press release On Wednesday, Dr. Anthony Fauci announced positive results for the antiviral drug remdesivir treating COVID-19. They were unimpressive and, suspiciously, announced by press release rather than scientific paper. It's all very fishy, but one thing's for sure. Gilead Sciences will make boatloads of money. I've been writing a lot about the unjustified and premature hype over hydroxychloroquine, an anti-malarial drug with mild immunosuppressive activity that is also used to treat rheumatoid arthritis and other autoimmune diseases and how the drug probably doesn't work against COVID-19, despite its being hyped by President Trump and his sycophants, toadies, and lackeys on Fox News, Dr. Mehmet Oz , Dr. Phil , Dr. Didier Raoult , and a bevy of irresponsible fame seeking doctors who have no idea how to do a proper clinical study.

There are, however, other drugs being hyped out there, drugs that might actually have a better chance of turning out to be effective treatments for COVID-19. Chief among these is remdesivir, the experimental antiviral drug being tested by Gilead Sciences.

Remdesivir is an adenosine (a nucleotide) analog that inhibits viral RNA polymerases. It is incorporated into RNA made by the virus, causing the premature termination of the RNA molecule, thus interfering with viral replication. The drug was originally developed to treat Ebola and Marburg but was ultimately found to be ineffective against these viruses . Because it inhibits the replication of a number of RNA viruses, it was only natural that it would be considered as a possible treatment for COVID-19, and Gilead has been relentlessly promoting it as such as the company has been working to carry out clinical trials.

What prompted me to write about remdesivir were headlines like Dr. Anthony Fauci says Gilead's remdesivir will set a new 'standard of care' for coronavirus treatment that started popping up on Wednesday afternoon:

White House health advisor Dr. Anthony Fauci said Wednesday that data from a coronavirus drug trial testing Gilead Sciences' antiviral drug remdesivir showed "quite good news" and sets a new standard of care for Covid-19 patients.

Speaking to reporters from the White House, Fauci said he was told data from the trial showed a "clear-cut positive effect in diminishing time to recover."

Fauci said the median time of recovery for patients taking the drug was 11 days, compared with 15 days in the placebo group. He said the mortality benefit of remdesivir "has not yet reached statistical significance."

The results suggested a survival benefit, with a mortality rate of 8% for the group receiving remdesivir versus 11.6% for the placebo group, according to a statement from the National Institutes of Health released later Wednesday.

"This will be the standard of care," Fauci, director of the National Institute of Allergy and Infectious Diseases, added. "When you know a drug works, you have to let people in the placebo group know so they can take it."

My skeptical antennae started twitching immediately, because on the same day a study from China was published in The Lancet that was far less impressive. In fact, it was a negative trial. What also got my skeptical antennae all aflutter twitching away was how the results of the remdesivir trial were announced. Normally, when a study is announced to the press, it's upon publication of the paper, and the press release is issued either the same day or the evening before publication. As of last night, as I wrote this, however, the actual paper reporting the results of the clinical trial had not yet been published. As I perused Twitter on Wednesday, I found even more reasons for skepticism.

So, before I get to the study touted by Dr. Fauci, let's review some history.

Remdesivir: The early days versus COVID-19 (like, you know, three weeks ago)

The first data published on remdesivir was a single-arm uncontrolled trial that somehow got published three weeks ago in The New England Journal of Medicine . This was peak COVID-19 publishing, when an uncontrolled case series of patients with severe COVID-19 treated with remdesivir under compassionate was published in a super high impact journal like NEJM and made headlines as a result. Be that as it may, the case series examined 61 patients with confirmed SARS-CoV-2 infection who had an oxygen saturation of 94% or less while they were breathing room air or who were receiving oxygen support. They received a 10-day course of remdesivir, consisting of 200 mg given intravenously on day 1, followed by 100 mg daily for the remaining 9 days of treatment. (Remdesivir is an intravenous drug.) The authors reported clinical improvement in 68% of evaluable patients:

Of the 61 patients who received at least one dose of remdesivir, data from 8 could not be analyzed (including 7 patients with no post-treatment data and 1 with a dosing error). Of the 53 patients whose data were analyzed, 22 were in the United States, 22 in Europe or Canada, and 9 in Japan. At baseline, 30 patients (57%) were receiving mechanical ventilation and 4 (8%) were receiving extracorporeal membrane oxygenation. During a median follow-up of 18 days, 36 patients (68%) had an improvement in oxygen-support class, including 17 of 30 patients (57%) receiving mechanical ventilation who were extubated. A total of 25 patients (47%) were discharged, and 7 patients (13%) died; mortality was 18% (6 of 34) among patients receiving invasive ventilation and 5% (1 of 19) among those not receiving invasive ventilation.

The case series also did not collect viral load data to confirm potential antiviral activity in humans or any association between declines in viral load and clinical improvement. Basically, when you get right down to it, this study was not really much better than Didier Raoult's crappy study of his hydroxychloroquine/azithromycin combination, but that didn't stop the authors from concluding that comparisons with contemporaneous cohorts "suggest that remdesivir may have clinical benefit in patients with severe Covid-19." In reality, like Raoult's trials, this trial said nothing about the efficacy of remdesivir against COVID-19 other than that the drug could be given to COVID-19 patients with a reasonable safety profile.

Less than week later, as related by Derek Lowe , came news that two clinical trials of remdesivir in China, one for severe disease and one for moderate disease had been suspended. (They still are.) Lowe noted that both trials had the notice: "The epidemic of COVID-19 has been controlled well at present, no eligible patients can be recruited." The apparent explanation was "the stringent inclusion criteria for the trials – apparently patients had to have no previous therapy with any other experimental agent to enroll, and that eliminates a lot of people." Around the same time, Adam Feuerstein and Matthew Herper published a story in STAT, Early peek at data on Gilead coronavirus drug suggests patients are responding to treatment :

The University of Chicago Medicine recruited 125 people with Covid-19 into Gilead's two Phase 3 clinical trials. Of those people, 113 had severe disease. All the patients have been treated with daily infusions of remdesivir.

"The best news is that most of our patients have already been discharged, which is great. We've only had two patients perish," said Kathleen Mullane, the University of Chicago infectious disease specialist overseeing the remdesivir studies for the hospital.

Her comments were made this week during a video discussion about the trial results with other University of Chicago faculty members. The discussion was recorded and STAT obtained a copy of the video.

Derek Lowe discussed this story in depth, and I largely agree with him that the leak of the video to STAT was a serious breach of clinical trial ethics and protocol. (I'm not alone in suspecting that it was almost certainly intentional to jack up Gilead's stock price, a result that was achieved.) Lowe also noted:

But now that it's out there, let's talk about what's in the leak. Gilead stock jumped like a spawning salmon in after-market trading on this, and one of the reasons was that that 113 of the 125 patients were classed as having "severe disease". People ran with the idea that these must have been people on ventilators who were walking out of the hospital, but that is not the case. As AndyBiotech pointed out on Twitter, all you had to do was read the trial's exclusion criteria : patients were not even admitted into the trial if they were on mechanical ventilation. Some will have moved on to ventilation during the trial, but we don't know how many (the trial protocol has these in a separate group).

Note also that this trial is open-label; both doctors and patients know who is getting what, and note the really key point: there is no control arm. This is one of the trials mentioned in this post on small-molecule therapies as being the most likely to read out first, but it's always been clear that the tradeoff for that speed is rigor. The observational paper that was published on remdesivir in the NEJM had no controls either, of course, and that made it hard to interpret. Scratch that, it made it impossible to interpret. It will likely be the same with this trial – the comparison is between a five-day course of remdesivir and a ten-day course, and the primary endpoint is the odds ratio for improvement between the two groups.

Again, these data, such as they are, are no more useful than Didier Raoult's data on hydroxychloroquine and azithromycin to treat COVID-19, but this brings us to the Chinese trial published in The Lancet on Wednesday.

The Chinese randomized clinical trial

The Chinese trial published two days ago is the first randomized, double-blind, placebo-controlled clinical trial of remdesivir to treat COVID-19, but it was also one of the studies halted. Eligible patients were adults admitted to the hospital with laboratory-confirmed SARS-CoV-2 whose symptoms had lasted less than 12 days before enrollment and who had an oxygen saturation on room air of 94% or less or a ratio of arterial oxygen partial pressure to fractional inspired oxygen of 300 mm Hg or less (another measure of hypoxia), and radiologically confirmed pneumonia.

Patients were randomly assigned in a 2:1 ratio to intravenous remdesivir at the same dose as the NIH trial touted by Dr. Fauci or the same volume of placebo infusions for 10 days and were permitted concomitant use of lopinavir–ritonavir, interferons, and corticosteroids. The primary endpoint was time to clinical improvement up to day 28, defined at the time from randomization to the point of a decline of two levels on a six-point ordinal scale of clinical status (from 1=discharged to 6=death) or discharged alive from hospital, whichever came first. An intention-to-treat analysis was carried out.

Basically, this was a negative trial. Of the 255 patients screened, 237 met the eligibility criteria, and 158 were assigned to the remdesivir group, with 79 assigned to placebo control. Unfortunately, remdesivir treatment was not associated with a shorter time to clinical improvement, and mortality was not different between the two groups. Subgroup analysis looking for hypotheses found that there was a trend towards a shorter duration of symptoms (not statistically significant) in patients treated with remdesivir who had had symptoms for less than ten days. Most disappointingly, there was no detectable difference in viral load between the remdesivir groups and the placebo controls. Again, basically this was a negative study with only the barest hint that remdesivir might -- I repeat, might -- work if administered earlier in the course of COVID-19. That's some pretty thin gruel.

Which brings us to the NIH trial of remdesivir touted by Anthony Fauci.

The NIH press release for its remdesivir trial.

The results of the NIH remdesivir trial can, unfortunately, only be gleaned from the press release and news stories so far:

For the first time, a major study suggests that an experimental drug works against the new coronavirus, and U.S. government officials said Wednesday that they would work to make it available to appropriate patients as quickly as possible.

In a study of 1,063 patients sick enough to be hospitalized, Gilead Sciences's remdesivir shortened the time to recovery by 31% -- 11 days on average versus 15 days for those just given usual care, officials said. The drug also might be reducing deaths, although that's not certain from the partial results revealed so far.

"What it has proven is that a drug can block this virus," the National Institutes of Health's Dr. Anthony Fauci said.

"This will be the standard of care," and any other potential treatments will now have to be tested against or in combination with remdesivir, he said.

Here is the press release , posted to the National Institute of Allergy and Infectious Diseases website:

Hospitalized patients with advanced COVID-19 and lung involvement who received remdesivir recovered faster than similar patients who received placebo, according to a preliminary data analysis from a randomized, controlled trial involving 1063 patients, which began on February 21. The trial (known as the Adaptive COVID-19 Treatment Trial, or ACTT), sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is the first clinical trial launched in the United States to evaluate an experimental treatment for COVID-19.

An independent data and safety monitoring board (DSMB) overseeing the trial met on April 27 to review data and shared their interim analysis with the study team. Based upon their review of the data, they noted that remdesivir was better than placebo from the perspective of the primary endpoint, time to recovery, a metric often used in influenza trials. Recovery in this study was defined as being well enough for hospital discharge or returning to normal activity level.

Preliminary results indicate that patients who received remdesivir had a 31% faster time to recovery than those who received placebo (p<0.001). Specifically, the median time to recovery was 11 days for patients treated with remdesivir compared with 15 days for those who received placebo. Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group (p=0.059).

More detailed information about the trial results, including more comprehensive data, will be available in a forthcoming report. As part of the U.S. Food and Drug Administration's commitment to expediting the development and availability of potential COVID-19 treatments, the agency has been engaged in sustained and ongoing discussions with Gilead Sciences regarding making remdesivir available to patients as quickly as possible, as appropriate. The trial closed to new enrollments on April 19. NIAID will also provide an update on the plans for the ACTT trial moving forward. This trial was an adaptive trial designed to incorporate additional investigative treatments.

As you can see, the difference in mortality was not statistically significantly different, although that could just be because of inadequate numbers. It's also very important to note the part about the adaptive trial design of this trial, which puts Dr. Fauci's comment about how remdesivir will become the "standard of care" going forward into the proper context. In this particular trial , multiple different drugs can be compared to placebo or standard of care. The idea is that, if a signal of efficacy is found with one drug, that drug becomes "standard of care" and the trial is adapted to study how adding other experimental drugs compares to the "standard of care." So what Dr. Fauci meant was that, based on the finding, going forward remdesivir will become the "standard of care" arm for the trial and the experimental arm will become remdesivir plus another experimental therapeutic. However, given that the FDA is on the verge of issuing an emergency use authorization for remdesivir to treat COVID-19, it looks as though remdesivir will become standard-of-care in general soon.

