Here are some #covid19 news, interesting research, vaccine, drug info. I’ll try to add to this post periodically if I can. (Last update: 20200310, Created: 20200302)
//Conclusion: Even after the lockdown of Wuhan on January 23, the number of seriously ill COVID-19 patients continued to rise, exceeding local hospitalization and ICU capacities for at least a month. Plans are urgently needed to mitigate the effect of COVID-19 outbreaks on the local healthcare system in US cities.//
//The demand for inpatient and ICU beds for COVID-19 in the US: lessons from Chinese cities// Many thanks to //Ruoran Li *1; [@ruoranepi] Caitlin Rivers 2; Qi Tan 3,4; Megan B Murray 3; Eric Toner 2; Marc Lipsitch 1 [@mlipsitch]//
20200306, CNN podcast, “Coronavirus: Fact vs Fiction”
20200304 NPR, “How Computer Modeling Of COVID-19’s Spread Could Help Fight The Virus” (~4 minutes)
20200304, NPR, (~4 mins) “How Computer Modeling Of COVID-19’s Spread Could Help Fight The Virus”
“The committee, chaired by Deputy Prime Minister Chrystia Freeland, will complement the work done by the Incident Response Group, meeting regularly to co-ordinate and prepare for a response to the health and economic impacts of the virus.
‘All possible measures’ to limit COVID-19 impact
Trudeau said the committee will work with provincial, territorial and international partners to make sure Canada’s response “takes all possible measures to prevent and limit the spread of the virus in Canada.”
Other ministers on the eight-member committee include Health Minister Patty Hajdu, Public Safety Minister Bill Blair and Finance Minister Bill Morneau.
Kirsty Duncan, deputy government House leader and scientist who wrote a book [BMJ book review of “Hunting the 1918 Flu: OneScientist’s Search for a Killer Virus” by Kirsty Duncan] on the origins of the 1918 Spanish flu, will also be a core participant of the meetings.“
20200304 NYT “Inside China’s All-Out War on the Coronavirus Dr. Bruce Aylward, of the W.H.O., got a rare glimpse into Beijing’s campaign to stop the epidemic. Here’s what he saw.” #covid19 #TheydWhipYouThroughaCTScan #WayneGretzkyOfViruses
Good questions and insightful/nuanced answers. Don’t be dogmatic and blindly mistrust WHO. *Blindly* anything is bad science. #TeachableMoments
//Dr. Aylward, who has 30 years experience in fighting polio, Ebola and other global health emergencies, detailed in an interview with The New York Times how he thinks the campaign against the virus should be run.//
//[Q] Are the cases in China really going down?
[A] I know there’s suspicion, but at every testing clinic we went to, people would say, “It’s not like it was three weeks ago.” It peaked at 46,000 people asking for tests a day; when we left, it was 13,000. Hospitals had empty beds.
I didn’t see anything that suggested manipulation of numbers. A rapidly escalating outbreak has plateaued, and come down faster than would have been expected. Back of the envelope, it’s hundreds of thousands of people in China that did not get Covid-19 because of this aggressive response.
[Q] Is the virus infecting almost everyone, as you would expect a novel flu to?
[A] No — 75 to 80 percent of all clusters are in families. You get the odd ones in hospitals or restaurants or prisons, but the vast majority are in families. And only 5 to 15 percent of your close contacts develop disease. So they try to isolate you from your relatives as quickly as possible, and find everyone you had contact with in 48 hours before that.
[Q] You said different cities responded differently. How?
[A] It depended on whether they had zero cases, sporadic ones, clusters or widespread transmission.
First, you have to make sure everyone knows the basics: hand-washing, masks, not shaking hands, what the symptoms are. Then, to find sporadic cases, they do fever checks everywhere, even stopping cars on highways to check everyone.
As soon as you find clusters, you shut schools, theaters, restaurants. Only Wuhan and the cities near it went into total lockdown.
[Q] How did the Chinese reorganize their medical response?