But back to the results. Derek Lowe observed:

it's worth noting that had there been "clear and substantial evidence of a treatment difference" during the trial that the DSMB was to have halted the study at that point. We can infer that nothing rose to that level, then: we have a difference, but not substantial enough to have ended the trial prematurely.

It's also worth noting some things posted on Twitter about the trial. For instance, Waller Gellad noted:

Since NIH remdesivir trial is in the news

was there an explanation about why the primary outcome (now positive) was changed last month to 'time until clinical recovery?' @matthewherper https://t.co/fCTc1EGI1d pic.twitter.com/W1hAACnO1r

-- Walid Gellad, MD MPH (@walidgellad) April 29, 2020

It's very odd that the primary endpoint was changed:

Thread that summarizes my concerns with Remdesivir press release (not science) as well.

Changing the endpoint midtrial this way is like hosting a race for one destination then declaring wherever you end up after running for an hour is the finish line. https://t.co/XMUXYW3njp

-- Mark Hoofnagle (@MarkHoofnagle) April 30, 2020

This long Twitter thread explains:

Here's Fauci talking about it. Give him a listen, sharpen your ears at about 0.30.

"The primary endpoint was the time to recovery, namely the ability to be discharged."

He's right, it was.

On April 16th. https://t.co/U6Cx3XSOJ6

-- 🏴James Heathers 🏴 (@jamesheathers) April 30, 2020

I'll summarize, so that you don't have to scroll through a Twitter thread if you don't want to. As James Heathers and Waller Gellad noted, the original primary outcome of the trial when it was registered on March 20. The original primary endpoint of the trial was an 8-point severity scale (death, on ventilator, hospitalized with oxygen, all the way down to discharged with no limits on activity) but was changed to time to recovery. There's still a similar scale for the secondary endpoints, but no numbers for that were reported. (Any bets on whether the results are negative?) This change was apparently made on or around April 16.

Gellad also notes:

last thing:
Here is the results table for the negative lancet trial of remdesivir. The highlighted results are what the primary outcome for the NIH trial was until 2 weeks ago. https://t.co/niQ65zgLF2

We need to see that outcome, in addition to time until recovery. pic.twitter.com/ptXGhPx13N

-- Walid Gellad, MD MPH (@walidgellad) April 30, 2020

It does look very fishy to me. Endpoint or outcome switching, particularly late in a clinical trial is a huge red flag. Don't get me wrong. There can be legitimate scientific reasons to switch primary endpoints of a trial. as James Heathers puts it:

Sometimes it becomes clear after you start that the registration is incomplete or wrong. Sometimes you have a better idea after you start. Sometimes your thinking changes.

Other times, you're trying to cherry-pick the results.

-- James Heathers 🏴 (@jamesheathers) April 30, 2020

There are also other reasons to question this trial, including how no confidence intervals were reported, that not even an abstract was published, just a press release with, as Heathers put it, "two results in four lines":

(2) the results in the press release. I call this 'two results, four sentences' – press releases describe the results in incredibly brief terms, usually the two most positive outcomes w the briefest explanation possible. He's me bitching about it earlier. https://t.co/FQlaAQaytG

-- James Heathers 🏴 (@jamesheathers) April 30, 2020

Basically, if you have two "good" results and twenty "bad" or uninterpretable results, what do you do? What are you going to tell people? The two "good" results, of course!

Gary Schwitzer has a nice summary of the negative reactions to the trial and how it was announced.

The bottom line

I remain very suspicious that the NIH study was announced the same day that a negative study out of China of remdesivir was published. It just seems too convenient. Maybe I'm being overly suspicious. Maybe I'm too suspicious. Maybe I'm falling prey to conspiracy mongering. However, in the Trump era, when the Trump administration has politicized previously (mostly) apolitical government agencies as never before, it's hard not to wonder.

Adding to my suspicion is the fact that the study was reported in a press release, rather than being published, which makes me wonder if the press release was written to counter the negative study from China that would certainly have tanked Gilead's stock prices. Yes, I know that the press release reported that this decis, apparently the announcement was decided upon after April 27 meeting of the data and safety monitoring board overseeing this trial, but the outcome switching so late in the trial makes me very suspicious. Yes, the explanation, which should have been in the press release, along with an acknowledgment that the primary outcome/endpoint had been changed, but wasn't is not unreasonable:

NIAID explains why endpoint of remdesivir trial was changed: pic.twitter.com/Zpl08nd4PL

-- Meg Tirrell (@megtirrell) April 30, 2020

Then there was this news report in which Fauci claimed that concerns about leaks fueled the announcement:

He expressed concern that leaks of partial information would lead to confusion. Since the White House was not planning a daily virus briefing, Fauci said he was invited to release the news at a news conference with Louisiana Gov. John Bel Edwards(D). "It was purely driven by ethical concerns," Fauci told Reuters in a telephone interview.

"I would love to wait to present it at a scientific meeting, but it's just not in the cards when you have a situation where the ethical concern about getting the drug to people on placebo dominates the conversation."

An independent data safety and monitoring board, which had looked at the preliminary results of the NIAID trial, determined it had met its primary goal of reducing hospital stays.

On Tuesday evening, that information was conveyed in a conference call to scientists studying the drug globally.

"There are literally dozens and dozens of investigators around the world," Fauci said. "People were starting to leak it." But he did not give details of where the unreported data was being shared.

I smell bullshit here. What probably really happened is that he was under enormous pressure to release the results. It was also unwise to discuss the results with so many scientists until the manuscript reporting the results of the trial had at least been submitted for publication. I agree with the scientists who had "expected it [the trial data] to be presented simultaneously in a detailed news release, a briefing at a medical meeting or in a scientific journal, allowing researchers to review the data." I also agree with Dr. Eric Topol, referring to the Chinese RCT and this one:

"That's the only thing I'll hang my hat on, and that was negative," said Dr. Eric Topol, director and founder of the Scripps Research Translational Institute in La Jolla, California.

He was unimpressed by remdesivir's modest benefit. "It was expected to be a whopping effect," Topol added. "It clearly does not have that."

Indeed, given that the pre-test probability of remdesivir having a significant effect was low, meaning that this trial is probably just noise:

Unfortunately, by the time you are symptomatic with a virus, you are usually already high/peak viral load. So, when you give an antiviral to someone who is already ill, the damage from the virus is largely done. It's there in big numbers and in the cells.

-- Mark Hoofnagle (@MarkHoofnagle) May 1, 2020

Indeed, I'm not only unimpressed with the modest benefit reported, I question whether there really was any benefit at all, particularly in light of the Chinese trial, which found zero difference in viral load in the remdesivir group.

The whole thing looks damned fishy, and we can't judge the study until it's actually published. Meanwhile, whatever the true reasons for releasing the study results this way, mission accomplished. The negative effect of the Chinese study on Gilead's stock price was successfully countered and remdesivir becomes a de facto standard of care for patients hospitalized with COVID-19. Worse, no further trials of remdesivir versus placebo will be possible, because it's been declared that remdesivir "works" against COVID-19 and is the new standard of care! As Mark Hoofnagle put it in a great Twitter thread, that echoes my thoughts:

By the end of the day, reports that FDA is going to emergently approve remdesivir for treatment of COVID.

Gilead gets what they want. No one will want to be in a control arm in further trials and they will argue all future trials must be noninferiority.

-- Mark Hoofnagle (@MarkHoofnagle) May 1, 2020

Absolute genius. You have to salute them. On the day a negative trial of their drug is reported, based on a press release they took over the news cycle, and with some midstream edits to their endpoints their now "positive" trial wins them FDA approval and a halted trial.

-- Mark Hoofnagle (@MarkHoofnagle) May 1, 2020

It's worse than that. If remdesivir is now the "standard of care" for hospitalized COVID-19 patients, it now becomes unethical to randomize them to a placebo group testing ANY new drug for COVID-19. Trials will now have to compare remdesivir alone to remdesivir plus experimental drug. We'll probably never know now for sure if remdesivir is truly effective against COVID-19.

But Gilead will make billions and billions of dollars.

Related The FDA's emergency use authorization of chloroquine and hydroxychloroquine for COVID-19: Dangerous politics, not science

Yesterday, the FDA issued emergency use authorization for hydroxychloroqine and chloroquine to treat COVID-19. Politics, not science, is why.

By Orac Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski ...

John Kane says: May 2, 2020 at 8:52 am

In long twitter exchange mainly led by James Heathers, has anyone noticed that there are a series of tweets by Didier Raoult ?

One tweet reads:

Could Anthony Fauci explain why the investigators of the NIAID remdesivir trial did change the primary outcome during the course of the project (16th April)? Removing "death" from primary outcome is a surprising decision.

In a quick search of the web I found the following two:

WHAT ARE SIDE EFFECTS OF REMDESIVIR (RDV)?

In the Ebola trial, researchers noted side effects of remdesivir (RDV) that included:

Typical antiviral drug side effects include:

Nausea
Vomiting

Found at: https://www.rxlist.com/consumer_remdesivir_rdv/drugs-condition.htm

Side effects

The most common adverse effects in studies of remdesivir for COVID-19 include respiratory failure and blood biomarkers of organ impairment, including low albumin, low potassium, low count of red blood cells, low count of platelets that help with clotting, and yellow discoloration of the skin. Other reported side effects include gastrointestinal distress, elevated transaminase levels in the blood (liver enzymes), and infusion site reactions.

Other possible side effects of remdesivir include:

Infusion‐related reactions. Infusion‐related reactions have been seen during a remdesivir infusion or around the time remdesivir was given.[8] Signs and symptoms of infusion‐related reactions may include: low blood pressure, nausea, vomiting, sweating, and shivering.

Increases in levels of liver enzymes, seen in abnormal liver blood tests. Increases in levels of liver enzymes have been seen in people who have received remdesivir, which may be a sign of inflammation or damage to cells in the liver.

Found at: https://en.wikipedia.org/wiki/Remdesivir

So, if it does shorten duration, is it worth potential liver damage, respiratory failure and organ impairment? In other words is the cure potentially as bad as the disease.

And, as Orac and many commenters have made more than clear, one more example of Trump's government, ignoring science, and jumping to conclusions.

And once more I suggest reading the following:

Jeanne Lenzer and Shannon Brownlee (April 28, 2020). Pandemic Science Out of Control. Issues in Science and Technology. Available at: https://issues.org/pandemic-science-out-of-control/

Joel A. Harrison, PhD, MPH says: May 2, 2020 at 7:05 pm
ADDENDUM

I found the following: "Particular laboratory features have also been associated with worse outcomes (table 2). These include: Elevated liver enzymes"

Found at: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-clinical-features-diagnosis-and-prevention?search=coronavirus-disease-2019-covid-19- demiology-virology-clinical-features-diagnosis-and-prevention&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

So, one of the side-effects has been associated with worse outcomes. Not exactly a ringing endorsement of Remdesivir.

Chris Preston says: May 2, 2020 at 6:52 pm
For yet another drug that was supposed to be a game changer, I am unimpressed by its results. The whole mechanism is wrong. A drug with this mechanism would need to be almost a prophylactic for it to be hugely effective.
Tim says: May 3, 2020 at 11:33 am

One thing they discovered is that the proteins involved have zinc atoms incorporated into their structure. This won't surprise any biochemists, as zinc-containing proteins are common. But there's been a steady flow of fringe treatments for the disease -- including some involving chloroquine derivatives -- in which zinc was a key component. We'll have to see whether that changes now that it's clear that zinc is needed to make copies of the virus (assuming that fact registers at all with the people prone to promoting fringe therapies).

https://arstechnica.com/science/2020/05/scientists-get-an-atomic-level-look-at-how-a-drug-blocks-the-coronavirus/

What is that saying about zinc? I've always heard that zinc was a good thing to have a high intracellular level of it to protect against viruses besides also being needed to make NO.

https://arstechnica.com/science/2020/05/nih-cuts-coronavirus-funding-amid-trump-comments-and-conspiracy-theories/

Joel A. Harrison, PhD, MPH says: May 4, 2020 at 1:11 pm
@ Reality

So: "Fauci just dropped down a level or two in my estimation of his commitment to rationality."