[A] First, they moved 50 percent of all medical care online so people didn’t come in. Have you ever tried to reach your doctor on Friday night? Instead, you contacted one online. If you needed prescriptions like insulin or heart medications, they could prescribe and deliver it.
[Q] But if you thought you had coronavirus?
[A] You would be sent to a fever clinic. They would take your temperature, your symptoms, medical history, ask where you’d traveled, your contact with anyone infected. They’d whip you through a CT scan …
[Q] Wait — “whip you through a CT scan”?
[A} Each machine did maybe 200 a day. Five, 10 minutes a scan. Maybe even partial scans. A typical hospital in the West does one or two an hour. And not X-rays; they could come up normal, but a CT would show the “ground-glass opacities” they were looking for.
(Dr. Aylward was referring to lung abnormalities seen in coronavirus patients.)
[Q] And then?
[A] If you were still a suspect case, you’d get swabbed. But a lot would be told, “You’re not Covid.” People would come in with colds, flu, runny noses. That’s not Covid. If you look at the symptoms, 90 percent have fever, 70 percent have dry coughs, 30 percent have malaise, trouble breathing. Runny noses were only 4 percent.
[Q] The swab was for a PCR test, right? How fast could they do that? Until recently, we were sending all of ours to Atlanta.
[A] They got it down to four hours.
[Q] So people weren’t sent home?
[A] No, they had to wait. You don’t want someone wandering around spreading virus.
[Q] If they were positive, what happened?
[A] They’d be isolated. In Wuhan, in the beginning, it was 15 days from getting sick to hospitalization. They got it down to two days from symptoms to isolation. That meant a lot fewer infected — you choke off this thing’s ability to find susceptibles.
[Q] What’s the difference between isolation and hospitalization?
[A] With mild symptoms, you go to an isolation center. They were set up in gymnasiums, stadiums — up to 1,000 beds. But if you were severe or critical, you’d go straight to hospitals. Anyone with other illnesses or over age 65 would also go straight to hospitals.
[Q] What were mild, severe and critical? We think of “mild” as like a minor cold.
[A] No. “Mild” was a positive test, fever, cough — maybe even pneumonia, but not needing oxygen. “Severe” was breathing rate up and oxygen saturation down, so needing oxygen or a ventilator. “Critical” was respiratory failure or multi-organ failure.
[Q] So saying 80 percent of all cases are mild doesn’t mean what we thought.
[A] I’m Canadian. This is the Wayne Gretzky of viruses — people didn’t think it was big enough or fast enough to have the impact it does.
[Q] Hospitals were also separated?
[A] Yes. The best hospitals were designated just for Covid, severe and critical. All elective surgeries were postponed. Patients were moved. Other hospitals were designated just for routine care: women still have to give birth, people still suffer trauma and heart attacks.
They built two new hospitals, and they rebuilt hospitals. If you had a long ward, they’d build a wall at the end with a window, so it was an isolation ward with “dirty” and “clean” zones. You’d go in, gown up, treat patients, and then go out the other way and de-gown. It was like an Ebola treatment unit, but without as much disinfection because it’s not body fluids.
[Q] How good were the severe and critical care?
[A] China is really good at keeping people alive. Its hospitals looked better than some I see here in Switzerland. We’d ask, “How many ventilators do you have?” They’d say “50.” Wow! We’d say, “How many ECMOs?” They’d say “five.” The team member from the Robert Koch Institute said, “Five? In Germany, you get three, maybe. And just in Berlin.”
(ECMOs are extracorporeal membrane oxygenation machines, which oxygenate the blood when the lungs fail.)
[Q] Who paid for all of this?
[A] The government made it clear: testing is free. And if it was Covid-19, when your insurance ended, the state picked up everything.
In the U.S., that’s a barrier to speed. People think: “If I see my doctor, it’s going to cost me $100. If I end up in the I.C.U., what’s it going to cost me?” That’ll kill you. That’s what could wreak havoc. This is where universal health care coverage and security intersect. The U.S. has to think this through.
[Q] What about the nonmedical response?
[A] It was nationwide. There was this tremendous sense of, “We’ve got to help Wuhan,” not “Wuhan got us into this.” Other provinces sent 40,000 medical workers, many of whom volunteered.