Let's look at the "Reality": "America needs a federal government that assertively promotes and helps to coordinate that, not one in which experts like Tony Fauci and Deborah Birx tiptoe around a president's tender ego."

I wouldn't want to be in Fauchi's shoes. If he openly criticizes Trump, he is out and staying in allows him to have some effect. Damned if he does and damned if he doesn't. So, he has to balance his "committment to rationality" to trying to modify/reduce the insanity of Trump. If he resigned or was fired, could he have more of an influence? Maybe, maybe not. I would not want to be in his shoes! ! ! Personally, I would probably resign and try to get our media to listen to me. Just standing next to Trump would turn my stomach.

So, maybe you should live up to your "name" and evaluate "reality" not an idealistic world.

Reality says: May 4, 2020 at 2:22 pm
So you wouldn't say what Fauci said and would quit, eh, Joel?
I wouldn't say what Fauci said about "standard of care" which is basically his endorsement of this.
I believe Orac wouldn't make that statement endorsing Remdesivir as the "standard of care".
I don't know of any self-respecting scientist who would make such a statement no matter what the pressure.
If I was pressured by DJT I would object but maybe agree to not make any statement pro or con about the subject – so as to keep my position and influence but if someone asked me to say something I thought was not true I would not do it and refuse.
.
Fauci didn't seem to have any problem cautioning against unwarranted optimism for CQ/HCQ even while DJT was championing the stuff. What is different about this?
.

That is the Reality of this Fauci statement.

A. Harrison, PhD, MPH says: May 4, 2020 at 4:31 pm
@ Reality

You write: "Fauci didn't seem to have any problem cautioning against unwarranted optimism for CQ/HCQ even while DJT was championing the stuff. What is different about this?"

Yep; but the only studies promoting CQ/HCQ was a fraudulent one in France and an in vitro study.

What about Remdesivir? First it is a nucleic acid analogue designed to directly disrupt replication of the viral genome. Chloroquine/Hydroxychloroquine were not even remotely designed to target viruses, though they have a moderate dampening effect on immune reactions, so they work for autoimmune diseases (e.g., lupus, rheumatoid arthritis); but, as I wrote in a previous exchange, the immune response in an autoimmune disease compared to a cytokine storm is like comparing 20 mile per hour winds to a category 5 hurricane, 160 mph winds. In addition, chloroquine/hydroxychloroquine have a large number of mild side-effects and some really serious major ones.

So, what did Fauci say about chloroquine? ""We've got to be careful that we don't make that majestic leap to assume that this is a knockout drug. We still need to do the kinds of studies that definitely prove whether any intervention is truly safe and effective," Fauci, who is also a member of the White House coronavirus task force, said during an interview on "Fox & Friends. . . "We don't operate on how you feel, we operate on what evidence and data is," Fauci said, adding that it was "not a very robust study" or "overwhelmingly strong."" (Concha, 2020 Apr 3)

Now, what did he say about Remdesivir: "Speaking to reporters from the White House, Fauci said he was told data from the trial showed a "clear-cut positive effect in diminishing time to recover." Fauci said the median time of recovery for patients taking the drug was 11 days, compared with 15 days in the placebo group. He said the mortality benefit of remdesivir "has not yet reached statistical significance."

The results suggested a survival benefit, with a mortality rate of 8% for the group receiving remdesivir versus 11.6% for the placebo group, according to a statement from the National Institutes of Health released later Wednesday. "This will be the standard of care," Fauci, director of the National Institute of Allergy and Infectious Diseases, added. "When you know a drug works, you have to let people in the placebo group know so they can take it." "What it has proven is a drug can block this virus," he said. (Lovelace, 2020 Apr 29)

"The data shows that remdesivir has a clear-cut, significant, positive effect in diminishing the time to recovery," Fauci said at the White House on Wednesday. The data he referred to is from a large study of more than 1,000 patients from multiple sites around the world. Patients either received the drug, called remdesivir, or a placebo.

Dr. Michael Saag, associate dean for global health at the University of Alabama at Birmingham, said the results seemed promising. Antiviral drugs such as remdesivir tend to work earlier in the course of an illness, so "the thing that I think is important in this study is the patients had advanced disease," said Saag, who is not involved with any remdesivir trials. (NBC News (2020 Apr 29)

Hospitalized patients with advanced COVID-19 and lung involvement who received remdesivir recovered faster than similar patients who received placebo, according to a preliminary data analysis from a randomized, controlled trial involving 1063 patients, which began on February 21. The trial (known as the Adaptive COVID-19 Treatment Trial, or ACTT), sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is the first clinical trial launched in the United States to evaluate an experimental treatment for COVID-19.

An independent data and safety monitoring board (DSMB) overseeing the trial met on April 27 to review data and shared their interim analysis with the study team. Based upon their review of the data, they noted that remdesivir was better than placebo from the perspective of the primary endpoint, time to recovery, a metric often used in influenza trials [my emphasis]. Recovery in this study was defined as being well enough for hospital discharge or returning to normal activity level. . .

Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group (p=0.059). the group receiving remdesivir versus 11.6% for the placebo group (National Institute of Allergy and Infectious Diseases (2020 Apr 29).

So, first I'd bet you don't understand how nucleic acid analogues work?
Second, though I tend not to rely on one study, this one was fairly large and the shortening of time to recovery was clinically significant, "defined as being well enough for hospital discharge or returning to normal activity level." And Dr. Michael Saag: "Antiviral drugs such as remdesivir tend to work earlier in the course of an illness, so "the thing that I think is important in this study is the patients had advanced disease,"

Standard of Care is more a legal definition than a clinical one. Basically it reduces risk of malpractice lawsuits.

While I probably would not have called it "standard of care", instead clearly stating that based on the recent trial, it is currently the best we have to offer or something to that effect.

So, Fauci didn't call it a cure, didn't claim it reduced mortality, though indications it did, and based on over 1,000 patients, found it reduced hospitalization and return to normal life by a clinically significant margin, the standard used for flu studies. Again, I would have been more cautious in my working; but your rank attack on a man who knows more about infectious diseases that you, I, and many others, a man who has dedicated his life to preventing and dealing with them is just plain sickening. Your black and white view of Fauci is how antivaccinationists and other adherers to unscience see the world. And an MPH probably means a couple of lower level epidemiology courses. So, the old saying: A little knowledge is a dangerous thing, coupled with a personality that prefers a dichotomous world is very very problematic.

Only time and further studies will tell if Remdesivir really does shorten recovery time and, perhaps, also lowers mortality. Right now, we have nothing else and I wouldn't jump on something because of this; but the over 1,000 patient study isn't nothing.

Just to be clear, Orac's critique is valid; but, as he says, by this time one becomes perhaps overly skeptical given Trump's insanity. How cautious should Fauci have been? People are becoming desperate. The risks from Remdesivir are extremely low, so currently, either use it or continue as is.

If there were significant risks and the one study had been one a much smaller group, the scales would be different. And, though Orac is right they changed the outcome points, as mentioned, shortening of recovery time is a criterion used for treatment of flu, so, though not, perhaps, the best end-point, it is certainly not the same as some studies using endpoints such as lowered cholesterol without looking at deaths. They did look at deaths and though not significant, in the right direction. By the way, do you even understand significance levels? Though only one study, p=0.059 isn't far from p=0.05.

References:

Reality says: May 5, 2020 at 10:58 am
Disappointingly, the lock down seems to have made a number of people irrational. Just a quick post to expound on my Fauci post for those who see the world as binary – ie: black or white. These people think you either support Fauci 100% or 0% and a single criticism of any Fauci statement means 0% support of Fauci. I do not happen to worship at the altar of Fauci or any scientist and recognize all are subject to errors – including myself. I view the world in a more nuanced manner than those with the black/white delusion. I find I can disagree with some things a person says or stands for and agree with some other things they say or do.

My criticism of Fauci in regard to his remdesivir endorsement does not mean I have 0% support for Fauci it means that with that statement and some others my positive view of him is now ~80% but not 100% and I will have to check up on what he is endorsing to make sure that I agree with it just like I do with any other scientist/person.

BTW – If some were to check my Disqus account history (Reality022) you would find posts strongly defending Fauci against the Loony Libertarians who seem to think he is the debil.
.
Now to a second point:

There appears to be a group of Fauci apologists who, to excuse Fauci's statement, say it is due to 'pressure from Trump/the administration'.
I do not subscribe to this excuse and think it is a horrible thing to say for 2 reasons:

1) There is absolutely no evidence that this statement was made under pressure. That idea is totally invented in the minds of the Fauci apologists in their attempt to exonerate Fauci.

2) It is a horrible thing to say about Fauci. I take him at his word. If he said it he meant it. The excuse actually means that Fauci's word is so untrustworthy that he can be pressured into being dishonest about his scientific opinions and only the apologists can tell us when he is lying or actually relating his honest view. The apologists are basically saying Fauci is dishonest.

I have much more respect for the man and believe he is honest but in this case merely wrong.
.
That is all I'm going to say about this subject as some people are going off the rails with their binary view of the world. (snicker)

A. Harrison, PhD, MPH says: May 5, 2020 at 11:06 am

@ Reality

And you continue to miss the point that "Standard of Care" is mainly a legal term. Are you that dense? It is you who stated your opinion of Fauci sank, so your binary view of the world. Try reading my other comments, closely, maybe you will learn something; but I doubt it. "Reality", lacks reality testing. Reply

Preston says: May 5, 2020 at 8:18 pm

I tend to agree. I am of the opinion that Fauci made a mistake here. The evidence for Remdesiver is nowhere near good enough for it to become the standard of care. But then I am not the one having to make these decisions under difficult circumstances. I don't pretend to understand why Fauci might have made the comment, so don't see a lot of point in speculating about it.

On the other hand, watching the White House performance from afar, I can see the administration is dysfunctional and is run by a narcissistic bully, who will publicly turn on anyone who disagrees with them. I also see there are people within and around the White House who are happy to tell whatever lies they think Trump wants to hear, either through fear or hope for advancement. I understand why people would add 2 and 2 and come up with 5.

Reality says: May 5, 2020 at 9:28 pm
Chris Preston said, "I am of the opinion that Fauci made a mistake here. The evidence for Remdesiver is nowhere near good enough for it to become the standard of care."

I believe that is the main thrust of this Orac article – that the evidence for Remdesiver efficacy is sorely lacking.

Quoting Orac's article above: "In reality, like Raoult's trials, this trial said nothing about the efficacy of remdesivir against COVID-19 other than that the drug could be given to COVID-19 patients with a reasonable safety profile."
.
I agree with your 2nd paragraph and think that Fauci is not one of those administration toadies and is being honest and has merely made a mistake perhaps brought about through grasping-at-straws desperation as described in a current SBM article.

I, as well, do not know why Fauci made the statement but to me it is very disrespectful of the man to use as an excuse that he is dishonest enough to lie like a toady when pressured by Trump.

I think we are essentially in agreement about this matter.
Have fun.

Denice Walter says: May 5, 2020 at 10:05 pm
re dysfunctional administration.. narcissistic bully et al

It seems that the aforementioned will now " wind down" the Covid task force ( The Hill reports) but Drs Fauci and Birx will still be involved in some capacity.

AS though the battle is already won. Hah! CA and the NY area are reporting lower numbers of deaths and hospital admissions BUT whilst
other areas are increasing theirs.

Maybe the Orange One imagines that if we discuss Covid less, people will think it's gone, go back to work, buy stuff and the economy will flourish. Ignore it and it'll go away. Wishful thinking as usual.

Joel A. Harrison, PhD, MPH says: May 5, 2020 at 10:55 pm
@ Chris Preston

Apparently you lack understanding of English. As I explained even grandfathered in medical treatments with no hard scientific evidence are considered the standard of care, that is, if a doctor uses them he/she lessens risk of lawsuits. Standard of care doesn't mean a high level of scientific validity.

I guess I am wasting my time. Think of it this way, if allowed for compassionate use advised by ones doctor, then doctor may not be protected against lawsuits. Unfortunately, as something I read a long time ago, even in Colonial times Americans would rather sue than eat breakfast. Just one more sickness of American exceptionalism, so maybe, just maybe, all Fauci was doing was trying to reduce this risk.

Tim says: May 5, 2020 at 10:56 pm
No shit???

https://www.youtube.com/embed/KzRhcjOG1es?version=3&rel=1&fs=1&autohide=2&showsearch=0&showinfo=1&iv_load_policy=1&wmode=transparent

At least, he had the googles on; Wouldn't want him to get fibres in his eyes.,

Aarno Syvänen says: May 6, 2020 at 12:34 am
Not to mention that CDC closed the lab. So CDC is not part of great vaccine conspiracy, after all. Huge news, I would say. One could mention, too, that Johnson & Johnson get COVID vaccine contract. So Dorit Reiss' plots are not very effective, ater all. Reply
Natalie White says: May 6, 2020 at 10:30 am
Aarno, you made me curious about how much $$$$ and how many companies. A list of the Convid19, oops, I mean Covid19 cash! https://www.fool.com/investing/2020/04/07/here-are-all-the-companies-working-on-covid-19-vac.aspx
Natalie White says: May 9, 2020 at 10:20 am
@Aarno- Sometimes the CDC gets it right and sometimes, well .. sometimes you can't truss it. https://arstechnica.com/science/2020/04/cdcs-failed-coronavirus-tests-were-tainted-with-coronavirus-feds-confirm/

https://www.youtube.com/embed/am9BqZ6eA5c

Natalie White says: May 9, 2020 at 11:47 am
Aarno writes, "Not to mention that CDC closed the lab." Yes, sometimes they get it right. Then, they fail miserably like this https://www.the-scientist.com/news-opinion/cdc-lab-contamination-delayed-coronavirus-testing-67438

Confidence meter less than zero.

Natalie White says: May 6, 2020 at 9:40 am
Hmm . Problems with the Wuhan Lab and those nasty bats back in 2018. Just another coincidence, I suppose. Weird. So many coincidences. https://www.washingtonpost.com/opinions/2020/04/14/state-department-cables-warned-safety-issues-wuhan-lab-studying-bat-coronaviruses/ Reply
Joel A. Harrison, PhD, MPH says: May 6, 2020 at 2:18 pm
@ Natalie White

You write: Hmm . Problems with the Wuhan Lab and those nasty bats back in 2018. Just another coincidence, I suppose. Weird. So many coincidences."

From a recent article in the Atlantic:

scientists have also identified about 500 other coronaviruses among China's many bat species. "There will be many more -- I think it's safe to say tens of thousands," says Peter Daszak of the EcoHealth Alliance, who has led that work. Laboratory experiments show that some of these new viruses could potentially infect humans. SARS-CoV-2 likely came from a bat, too.

It seems unlikely that a random bat virus should somehow jump into a susceptible human. But when you consider millions of people, in regular contact with millions of bats, which carry tens of thousands of new viruses, vanishingly improbable events become probable ones. In 2015, Daszak's team found that 3 percent of people from four Chinese villages that are close to bat caves had antibodies that indicated a previous encounter with SARS-like coronaviruses. "Bats fly out every night over their houses.

Some of them shelter from rain in caves, or collect guano for fertilizer," Daszak says. "If you extrapolate up to the rural population, across the region where the bats that carry these viruses live, you're talking 1 [million] to 7 million people a year exposed." Most of these infections likely go nowhere. It takes just one to trigger an epidemic.

Ed Yong (2020 Apr 29). Why the Coronavirus Is So Confusing. Available at: https://www.theatlantic.com/health/archive/2020/04/pandemic-confusing-uncertainty/610819/

Note. he links to peer-reviewed journal articles. So, as the second paragraph makes clear, antibodies to bat coronaviruses exist in the population, etc. Add this to the sequencing of the genome that shows just how close it is to the 2003 SARS corona virus and to bat coronaviruses and, as usual, your moronic "coincidences" just lacks any validity.

Note also that his article links to many other good ones.

As I've written before, nature is quite capable of creating really nasty microbes.

Natalie White says: May 6, 2020 at 10:17 am

Oh this guy needs a dishonorable mention, Harvard traitor, Charles Leiber. "has received more than $15,000,000 in grant funding from the National Institutes of Health (NIH) and Department of Defense (DOD)." Our tax dollars hard at work for this POS.

Dude is still collecting a paycheck. https://www.justice.gov/opa/pr/harvard-university-professor-and-two-chinese-nationals-charged-three-separate-china-related Reply

Aarno Syvänen says: May 6, 2020 at 11:00 am

This is our guy:
Charles M. Lieber
Semiconductor nanowires: A platform for nanoscience and nanotechnology
MRS Bulletin
Volume 36, Issue 12 (Laser micro- and nanofabrication of biomaterials)December 2011 , pp. 1052-1063
DOI: https://doi.org/10.1557/mrs.2011.26
So COVID 19 was not involved. One should indeed not serve two masters, DOD and a Chinese university Reply
Joel A. Harrison, PhD, MPH says: May 6, 2020 at 4:48 pm
@ Natalie White

You write: "Hmm . Problems with the Wuhan Lab and those nasty bats back in 2018. Just another coincidence, I suppose. Weird. So many coincidences."

From a recent article by Ed Yong (2020 Apr 29). "Why the Coronavirus Is So Confusing: A guide to making sense of a problem that is now too big for any one person to fully comprehend." The Atlantic. Available at: https://www.theatlantic.com/health/archive/2020/04/pandemic-confusing-uncertainty/610819/

Note that he links to a number of excellent articles, including the two that the following is based on:

"scientists have also identified about 500 other coronaviruses among China's many bat species. "There will be many more -- I think it's safe to say tens of thousands," says Peter Daszak of the EcoHealth Alliance, who has led that work. Laboratory experiments show that some of these new viruses could potentially infect humans. SARS-CoV-2 likely came from a bat, too.

It seems unlikely that a random bat virus should somehow jump into a susceptible human. But when you consider millions of people, in regular contact with millions of bats, which carry tens of thousands of new viruses, vanishingly improbable events become probable ones. In 2015, Daszak's team found that 3 percent of people from four Chinese villages that are close to bat caves had antibodies that indicated a previous encounter with SARS-like coronaviruses. "Bats fly out every night over their houses. Some of them shelter from rain in caves, or collect guano for fertilizer," Daszak says. "If you extrapolate up to the rural population, across the region where the bats that carry these viruses live, you're talking 1 [million] to 7 million people a year exposed." Most of these infections likely go nowhere. It takes just one to trigger an epidemic."

So, 3 percent of people had antibodies to bat corona viruses. As the above explains, it is quite probable that the current virus came from someone infected by a bat. Now, since sequencing of the current SARS-Cov-2 has found its genome quite close to the 2003 SARS virus and to several bat coronavirus genomes, goes against your sick need to blame the Chinese. A coincidence is not even close to any type of proof, except in the mind of a moron like you looking to place blame. And there is a great book on "coincidences": David J. Hand (2014). "The Improbability Principle: Why Coincidences, Miracles, and Rare Events Happen Every Day." Basically, what someone might think is a rare coincidence isn't.

And, the major blame for what is happening in the U.S. is a combination of Trump and overall American unappreciation for Public Health and, thus, pandemic preparedness. When it comes to cutting funding, first to go.

I realize that real research, logic, etc. have NO effect on moron's like you; but, hopefully, others monitoring this exchange are open-minded.

And as Aarno pointed out, you attacked someone who had nothing to do with COVID. He worked with the Wuhan Institute of Technology; yep, in Wuhan and that's it. It's a large city dimwit. More importantly, he has been charged, not found guilty. I realize that the old adage innocent until proven guilty doesn't apply to anyone you chose to attack. You just don't know when to stop. YOU ARE DESPICABLE! Reply

[May 07, 2020] The Puzzling Questions of the Coronavirus: A Doctor Addresses 6 Questions That Are Stumping Physicians

Notable quotes:
"... Originally published at The Conversation ..."
"... Editor's Note: As researchers try to find treatments and create a vaccine for COVID-19, doctors and others on the front lines continue to find perplexing symptoms. And the disease itself has unpredictable effects on various people. Dr. William Petri, a professor of medicine at the University of Virginia Medical School, answers questions about these confusing findings. ..."
"... Even before symptoms arise ..."
"... Differences in susceptibility to a virus is one of the main working hypotheses regarding the disease Chronic Fatigue Syndrome (a.k.a. myalgic encephalomyelitis (ME), and systemic exertion intolerance disease (SEID). ..."
"... It is possible that the virus is spreading within crowded and substandard apartment complexes. One possible mechanism? Toilets, as an outbreak of SARs in 2003 demonstrated: https://www.cnn.com/2013/02/21/world/asia/sars-amoy-gardens/index.html ..."
"... In addition in poorly maintained buildings just going out in the hallways to put out your garbage, for example, might well expose a home bound residents to viruses lingering on common surfaces. ..."
"... The city of Hong Kong is even more crowded than New York, but last I checked its virus deaths and hospitalizations were much lower. ..."
"... This link has the slides Cuomo used plus more details: https://www.cnbc.com/2020/05/06/ny-gov-cuomo-says-its-shocking-most-new-coronavirus-hospitalizations-are-people-staying-home.html ..."
"... some aspect of their domiciles, such as plumbing or ventilation; or are they permitting non-household individuals to visit them. ..."
"... It would be interesting to see if there is a connection between the virus and apartments/co-living. ..."
"... Indians and Pakistani's in particular seem to have been hit very hard in the UK, and yet the same can't be said in their home countries. ..."
"... The drug, made by the US company Gilead Sciences, is an antiviral that was trialled in Ebola, but which failed to show benefits in Africa. ..."
"... Here is a study on an early transmission site in China, where incidents of infection seem to correlate to ventilated air flow in a restaurant: COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020 https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article ..."
"... Here is a not-yet-reviewed preprint of a study of two buses transporting attendees to and from an event in China. One bus (#2) had a suspected "index patient" (IP), the other didn't. https://twitter.com/zeynep/status/1255579524047220741 ..."
"... Interestingly, the conference itself produced few further cases, these were all traced to prolonged interactions with the IP. Generally with viruses, some critical mass of virions must accumulate in sufficient number to produce infection, and total net exposure may approximately correlate with severity. Untreated recirculated air bearing virus-laden droplets may lead to repeated exposure and increase concentration of virions in individuals. ..."
May 07, 2020 | www.nakedcapitalism.com

Yves here. While a list of coronavirus "known unknowns" is useful, I imagine most readers would have focused on other questions, like "When will we know how much if any immunity you get from contracting the virus?" However, this article likely reflects issues that seem to be coming up in layperson discussions .which in turn reflects the informational nuggets that attract media attention.

Originally published at The Conversation

Editor's Note: As researchers try to find treatments and create a vaccine for COVID-19, doctors and others on the front lines continue to find perplexing symptoms. And the disease itself has unpredictable effects on various people. Dr. William Petri, a professor of medicine at the University of Virginia Medical School, answers questions about these confusing findings.

Some evidence suggests that patients experience low oxygen saturation days before they appear in the ER. If so, is there a way to treat patients earlier?

Even before symptoms arise, people infected with SARS-CoV-2 show damage to their lungs. This is likely why low oxygen saturation – that is, below-normal oxygen levels in their blood – occurs before the patient goes to the ER . Restoring those levels to normal is presumed, though not proven, to be beneficial; giving patients supplemental oxygen via a nasal cannula, a flexible tube that delivers oxygen, placed just inside the nostrils, will restore oxygen to normal levels unless disease worsens to the extent that mechanical ventilation is needed.

Young adults are having strokes with COVID-19. Does this suggest the illness is more of a vascular disease than a lung disease in that age group ?

COVID-19 can be a devastating disease to multiple organs and systems in the body, including the vascular and immune systems. A lung infection is the primary cause of disease and death. There are examples of the clotting system being activated and causing strokes, perhaps caused by an immune system responding abnormally to COVID-19 .

The Centers for Disease Control and Prevention recently updated its official list of symptoms. Does this suggest anything unusual about COVID-19?

This new information is due to a greater number of infected individuals being studied . The update simply reflects a better understanding of the full spectrum of illness due to COVID-19, from asymptomatic to presymptomatic to severe and fatal infections.

How can so many people experience such mild symptoms and others quickly die from it?

One of the most fascinating aspects of these diseases is the huge difference that individuals experience with an infection. In our own research, we have found that many children in the U.S. infected with cryptosporidia have no symptoms, yet this parasite is a major killer of infants in the developing world. After an infection of SARS-CoV-2, the severity of the illness is likely due in part to how the patient's immune system responds; an overzealous immune response may cause death through what is called colloquially a " cytokine storm. ." We do not know yet if cytokine storms occur more in one group than another – for example, older versus younger.

The disease appears now to affect various other organs – heart and kidney, for example. What does this suggest?