In Wuhan, our special train pulled in at night, and it was the saddest thing — the big intercity trains roar right through, with the blinds down.
We got off, and another group did. I said, “Hang on a minute, I thought we were the only ones allowed to get off.” They had these little jackets and a flag — it was a medical team from Guangdong coming in to help. […]
[Q] Isn’t all of this impossible in America?
[A] Look, journalists are always saying: “Well, we can’t do this in our country.” There has to be a shift in mind-set to rapid response thinking. Are you just going to throw up your hands? There’s a real moral hazard in that, a judgment call on what you think of your vulnerable populations.
Ask yourself: Can you do the easy stuff? Can you isolate 100 patients? Can you trace 1,000 contacts? If you don’t, this will roar through a community.
[Q] Isn’t it possible only because China is an autocracy?
[A] Journalists also say, “Well, they’re only acting out of fear of the government,” as if it’s some evil fire-breathing regime that eats babies. I talked to lots of people outside the system — in hotels, on trains, in the streets at night.
They’re mobilized, like in a war, and it’s fear of the virus that was driving them. They really saw themselves as on the front lines of protecting the rest of China. And the world.
[Q] China is restarting its economy now. How can it do that without creating a new wave of infections?
[A] It’s a “phased restart.” It means different things in different provinces.
Some are keeping schools closed longer. Some are only letting factories that make things crucial to the supply chain open. For migrant workers who went home — well, Chengdu has 5 million migrant workers.
First, you have to see a doctor and get a certificate that you’re “no risk.” It’s good for three days.
Then you take the train to where you work. If it’s Beijing, you then have to self-quarantine for two weeks. Your temperature is monitored, sometimes by phone, sometimes by physical check.
[Q] What’s going on with the treatment clinical trials?
[A] They’re double-blind trials, so I don’t know the results. We should know more in a couple of weeks.
The biggest challenge was enrolling people. The number of severe patients is dropping, and there’s competition for them. And every ward is run by a team from another province, so you have to negotiate with each one, make sure they’re doing the protocols right.
And there are 200 trials registered — too many. I told them: “You’ve got to prioritize things that have promising antiviral properties.”//
20200304 CNN, “Canceling SXSW festival won’t make the community safer, Austin health officials say” [Note: Time will tell if this decision is wise or not. I worry not. They may change this decision later too. Will see.]
20200303 Science Mag “Indonesia finally reports two coronavirus cases. Scientists worry it has many more”
“But epidemiologists have long said COVID-19’s absence in the world’s fourth most populous nation was implausible, given the large number of visitors—both for tourism and business—from nearby China. A modeling study based on the number of travelers from Wuhan, published by a team at the Harvard T.H. Chan School of Public Health on bioRxiv on 11 February, concluded that even then, it was unlikely that Indonesia did not have a single COVID-19 case. (Indonesian Minister of Health Terawan Agus Putranto called the study insulting and later said the lack of cases was the result of prayer.)“
20200302 (hope we don’t need this but SK is cool in this efficient way to do test and get sample) //South Korea is pioneering a coronavirus drive-through testing station that officials say is faster and safer than going to a hospital or clinic// [HT @klustout]
20200303 Vox, “China’s cases of Covid-19 are finally declining. A WHO expert explains why. “It’s all about speed”: the most important lessons from China’s Covid-19 response.” [HT Kai “Also highly recommend reading this great interview by @juliaoftoronto with mission head Bruce Aylward:”]
“Q: Julia Belluz
In the elderly, what explains the high death rate? Is it something about deterioration of the immune system with age or the higher probability you have [of developing] other illnesses as you age?
A: Bruce Aylward
I think it’s the latter. These people are dying of an inflammatory process in their lungs. It’s not an infectious process, like a bacterial or viral infection. It’s inflammatory, like we see with SARS. We’re not sure of the mechanism. We do know the proportion of people who die who had cancer was half compared to hypertension and cardiovascular disease. Diabetes is a little bit lower than those two, and cancer lower again.”