What we know most clearly is that infection starts only in human cells with the ACE2 receptor – that is, in a cell that is capable of receiving the virus. That is present not only in the lungs, but in other cells as well, including those in the intestine and in the nasal mucosa, which lines the nasal cavity. When those cells are infected, the immune system is activated. A consequence is that both the heart and kidney are affected.

Why are some countries not experiencing as much COVID-19 as the U.S., Europe and China?

I think it's too early in the pandemic to know if certain countries or populations are relatively less susceptible. The younger overall age of a population could be a primary factor. Or perhaps the virus, so far at least, has not had time to spread more widely in these countries.


PlutoniumKun , May 7, 2020 at 10:12 am

I'd add that the FT has a very good free to read article on the 'unknowns' around the virus: From Blood Clots to 'Covid Toe', the Medical Mysteries of Coronavirus.

The Rev Kev , May 7, 2020 at 10:25 am

The thing about this virus is that it seems to be the Swiss Army knife of the virus world. Instead of a simple virus, as time goes along you find out that it has all sorts of weird and damaging effects in all sorts of places. And that just because you get it does not mean that the won't get the next strain.

We aren't even sure how to treat it and financial interest are clouding the search for a treatment. It is like we just can't get a handle on just what this virus really is or just what it does to the human body.

Synoia , May 7, 2020 at 11:41 am

The Eco-sphere strikes back? There are a lot of humans to infect, appears to the virus as a bountiful place to inhabit.

Lee , May 7, 2020 at 10:34 am

Differences in susceptibility to a virus is one of the main working hypotheses regarding the disease Chronic Fatigue Syndrome (a.k.a. myalgic encephalomyelitis (ME), and systemic exertion intolerance disease (SEID).

The assumption is that the symptoms represent a relatively rare immune system over-reaction in a relatively small percentage of the population to a viruses that in the vast majority of persons is part of their normal viral load producing no symptoms.

Hana M , May 7, 2020 at 10:50 am

Yet another puzzling note on Coronavirus transmission. Sixty-six percent of coronavirus hospital admissions in New York in a recent study cited by Gov. Cuomo, were people who had been staying home. Most of the cases were elderly, and either retired or unemployed. The vast majority had other conditions. And African-Americans and Hispanics were disproportionately affected. My apologies for not linking to the original study–I'm still trying to track it down.

https://www.forbes.com/sites/lisettevoytko/2020/05/06/majority-of-new-coronavirus-cases-in-new-york-are-from-people-staying-at-home-not-traveling-or-working/#792178af1655

It is possible that the virus is spreading within crowded and substandard apartment complexes. One possible mechanism? Toilets, as an outbreak of SARs in 2003 demonstrated: https://www.cnn.com/2013/02/21/world/asia/sars-amoy-gardens/index.html

In addition in poorly maintained buildings just going out in the hallways to put out your garbage, for example, might well expose a home bound residents to viruses lingering on common surfaces.

Bob Hertz , May 7, 2020 at 10:54 am

The city of Hong Kong is even more crowded than New York, but last I checked its virus deaths and hospitalizations were much lower.

Hana M , May 7, 2020 at 4:26 pm

Hong Kong and New York are completely different on so many levels apart from population density. The differences are more instructive than the similarities. Hong Kong had a devastating experience with the SARs coronovirus epidemic in 2003 so they had a much clearer idea what they were dealing with; much of the early response (masks, increased social hygiene) was a bottom up response by people who had gone through it before.

https://www.straitstimes.com/asia/east-asia/coronavirus-sense-of-crisis-scars-from-sars-help-keep-cases-in-hong-kong-lower-than

The HK response to COVID-19 was also earlier, more targeted, both more draconian in some ways and much less so in others.

https://www.sfgate.com/science/article/How-Hong-Kong-kept-COVID-19-at-bay-15254007.php .

Still, the two apartment building outbreaks I've referenced in these threads both occurred in Hong Kong.

Hana M , May 7, 2020 at 10:58 am

This link has the slides Cuomo used plus more details: https://www.cnbc.com/2020/05/06/ny-gov-cuomo-says-its-shocking-most-new-coronavirus-hospitalizations-are-people-staying-home.html

Hana M , May 7, 2020 at 11:00 am

What a surprise! You're on your own, says Cuomo.

'"Much of this comes down to what you do to protect yourself. Everything is closed down, government has done everything it could, society has done everything it could. Now it's up to you," Cuomo said.'

IsabelPS , May 7, 2020 at 11:13 am

"How can so many people experience such mild symptoms and others quickly die from it?"

There seems to be another possibility, that SARS-CoV-2 can infect both the upper respiratory tract (like the coronavirus responsible for the common cold) and the lower respiratory tract, eventually causing pneumonia (like the SARS-CoV)

anon in so cal , May 7, 2020 at 12:38 pm

This is an alarming development, not least because anti lockdown GOP and Libertarian types have jumped on it to argue that the lockdowns are misguided. The news item raises many questions, such as, are the afflicted individuals getting the virus from groceries; some aspect of their domiciles, such as plumbing or ventilation; or are they permitting non-household individuals to visit them. Obviously, more detailed data are needed.

PlutoniumKun , May 7, 2020 at 11:02 am

It would be interesting to see if there is a connection between the virus and apartments/co-living.

The one thing for sure is that this virus is extremely contagious for those who are vulnerable. A colleague of mine cocooned himself with his two elderly parents in their detached suburban house at the very beginning of this, back in late February (he could see it coming). I know he was very cautious in order to protect them. But both his parents died from it over the last 2 weeks, and he is only just recovering from it. So far as I know, he has no idea how the infection got into the house.

Synoia , May 7, 2020 at 11:50 am

Is the address data for the death available? It would be interesting to look for correlation between Covid deaths and the ages of the apartment complex.

Hana M , May 7, 2020 at 12:53 pm

What a terrifying story! Really we are so far behind on the basic public health detective work and analysis that we need to do to beat this.

rtah100 , May 7, 2020 at 5:12 pm

We have been isolating since mid- March. All food delivered and disinfected, post heat-treated. Never eaten a healthier diet or taken more vitamins. Been out (beach and moor) just a handful of times, no contact, always hand sanitizer etc.

Nevertheless, still had three colds!

Viruses are damn infectious.

Also, pace the Kawasaki-like syndrome in children putatively linked to sars-cov-2, true Kawasaki syndrome has no known causal agent but it is believed to be infectious in origin because it is reliably linked to wind: when it blows from central Asia, cases spike in Japan and Hawaii.

Could Sars-cov-2 be hitching a ride on the wind / pollen and infecting people long distance?

Oso , May 7, 2020 at 12:20 pm

Hana M, good post and links

"It is possible that the virus is spreading within crowded and substandard apartment complexes. One possible mechanism? Toilets, as an outbreak of SARs in 2003 demonstrated"

brought to mind one of the possible causes among my community (field workers). porta pottys are badly maintained as well as in short supply. among the many hazards, also particle board living quarters where people sleep in shifts.

Oso , May 7, 2020 at 1:45 pm

you're welcome Hana M.
also, along similar lines a group of us here in oakland (with some city council buy in) are asking for a black new deal dealing with covid-19. demands are specific as well as linked to available funding. i'll share them if ur interested.

Oregoncharles , May 7, 2020 at 4:08 pm

We've been having groceries and other items delivered; one just arrived. This leads to a big disinfecting operation, focused on containers, sacks, etc. I even wash all the veggies before bringing them in. It's more trouble than doing the shopping was, but so far it's worked. We're healthy so far, salt over shoulder.

Fortunately there's minimal infection here, but it is present.

I'm just thinking if you DON'T disinfect the packaging and then your hands, you might well introduce the virus.

Ignacio , May 7, 2020 at 6:18 pm

Indeed, two weeks after a lockdown most hospitalizations must be originated in contagions inside houses or residential buildings where most direct or indirect contacts occur. This suggests that fomites-led contagions are important in Covid-19 transmission. During a lockdown, with very few getting in and out one should basically beware about touching things like doors, elevator buttons, or light switches rather than breathing contaminated air. In buildings with wealthy residents someone will be paid to keep all these surfaces clean once or twice a day but in less wealthy sites it has to be done by oneself.

cnchal , May 7, 2020 at 8:31 pm

> . . . Sixty-six percent of coronavirus hospital admissions in New York in a recent study cited by Gov. Cuomo, were people who had been staying home.

Anyone check if there is a stack of empty Amazon boxes in the corner? Every one of their warehouses has infected workers, and we all know how much people like to push the buy button and crack that whip.

Hana M , May 7, 2020 at 10:51 am

More on the toilet problem with technical notes and 'news you can use': https://waterandhealth.org/disinfect/preventing-infection/can-coronavirus-spread-through-defective-bathroom-sewage-pipes/

CuriosityConcern , May 7, 2020 at 10:58 am

I had a thought yesterday, and it probably has nothing to do with COVID19, but remember the vaping injuries to young people last year? What if those were early infections transmitted via infected vape devices or accessories? Points against this being true: didn't appear to be any spread among medical personnel treating the vape injury population.

Final verdict if I remember right was some form of vitamin e being in the vape liquid. Points in favor: I thought certain quarters were not satisfied with the vit e explanation. Just wild speculation on my part, but interesting idea, no?

Code Name D , May 7, 2020 at 3:37 pm

I remember hearing a roomer that smokers were more susceptible to covid. Not seen anything to support that though.

ShamanicFallout , May 7, 2020 at 4:12 pm

It is actually now appearing to be the opposite- smoking (and/or nicotine) is something of a prophylactic. There have been several links floating around here discussing this. Not sure how definite the conclusions though.

Also, I am untrained in any of this stuff, though have been following, but it seems that something that hits a small majority of people very hard, while so many seem to not even know they have it, says to me it's some specific genetic issue.

Hayek's Heelbiter , May 7, 2020 at 11:17 am

https://www.the-scientist.com/research-round-up/could-the-black-death-protect-against-hiv-54468

Strangely enough, one possible explanation of why ethnic minorities are more susceptible to Corona virus is the same reason that Northern Europeans seem to have greater resistance to HIV. Corona virus and HIV both are single-stranded RNA viruses. (And why remdesivir, effective against Ebola [a double-stranded RNA virus] is also showing effectiveness against Corona virus).

If you are alive today and have Northern European ancestry, they were quite likely survivors of the Black Death with a mutation that disables CCR-5 . It's Evolution 101.

Africa, Asia and the Americas were never exposed to the plague with the same virulence that Northern Europe was, and thus populations there did not develop the same level of of immunity that has lingered in people with Northern European ancestry.

As this is already a plausible theory for HIV, I have been unable to find the same research on Coronavirus as to whether people who are immune to it somehow have similarly disabled receptors on ACE-2.

Synoia , May 7, 2020 at 11:48 am

How could the two Black Death plagues, the 1347one and the 1665 affect your hypothesis?

I believe the 1347 plague was not brought to the west by sea, as it predates the Portuguese exploration of the sea route to the orient.

The Historian , May 7, 2020 at 12:03 pm

There are many good books on the Black Plague of 1347 and how it originated and spread. The most common theory is that it came with the Huns as they attacked shipping ports on the Black Sea which were connected to the overland shipping routes to China. Yes, Europe had trade with the Orient before the Portuguese rounded Africa. And then the ships in the Black Sea started bringing it west to ports in Italy and beyond.

For a simple yet historically accepted theory of the Black Plague, there is a well done course on Great Courses Plus, as well as a ton of written histories. Just search your favorite bookstore.

Harold , May 7, 2020 at 2:31 pm

By "Huns" do you mean Mongols? The disease is endemic to the grasslands of Mongolia and also the Western United States. Supposedly Genoese traders brought it to Constantinople from their ports in the Crimea, I thought.

The Historian , May 7, 2020 at 6:19 pm

Yes, it is probably more correct to call them Mongols because that is who they were fighting under, although some of the midieval historians that I have been reading called them Tartars and Huns, based on what tribes they belonged to. And Caffa, the city where the plague probably got its foothold, was both in Crimea and a port on the Black Sea. And yes, it did strike Constantinople first but since the topic was Europe proper, I just stated that ships brought it to Italy.

Hayek's Heelbiter , May 7, 2020 at 12:12 pm

https://www.scientificamerican.com/article/the-mutant-genes-behind-the-black-death/

https://www.sciencemag.org/news/2014/02/black-death-left-mark-human-genome

PlutoniumKun , May 7, 2020 at 1:01 pm

I'm not really convinced – for one thing I'd always understood that the Black Death did hit many other populations, they just weren't recorded so well (I can stand corrected by this, I don't know the latest research). It also doesn't explain why so far the home countries of those ethnicities that have been hit so hard in the west – East Asians, Iranians, SE Asians, have so far not been hit so hard by Covid. Indians and Pakistani's in particular seem to have been hit very hard in the UK, and yet the same can't be said in their home countries. This is why I suspect that a mix of socio economic (there is evidence that non-white healthcare workers are more likely to be put on the frontline), plus dietary/vitamin D related explanations may be stronger.

But its an interesting theory, nonetheless.

Synoia , May 7, 2020 at 1:28 pm

East Asians, Iranians, SE Asians, have so far not been hit so hard by Covid. Indians and Pakistani's in particular seem to have been hit very hard in the UK, and yet the same can't be said in their home countries.

Ambient Temperatures are very different, and there are some reports of less virulence in hotter climates.

PlutoniumKun , May 7, 2020 at 2:13 pm

Iran and a large chunk of Pakistan is actually quite cold in winter and early Spring. Tehran temperatures only went above a max of 20C in the last 2 weeks or so. Much of the temperature range of that region is not all that different from the inland cities of northern Italy and Spain.

HotFlash , May 7, 2020 at 4:53 pm

Indians and Pakistani's in particular seem to have been hit very hard in the UK, and yet the same can't be said in their home countries.

I wonder, are there differenced betw first or second generation immigrants? Age groups? Another factor that seems to correlate is vaccination for tuberculosis. The BCG vaccine (which is the only tuberculosis vaccine, although there are several strains and manufacturers of it) is mandatory in a number of countries, including India and Pakistan. Some countries never did it, and others have ended or limited their TB vaccination programs as cases of TB diminished.

There are lots of variables to work out -- lockdown, distancing, age of population, co-morbidities, yada yada. But just doing a deeper dive into Spain is interesting. Universal vaccination program started in 1965 for all newborns, no booster, and stopped in 1981, except for at-risk children. So that is a cohort of approx 49 to 55 year olds vaccinated. It would be interesting to see if the mortality rate was different in that group. Bonus! Basque region children are automatically considered 'at-risk' and have been vaccinated up to present! We have a control group! Would love to see data on that.

Here are the charts, people, go crazy. 91-divoc , this is deaths normalized for population, and the BCG World Atlas .

Bsoder , May 7, 2020 at 2:27 pm

Too bad Evolution 101 or 202 is not taught in red states, just not how god does things.

Science Officer Smirnoff , May 7, 2020 at 4:02 pm

Reply to Hayek's Heelbiter
May 7, 2020 at 11:17 am
On remdesivir:
The drug, made by the US company Gilead Sciences, is an antiviral that was trialled in Ebola, but which failed to show benefits in Africa. -- The Guardian Thu 23 Apr 2020 15.35 EDT
[emphasis added]

Hayek's Heelbiter , May 7, 2020 at 6:55 pm

https://en.wikipedia.org/wiki/Remdesivir
Nevertheless (emphasis mine)

As an adenosine nucleotide triphosphate analog, the active metabolite of remdesivir interferes with the action of viral RNA-dependent RNA polymerase and evades proofreading by viral exoribonuclease its predominant effect (as in Ebola) is to induce an irreversible chain termination. Unlike with many other chain terminators, this is not mediated by preventing addition of the immediately subsequent nucleotide, but is instead delayed, occurring after five additional bases have been added to the growing RNA chain.[56] Hence remdesivir is classified as a delayed chain terminator.

[56] Tchesnokov EP, Feng JY, Porter DP, Götte M (April 2019). "Mechanism of Inhibition of Ebola Virus RNA-Dependent RNA Polymerase by Remdesivir". Viruses. 11 (4): 326. doi:10.3390/v11040326. PMC 6520719. PMID 30987343.

Carolinian , May 7, 2020 at 1:01 pm

A useful discussion of the models versus evidence schools of epidemiology. While the evidence school sounds a lot more like science, the models school currently has the upper hand given the emergency nature of the response. Are they "assuming a can opener?"

https://bostonreview.net/science-nature/jonathan-fuller-models-v-evidence

Cuibono , May 7, 2020 at 1:17 pm

My questions

  1. how important is asymptomatic transmission?
  2. what is the relative importance of different locales of transmission
  3. does prior SARS infection provide protection

Ignacio , May 7, 2020 at 6:50 pm

Your first two questions are unfortunately very difficult to address.

I think asymptomatic or nearly asymptomatic direct transmission is very important when there is not awareness of disease in the community. Then, there is fomites-led transmission which is even more elusive than asymptomatic direct transmission. So, when you detect someone with symptoms in a community if then everyone is tested it is almost certain some more will show positive. A couple of days later some many more will. So when first symptoms appear everyone must be isolated from each other, clean all surfaces, masks mandatory, and if the community includes some medical and other care full protection by and for the providers. Suddenly the community transforms into something resembling a military camp in wartime.

What i find most difficult is to decide what discipline to keep BEFORE the first case appears.

John k , May 7, 2020 at 2:03 pm

Everybody's different, flu only kills a very small fraction, granted elderly get shots. Maybe some differences are nutritional.

My thought is that there is a wide variety of vitamin d and zinc levels in those that get the virus, and that low levels worsen the outcome. And maybe nicotine also provides protection.

Diets low in red meat and oysters typically mean low zinc, plus local soils may be low, too I saw an indication North American soils are generally low. Poor people on cheap diets likely get little red meat. Hiding inside means low vit d, plus many seniors like me anyway seek shade to avoid harmful rays. And most living seniors stopped smoking, so no nicotine input.

I take vit d, plus zinc in a multi, have zinc lozenges on hand if I get symptoms, and if they worsen would add nicotine patch.

Bsoder , May 7, 2020 at 2:32 pm

American soils remain the richest in the world. Zinc would be a mineral and mined. There's no evidence based data to indicate for people in general zinc going to do anything. But if makes you happy sure why not. I'd ask my doc for a blood test on minerals and a vitamin panel. Then you'd know.

rd , May 7, 2020 at 7:31 pm

It is a function of regional geology. The northern US and Canada were largely glaciated and the soils are very recent (<100,000 years old) and so have not leached their nutrients and miinerals out. The rolling farmed plains of Western NY, OH, IL, KS, NE, etc. are glacial till plains or old glacial lakebeds. The Russian steppes are similar. Much of the major floodplains come from such soils and are rich as well (e.g. Mississippi).

Much of the South and California are old soils that are classified as "residual", basically bedrock weathered in place with a lot of leaching over hundreds of thousands or millions of years. These regions often have limited crops that can be grown or require a lot of fertilizer and maintenance. The same issues hold true for much ot the tropics (the reason why the Amazon rainforest has slash and burn agriculture to open up new areas that are temporarily rich.

Bob , May 7, 2020 at 2:39 pm

Regarding why are some countries not experiencing as much COVID-19 as the U.S., Europe and China, my personal non-scientifcally vetted opinion is that this this virus spreads indoors. Fresh air, ozone and UV radiation are all natural disinfectants. Outdoors, coughs and sneezes are dispersed via the wind.

This could also explain why the disease is concentrated in urban settings like NYC, present in warm weather locations like Singapore and implies it won't necessarily go away come the summer. On the other hand, the poorest citizens in the poorest countries spend a lot of time outdoors and don't seem to be as hard hit. Though this has been attributed to a lack of testing, their homes aren't hermetically sealed and climate controlled like those in the US, Europe or China which I believe leads to a lower infection rate. That being said, people who live in urban slums are certainly vulnerable.

Moshe Braner , May 7, 2020 at 3:59 pm

There is also the issue, recently somewhat in the news, of different genetic variants of the virus. I've heard the claim that that explains why NY has been hit harder than the US West Coast – that the variant in NY supposedly came from Italy, while the West Coast got it from China. Of course they also spend more time outdoors on the West Coast than in NY, especially in February.

WhoaMolly , May 7, 2020 at 3:40 pm

I wonder if air conditioning systems could be contributing to infections by recirculating the air inside buildings.

My reasoning:

rd , May 7, 2020 at 7:33 pm

Commercial real estate is probably going to have to increase their fresh air exchange and potentially install electrostatic filters if they don't have them. Without that, offices are likely to be unhealthy.

neo-realist , May 7, 2020 at 10:05 pm

Offices have been unhealthy, air wise, for years. We just cough, hack, adapt, deal.

dk , May 7, 2020 at 7:41 pm

The short answer is yes.

The term for the motile form of a virus is virion , one or more strands for RNA (of DNA but SARS-CoV-19 is RNA) enclosed in a fatty lipid capsule ("capsid"), usually with protruding receptors with which the virion can attach to and inject it RNA strand into a host cell. Coronaviruses have characteristically prominent "spikes," receptors that extend beyond the capsid surface.

Basically, virions are little blobs of fat. When exposed directly to air they quickly rancidify and the exposed RNA strand disintegrates. Riding air pollution particles is possible but unlikely, as many of these kinds of particles have surfaces antagonistic to the fatty capsid. However, exhaled particulate droplets suspended in air can pass through coarse filtration. HEPA filters are designed to trap such droplets, UV irradiation can "cook" them.

Here is a study on an early transmission site in China, where incidents of infection seem to correlate to ventilated air flow in a restaurant: COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020 https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article

The Figure 1 illustration helps to visualize this: https://wwwnc.cdc.gov/eid/article/26/7/20-0764-f1

Here is a not-yet-reviewed preprint of a study of two buses transporting attendees to and from an event in China. One bus (#2) had a suspected "index patient" (IP), the other didn't. https://twitter.com/zeynep/status/1255579524047220741

From the article: "In both buses and conference rooms, central air-conditioners were in indoor re-circulation mode."

Interestingly, the conference itself produced few further cases, these were all traced to prolonged interactions with the IP. Generally with viruses, some critical mass of virions must accumulate in sufficient number to produce infection, and total net exposure may approximately correlate with severity. Untreated recirculated air bearing virus-laden droplets may lead to repeated exposure and increase concentration of virions in individuals.

[May 07, 2020] Why didn't we shutdown everything in 1968?

May 07, 2020 | www.zerohedge.com

xxx Anonymous IX,

xxx 3 hours ago

You might be interested in this little tidbit, Quy. From the CDC . You do "trust" them, don't you?

Just one question for you. Why didn't we shutdown everything in 1968?

1968 Pandemic (H3N2 virus)

The 1968 pandemic was caused by an influenza A (H3N2) virus comprised of two genes from an avian influenza A virus, including a new H3 hemagglutinin, but also contained the N2 neuraminidase from the 1957 H2N2 virus. It was first noted in the United States in September 1968. The estimated number of deaths was 1 million worldwide and about 100,000 in the United States. Most excess deaths were in people 65 years and older. The H3N2 virus continues to circulate worldwide as a seasonal influenza A virus. Seasonal H3N2 viruses, which are associated with severe illness in older people, undergo regular antigenic drift .

"The estimated number of deaths was 1 million worldwide and about 100,000 in the United States."

[May 07, 2020] Locking down without specific actions to shield the vulnerable will yield no better results than no lockdown or the sweden approach

May 07, 2020 | www.moonofalabama.org

Alaric , May 6 2020 21:13 utc | 20

Reading some of the other comments, I see many recognize the incredible specificity involved here in outcomes, treatment, etc. Lockdown is an indirect way to impact those variables but locking down without specific actions to shield the vulnerable will yield no better results than no lockdown or the sweden approach. A sweden approach that does protect those vulnerable is likely more effective than a lockdown that does not.

NYC has nursing homes that are 700 and more persons. Large nursing homes should be banned if we want to stop this sort of thing in the future. Residents of such facilities should be moved to smaller temporary housing. NY State allowed persons who tested positive for Covid to go back to nursing homes -- disaster. Employees of such facilities and visitors would ideally be tested. Employees of such facilities should not be taking the NYC subway to get to work as Subways are major transmission points. Nosocomial infections were a big part of the problem in NYC as well. We needed separate facilities for suspected covid patients. 88.1% of those on mechanical ventilation in NYC (according to a JAMA study) died. That's junk medicine and it was implemented in part out of fear of spreading and probably for financial gain....ick.

There are a lot of things that could and should be done but we don't talk about that because it doesn't fit the media narrative of fear, panic, fear, lockdown, lockdown, lockdown or bust.

The media has done us and the elderly a great disservice......again

[May 07, 2020] Post-Lockdown Insist on the Old Normal by Helen Andrews

May 07, 2020 | www.theamericanconservative.com
When the CIA wanted to circumvent possible Chinese bugging of its offices in Beijing in the 1980s, it came up with a voice protector or "hush phone," essentially two masks with tubes running between them. It worked, but no one would use it. George Shultz said he felt "ludicrous" wearing something that made him look "like Siamese-twin elephants joined at the trunk." Even during planning for Reagan's state visit in 1984 when secrecy was essential, staff in Beijing simply refused to use a device that made them sound like Donald Duck.

And good for them. There were logistical reasons to reject the hush phone, like the impossibility of more than two people talking to each other at a time, but there is also something creditable about whatever part of Secretary Shultz said: I am a grown man, and I have some dignity.

Everyone is wondering what life will look like at the end of the month. Lockdown bitter-enders insist that the return to normal will not be like flipping a light switch, to borrow Maryland governor Larry Hogan's expression. Instead, they say, we will need to spend an indefinite period in a twilight zone of half-freedom where lockdown orders have been lifted but aggressive safety measures remain -- a "new normal."

Based on descriptions of the new normal, I am not sure we should allow ourselves to get used to it. As eager as we are to get the lockdowns over with, we must not let desperation compel us to put up with things we shouldn't.

Ross Douthat thinks that long lines outside grocery stores of people waiting to come inside and shop "may become a permanent feature of the semi-normal landscape." That's absurd, and, like the hush phone, there are both good reasons and gut reasons why.

One-way aisles and occupancy caps don't do much to stop the spread of disease considering how little transmission takes place between shoppers who pass like ships in the night. Also, queuing down the block for groceries is just too grimly Soviet.

Social distancing measures should remain in place even after schools and businesses reopen, many say. But enforced by whom? Continuing to make cops responsible for enforcing a six-feet-apart rule will only lead to more viral videos like this week's from New York, which depicts the violent conclusion of what started as a social distancing stop.

The New York City Police Benevolent Association says officers shouldn't be enforcing "vague guidelines and mixed messages." It wants the mayor to "get cops out of the social distancing enforcement business altogether." The PBA is right. The alternative is for Americans to get accustomed to being hustled along by police for the crime of picnicking on the grass or reading a book on a park bench, which would be an ominous thing to start shrugging off.

Australia is making its new normal conditional upon citizens downloading a location-tracking app modeled on Singapore's. The prime minister insists the app is voluntary, but business groups like Restaurant and Catering Australia are already considering requiring diners and shoppers to download the app before being served.

The government says its goal is for 40 percent of the population to download the app, a target still more than halfway off after its first week in the app store. "Downloading the COVIDSafe app is the major obstacle now between us freeing up a lot of these restrictions in a cautious way," Prime Minister Scott Morrison said, not disguising the ultimatum.

The last time the Australian government requested emergency permission to track its citizens' phones was the metadata retention law of 2015. As with COVIDSafe, repeated assurances were made about privacy and civil liberties. Later it was revealed that users' metadata had been used by local city councils in order to track down litterbugs and other mundane offenders who had nothing to do with the law's original justification, counter-terrorism.

The United States is not Singapore, and there are certain restrictions on our liberty that we won't tolerate. A government location-tracking app should be one of them. Such excessive post-lockout safety measures are not needed to deal with a disease that is no longer in danger of overloading our hospital capacity. More importantly, Americans' gut aversion to being overpoliced is worth preserving. Ordinary aspects of pre-coronavirus life should not be sacrificed in order to give those still attached to the lockdowns a psychological on-ramp or a face-saving pretense that their doomsday forecasts were more accurate than they were.

Except for open plan offices. Ban those permanently, for the good of the nation's health.

[May 07, 2020] A Tale of Two Countries: Denmark and Sweden

May 07, 2020 | www.moonofalabama.org

Jen , May 7 2020 1:32 utc | 50

It is interesting if perhaps concerning that of all the comments on the Peter Turchin article "A Tale of Two Countries [Denmark and Sweden]" , the one comment B chose to zero in on and highlight for his post is one by Richard England who refers to the lockdown of fiat and the lockdown of fear but provides no link to any information (such as polls, questionnaires or surveys) that would support his argument of most Swedes complying with recommendations and regulations voluntarily out of fear.

Turchin started his comparison of the progress of COVID-19 in Denmark and Sweden expecting that the death rates in Denmark compared to those in Sweden would support his belief that a lockdown was necessary. He did not expect to see that by 1 May 2020, the trends in new cases, transmission rates and even death rates in Sweden were actually comparing well with equivalent data in Denmark.

One commenter on the Turchin article, Ernst Nilsson, says that 80% of COVID-19 deaths in Sweden were of people aged 70+ years and that Swedish authorities have acknowledged that people in aged care homes and similar facilities had not been well protected.

Karl Kling points out that in Sweden, aged care facilities are the responsibility of municipal governments that have been cutting labour costs in those places by using workers, many of them on hourly contracts and / or not being fluent Swedish speakers. It is likely then that these workers have been spreading the virus among the people they care for because they are working long hours to make ends meet, are being exposed themselves to the virus more than they would be if they were working regular hours on their shifts and were being paid adequately, and do not have a good understanding of what they should be doing to avoid being infected and spreading the disease in their own languages because Swedish authorities failed to communicate adequate information about COVID-19 to immigrant communities and foreign workers.

Other commenters point out that Sweden has a large immigrant population ( Wikipedia states that the immigrant population and their children make up at least 24% of the total population; incidentally this means comparisons between Sweden and other Nordic nations, where the immigrant population and their children are about 15%, of dubious worth) and sections of this population may be behaving differently in ways that exacerbate COVID-19 incidence and mortality. The Somali community in Sweden is known to be very hard-hit by COVID-19 due in large part to living in dense and crowded housing in impoverished communities where access to healthcare, other social services and information about the disease is poor.

That aged care facilities and immigrant communities have been badly affected by COVID-19 disease is not a consequence of not having a lockdown or shutdown but is rather a consequence of past Swedish policies in allowing nursing homes and similar institutions to be rundown or badly managed, and in neglecting other vulnerable groups by not giving them information about the disease in ways they can access. That immigrants are also working in aged care facilities helps to circulate the disease among vulnerable groups.

[May 07, 2020] Sweden is a valuable case but the only viable option

May 07, 2020 | www.moonofalabama.org

Tuyzentfloot , May 7 2020 7:13 utc | 77

Sweden is a valuable case. I see three categories of measures which can be combined:
- top down centrally managed/enforced
- self organized
- negotiated
The first relies on central planning and as central planning goes, it can be powerful and at the same time crude and wasteful. The second resembles more the 'free market' approach , it has the advantage of 'on the terrain' adjustments which can be much smarter than in the centrally organized case but it does not necessarily work in the desired direction. Much depends on the feedback mechanisms which are available.

The third is where a group of people is willing to do their sacrifices for the greater good(or the lesser evil) but they should expect something in return from other groups of people because it shifts the balance of power.

An example of the difference between 1 and 2 is how masks were handled in Belgium vs Czechia. Czechia took the more trusting decentralized approach. Belgium followed the WHO and was more guided by fear that people would do it wrong, with the scarcity and all. But people perform better if you give them trust and responsibility. Also using masks is a learning process so now you see in Belgium it takes time to get it going.

The main flaws in thinking about Sweden is that it relied entirely on the second group, that this second group by itself should be able to fix it all, and that this second group did not hit the economy hard. But for the cinema owner it does not make a big difference if they have to close down because nobody is allowed to visit, or because there are only 2 people in the theater anyway. In the restaurant sector the self organizing approach will have softened the blow. I read visitors dropped to 1/3.

I think Sweden has used a variety of measures with a variety of results. They flattened the curve without lockdown. We can learn from them, or to put it differently, steal ideas from them.

r , May 7 2020 7:23 utc | 78

so maybe Japan's strategy was better than the others ... delayed "lockdown" with very low testing ratio per million resident (even after promising about 20000 tests per day last April, to this date J-lawmakers blame lack of manpower and preparation for not being able to reach that objective). we got low numbers ... and reported infections have been declining in Tokyo.

the "lockdown" is simply a request for people to follow 3密 (san mitsu). people have explained that Japan can force the people to lockdown. the government does not have the authority. most people followed the requests ... i don't know if it's because they respected the request of the gov't or just because of fear.

GW just finished, it is a yearly migration of people from the cities back to their home towns. or people trying to refresh, go on vacation/travel. i traveled from Kanagawa (where I live) to Tokyo and was surprised at how empty it was. the trains, train stations, the areas. locally in Kanagawa, the parks are full of people, under sun shades, kids playing around.

J-media highlighted 2 cases where asymptomatic person died in self isolation in Saitama, and has now modified the requirements for getting a PCR test. i myself would like to get an antibody test ... well waiting, that is.

waiting to be able to apply for the 10万円 (100000 thousand yen) being given by the government.

i am still waiting for my アベノマスク (Abenomask). distribution is delayed because the masks were soiled/moldy/dirty. a failed stunt which cost 466億円 (466 billion yen).

the best place to buy masks now is in Chinatown ... price is high ... but there is supply ... and there is demand. Sharp (TV/LED maker) is making masks, but has to raffle it off because of the demand.

Abe-extended the State of Emergency to enf-of-May ... but if they think everything is clear they can lift the SoE as early as May 15.

[May 07, 2020] Sheriffs in Arizona have announced that they will not arrest or fine people who violate the governor's virus diktats. Police always have discretion to charge or ignore any crime, but this is a direct challenge to the governor.

May 07, 2020 | www.moonofalabama.org

karlof1 , May 6 2020 0:29 utc | 41

I usually don't read The Atlantic , but I was shocked its staff writer George Packer wrote this : "We Are Living in a Failed State: The coronavirus didn't break America. It revealed what was already broken." It's a special preview of the June issue, so I don't know how long it'll be at the link. Yes, the title foretells the content!

Hoyeru , May 6 2020 0:31 utc | 42

PIF GADGET comics magazine(a famous French comics anthology magazine for children produced by the French communist party) predicted the corona virus epidemic back in one of its January 1979 issues, not sure which, because they came out weekly. It was in Doctor Justice series, about a doctor named Benjamin Justice who travels around the world helping poor nations. It even had a drawing of a corona virus. Interesting.

Back in the 1970s, growing in a communist country, we were repeatedly warned that Americans want to wage bio war against the communists countries using viruses and bacteria. We were told they will try to spread the bio weapons around. And here we are, 2020. Seems the communists KNEW.

Trailer Trash , May 6 2020 3:25 utc | 47
>We Are Living in a Failed State

Not yet. Uncle Sam still has a near-monopoly on violence. But civilians with 400 million guns (really, more guns than people) might have something to say about that in the near future. Meanwhile, sheriffs in Arizona have announced that they will not arrest or fine people who violate the governor's virus diktats. Police always have discretion to charge or ignore any crime, but this is a direct challenge to the governor.

If an individual directly challenges the police, over anything at all, they will be abruptly dealt with. Failure to Obey is the second worst crime, right next to killing a cop. So what can a governor do, call out the National Guard against the sheriffs? That would be a big deal. But he can't let a direct challenge to his authority go unanswered. That is unthinkable in a rigid hierarchy.

[May 07, 2020] Closing cinemas and bars is a bit inconvenient but can be done without much protest. We have little experience in taking such measures. The model builders do not know how much each of those restrictions will contribute to the lowering of the peak.

May 07, 2020 | www.moonofalabama.org

We have little experience in taking such measures. The model builders do not know how much each of those restrictions will contribute to the lowering of the peak. They have to estimate those parameters. Until this month it was not even clear if children could get infected or were infectious. Arguing for closing schools without knowing that is quite difficult.

Clinical epidemiologists, who mostly work on randomized trials which produce hard data, are often critical of the model builders. They dislike the many assumptions that go into modeling and demand more hard data. Stanford's professor John Ioannidis, who ran the Santa Clara antibody study , is one of them. He is somewhat right. All models are wrong, but some are useful. A recent Boston Review piece looks at the differences between the two tribes of epidemiologists. It finds that we need both.

When the politicians take measures they are only in part based on the predictions the modelers made. They also have to look at economic outcomes, at other security issues and they have to take public opinion into account. Quite strict measures were taken in many western countries. They worked well in some of them. Germany has hardly any 'excess death' from Covid-19. Other countries, like Britain, acted too late or not to a sufficient degree and had to pay the price for that.

As the epidemic now starts to recede a bit there is quite a lot of criticism of the lockdown in Germany. 'The models were wrong,' some people claim. 'The lockdown measures were unnecessary.' Then follow demands for the immediate lifting of most restrictions.

"There is no glory in prevention" is the frustrating aspects in the life of an epidemiologist. If they do their job too well everyone will bash them.

A month ago Max Abrams saw this development coming and commented :

A month ago Max Abrams saw this development coming and commented :
  1. Models make assumption of how much people will social distance.
  2. Based on this assumption model predicts virus cases.
  3. More social distancing is practiced than assumed.
  4. Model over-predicts virus cases.
  5. Idiots say models are wrong so we don't need social distance.

Others point to Sweden and claim that its decision to let the epidemic burn without much intervention was a much better way than to go for lockdowns. But the evidence for that isn't there . The numbers show a different picture:

Barry Ritholtz @ritholtz - 18:03 UTC · May 3, 2020

Sweden's Coronavirus death rate > its neighbors https://www.worldometers.info/coronavirus/#countries

Sweden
Total Cases: 22,317
Per /1m Pop: 2,210
Deaths: 2,679
Recovered: 1,005

Denmark
Cases: 9,523
/1m: 1,644
Deaths: 484
Recovered: 6,987

Norway
Cases: 7,809
/1m: 1,440
Deaths: 211
Recovered: 32

Sweden in fact had the very same problems with its medical systems that some other countries also had. It had to ration ICU beds by denying them to people above a certain age. Its economy was hit as bad as other ones :

The effect of virus-fighting efforts on the Swedish economy has been devastating. A very large number of small businesses have collapsed. All but essential industries closed down almost immediately and many face bankruptcy. People have been told to refrain from all non-essential travel. Virtually all air travel has been suspended. Unemployment figures are soaring. The opposition parties deem government counter-measures to be too little too late.
...
Contrary to impressions created in American media, Sweden's approach to handling the pandemic has not been "relaxed," but essentially the same as in other Western countries. This country of 10 million has been at least as preoccupied with the pandemic as other countries. Whether its approach has been as efficient remains to be seen. What may stand out as exceptional in the end is Sweden's glaring lack of preparedness for a pandemic, especially for protecting its elderly, and that the dead are disproportionately recent immigrants.

While Sweden may not have ordered everyone into a total lockdown the people have largely done that by themselves simply out fo fear.

As a comment by one Richard England here (May 6, 2020 at 3:40am) describes that effect:

There are two kinds of lock-down, lock-down by fiat and lock-down by fear (or for that matter, self-preservation). The importance of lock-down by fear explains why Sweden has not done as badly as would be expected. Both forms of lock-down are economically destructive. Lock-down by fiat is usually either too slow or too incomplete to be much different from lock-down by fear, and both are more than enough to knock over a weak economy. Fear dissipates, and the economic life resumes more quickly where the disease has been essentially eliminated.

The effect is also captured in this graph by the German equivalent to the CDC, the Robert Koch Institute. It shows the replication factor R of the epidemic in Germany and three points in time where official lockdown measures were taken.


bigger

The replication factor of the disease in Germany was already decreasing in mid March before the more severe measures were ordered. R was below 1 even before March 23 when the government ordered the lockdown.

The simple reason for that is the people heard the news and watched TV. The pictures and death numbers from Italy in late February were quite brutal. When herd animals sense that an epidemic is taken place within their herd they distance themselves from each other. Humans behave similarly. As in Sweden many people in Germany went into some kind of lockdown and practiced social distancing even before it was ordered.

Some now claim that the RKI graph shows that the measures were not necessary. They are wrong. The data was not known when the measures were taken. The first of the simulations shown in the graph was done on April 1. In late March the R seemed to go again above 1 which meant that the epidemic was again expanding. Only the lockdown measures taken on March 23 pressed R below 1 and led to a slow decrease of new daily cases.

Germany is now slowly coming out of its lockdown. The U.S. is doing this too but at a point of the epidemic where it is way too early. There are economic reasons to do so but the early lifting of lockdown measures will likely cost the U.S. many human lives.

Fear will help to overrule that overhasty political decision. The news will continue to report new mass outbreaks in this or that part of the country. The fear will therefore also continue and the people will keep distancing themselves from each other. How much that will help to slow down the epidemic is difficult to estimate.

There is now some evidence that the summer will bring some relief from the onslaught of bad news. A study with data from 166 countries and published in Science of The Total Environment finds :

A 1 °C increase in temperature was associated with a 3.08% (95% CI: 1.53%, 4.63%) reduction in daily new cases and a 1.19% (95% CI: 0.44%, 1.95%) reduction in daily new deaths, whereas a 1% increase in relative humidity was associated with a 0.85% (95% CI: 0.51%, 1.19%) reduction in daily new cases and a 0.51% (95% CI: 0.34%, 0.67%) reduction in daily new deaths. The results remained robust when different lag structures and the sensitivity analysis were used. These findings provide preliminary evidence that the COVID-19 pandemic may be partially suppressed with temperature and humidity increases. However, active measures must be taken to control the source of infection, block transmission and prevent further spread of COVID-19.

A hot and wet summer is likely to lower the number of new Covid-19 cases. But after the summer come fall and winter during which we are likely to see a new peak. The fear will be back, social distances will again be practiced and the economic damage will further increase.

We had the chance to do otherwise. China gave us time to take the right measures. It has, like Hong Kong, Vietnam, South Korea and New Zealand, practically eradicated the disease within its boarders. It now has an advantage that will be difficult to beat.

Posted by b on May 6, 2020 at 18:57 UTC | Permalink

Posted by b at 18:57 UTC , Comments (149)

Posted by b at 18:57 UTC | Comments (149) /div

[May 07, 2020] Government sponcored lockdown vs self-imposed lockdown driven by fear

May 07, 2020 | www.moonofalabama.org

bevin , May 6 2020 19:15 utc | 1

"The importance of lock-down by fear explains why Sweden has not done as badly as would be expected. Both forms of lock-down are economically destructive."

The difference being that where the government plans and controls the lockdown it can mitigate many of the economic consequences by, for example, ensuring that nobody runs out of money to buy essentials, subsidising prices in agriculture and buying surpluses arising from lower demand, and various other measures, including rationing, which will ensure that the 'lockdown' does not lead to the deaths of anything except marginal businesses.

Many and sincere thanks, b, for these thoughtful and prescient posts. Yours has been a rare voice of sanity and social responsibility in this pandemic. It is to be hoped that even those who disagree with your conclusions recognise the honest and agonising analysis behind them.


C , May 6 2020 20:14 utc | 9

Regarding the imposed versus fear lockdown: Spain had (has) an imposed lockdown, but from the first day the new PSOE/Podemos government announced unprecedente measures to prevent evictions, layoffs, and provide income support that would help working people, including the irregular "gig economy" types that usually fall through the cracks of many such efforts. Big diference from 2007_8. The battle is now with the EU. We Will see if the Dutch and Germán bankers Will pull their heads out of their collective asses, or take the while EU down.
Alaric , May 6 2020 20:27 utc | 10
One really needs to take a closer, deeper look at Sweden and most every place. The lockdown vs. not lockdown mentality is overly simplistic and inaccurate.

Sweden has a high level of obesity (21%) and 44% of Swedes are overweight. Norway is similar but Denmark has 9.5% obesity. Sweden has a larger immigrant (% pop) than Norway and probably than Denmark. Immigrant population in Sweden did not seem to listen to the measures sweden took. Nearly 50% (maybe more now)of the deceased in Sweden are from nursing homes and Sweden's nursing homes are on average bigger (200 plus persons) compared to those in Norway (about 45 people). The Swedes failed to take actions to protect those nursing homes until it was too late and 1/3 had infections. Its worth pointing out that immigrants are over represented among employees of said institutions too.

The over simplification is a tool lockdown advocates are using to ignore the basic reality. Deaths are ultimately about percent of vulnerable in the population (elderly mostly) and success in protecting them from the Virus. The virus yields asymptomatic to mild results in 95% of more of the population so its really all about the vulnerable population. If you want a meaningful chart, then you need to chart deaths vs over 65 population and vs persons with comorbidities.

NY/NJ shut down and still had a lot more deaths per capita than Sweden. NY/NJ failed in the same way Sweden failed. They did not protect the vulnerable.

Lurk , May 6 2020 20:31 utc | 11
When I was in Sweden last summer, I was perplexed how unhealthy many Swedes look. The picture in Denmark was completely different. Curiously, the Covid-19 incidence rates in Denmark, Norway and Sweden mostly mirror my (superficial and subjective) impression of the health of the citizens of these countries. Lots of obesity in Sweden, lots of cyclists in Denmark.

[May 07, 2020] Will the American Way of Life Become a Casualty of the Coronavirus

May 07, 2020 | nationalinterest.org

By April, the country had changed. A virus that had gained footing overseas had spread like wildfire in major cities, forcing bars and restaurants to shutter their doors. The long days at the office were gone. Economic stability had disappeared. At night, the news organizations displayed images of corpses wrapped in white bags being loaded into refrigerated trucks in the once-busy streets of New York City. They showed video footage of people in biohazard suits placing bodies into a mass grave on Hart Island . The gears in the clock were moving at a fast pace in high-density parts of the country: alive this month and dead the next. By May, those who resided outside of the coronavirus hot zones though, who didn't have to see the deadly virus's grim threats on a daily basis, yearned for their old ways of living.

[May 07, 2020] As of a few weeks ago in one NJ hospital Plaquenil (hydroxychloroquine) was the standard treatment, along with azithromycin and zinc which is the most common protocol.

May 07, 2020 | turcopolier.typepad.com

Valissa , 06 May 2020 at 06:03 PM

Eakens, thanks for the link to the Plandemic video! I was chatting with my sister today and she recommended it as well.

BTW, my sister is a nurse in NJ in a hospital about 60 mi south of NYC near the shore. Several wards in her hospital were converted to ICUs to handle the influx of covid patients, so I have been asking her what meds they are given. As of a few weeks ago Plaquenil (hydroxychloroquine) was the standard treatment, along with azithromycin and zinc which is the most common protocol. Most patients are getting this and to quote her directly: "It's standard treatment and saving lives daily." She is perplexed by the politicization. While she is a conservative, the great majority of her coworkers are not.

The other two standard treatments added more recently to their covid protocols are tocizulamab (IL-6) and plasma with antibodies.

Here is a recent article on the tocizulamb, which I had never heard of before my sister mentioned it.

https://www.msn.com/en-us/health/medical/tocilizumab-drug-shows-coronavirus-treatment-promise-doctor-says/ar-BB13HNun

optimax , 06 May 2020 at 11:23 PM
Teachers want their students back in the classroom before they start thinking for themselves. (drum roll). The NYT published a letter from a middle school girl who says she learns better, faster and deeper, distance learning than in class. Teachers have to spend too much time dealing with disruptive knuckleheads. Teachers didn't put up with any crap when I went to school.

Doctors that use hydroxychloroquine as a covid treatment report up to a 90% success rate, and works best when given early. On the other hand, the ebola wonder drug shortens the hospital stay from 15 to 11 days. I don't understand Ain't So Bright's, and many of the "experts," dismissal of of what treating physicians report an effective treatment in favor of one that less effictive. I trust the observations of the doctors on the ground more than some office dweller reading numbers, the most important ones being those in his paycheck.

[May 07, 2020] 2020 US Pentagon study that found that the flu shot INCREASES the risks from coronavirus by 36%

May 07, 2020 | www.zerohedge.com

xxx Anonymous IX, 4 hours ago

Do you believe the Pentagon? From their study published this year. From Children's Health Defense entitled "Pentagon Study: Flu Shot Raises Risk of Coronavirus by 36% (and Other Supporting Studies)."

In searching the literature, the only study we have been able to find assessing flu shots and coronavirus is a 2020 US Pentagon study that found that the flu shot INCREASES the risks from coronavirus by 36%. "Receiving influenza vaccination may increase the risk of other respiratory viruses, a phenomenon known as "virus interference 'vaccine derived' virus interference was significantly associated with coronavirus " Here are the findings:

2020 Pentagon study: Flu vaccines increase risk of coronavirus by 36%

Examining non-influenza viruses specifically, the odds of coronavirus in vaccinated individuals were significantly higher when compared to unvaccinated individuals with an odds ratio (association between an exposure and an outcome) of 1.36. In other words, the vaccinated were 36% more likely to get coronavirus.

[May 07, 2020] There is evidence that vitamin D is involved in our defense against respiratory tract infections

May 07, 2020 | www.moonofalabama.org

Lurk , May 6 2020 20:46 utc | 14