Untangling Flu and SARS-CoV-2 Prevalence

From JAMA

Community Prevalence of SARS-CoV-2 Among Patients With Influenzalike Illnesses Presenting to a Los Angeles Medical Center in March 2020

Brad Spellberg, MD1; Meredith Haddix, MPH2; Rebecca Lee, MPH2; et al Susan Butler-Wu, PhD1; Paul Holtom, MD1; Hal Yee, MD, PhD3; Prabhu Gounder, MD2

Author Affiliations Article Information

JAMA. Published online March 31, 2020. doi:10.1001/jama.2020.4958

Excerpts:

Until recently, diagnostic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), was only available through public health laboratories.13 This limited testing was prioritized for persons who had severe illness or identifiable risk factors, such as travel to an area with ongoing transmission. Thus, the incidence of community transmission by persons with mild illness and without risk factors remains ill-defined.

The current public health strategy of case containment is premised on the assumption of no or limited community transmission. Identifying a high rate of community transmission would indicate a need to shift the public health strategy from containment to mitigation of spread. Thus, determining the rate at which mild disease is spreading in the community, particularly among persons without risk factors for acquisition of the virus, is critically important.

Methods

Between March 12-13 and 15-16, 2020, the Los Angeles County + University of Southern California Medical Center conducted testing among patients presenting with mild influenzalike illness to the emergency department or urgent care. Patients who had nasopharyngeal swabs tested with polymerase chain reaction assays for influenza and respiratory syncytial virus (GeneXpert Flu, Cepheid) were automatically tested for SARS-CoV-2 (Quest Diagnostics).

Only the influenza tests conducted during the day shift were automatically tested for SARS-CoV-2 because the process was manual. Patients were excluded if they had specific risk factors for SARS-CoV-2 (eg, travel exposure or known contact with a traveler, severely ill patients admitted for respiratory tract infections). Positive test results were followed up by Department of Public Health experts to assess clinical factors and demographics.

Results

One hundred thirty-one tests for SARS-CoV-2 were obtained and 7 were positive (5.3%; 95% CI, 2.2%-10.7%). The median age of patients who tested positive was 38 years (range, 34-44 years), 3 were male (43%), and the median duration of symptoms was 4 days (range, 2-4 days) at presentation. Six of 7 patients presented with fever, 5 with myalgias, and only 1 with cough. Only 1 patient had a travel history (returned from Miami, Florida). All patients had mild illnesses, and all tested negative for influenza and respiratory syncytial virus.

At the Los Angeles County + University of Southern California Medical Center, the number of influenza tests ordered by physicians was relatively stable, but the percentage of positive test results for influenza declined around the time of the study (Figure 1). Across the county, sentinel testing revealed a third seasonal spike in influenzalike illnesses during the weeks before the study; no third seasonal spike was seen during the prior 4 years, and the third spike occurred later than any spike during those years (Figure 2A). This late, third seasonal influenzalike illness spike occurred even as the percentage of respiratory specimens that tested positive for influenza steadily declined (Figure 2B).

And the discussion

The 5% rate of SARS-CoV-2 among patients with mild influenzalike illness without risk factors is concerning. These patients had sufficiently mild illness to be active in the community throughout their illness, increasing the possibility of transmission. Such transmission is consistent with the unusual, third countywide influenzalike illness spike that occurred late in the season and with declining rates of influenza positivity.

Full article here.  Good graphs.

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John Tillman
April 1, 2020 6:09 am

Esteemed CTM:

I hope that your linking this to the Permian mass extinction post doesn’t mean you know something dire which everyone else has missed!

Vuk
Reply to  John Tillman
April 1, 2020 8:09 am

Italy and Spain are in big trouble, UK is catching faster than expected. Wednesday’s Covid-19 update here:
http://www.vukcevic.co.uk/UK-COVID-19.htm

John TIllman
Reply to  Vuk
April 1, 2020 8:38 am

A big jump in new deaths yesterday after two days of decline. New cases still look like possible topping however.

Will see what happens before Easter.

Reply to  John TIllman
April 1, 2020 1:38 pm

Here are some positive numbers, imo. California had one of the first deaths almost one month ago. Today’s numbers are 8,704 total cases and 184 deaths. I think that public awareness is having a greater effect than the models thinks. Time will tell.

Iran is an interesting to look at on their numbers. They have had 2 peaks over the last several weeks with new cases running around 3 K/day for the last 6 days. Their death rate though has remained within an upper range for 17 days now between 110 to 157. Why no surge in daily death numbers into the hundreds per day or worse? Iran had the earliest outbreak outside of China.

D. J. Hawkins
Reply to  goldminor
April 1, 2020 4:02 pm

So, you’re confident that Iran isn’t cooking the books on rates of infection and deaths? ‘Cause they’ve been soooo trustworthy in every other aspect of international relations.

anna v
Reply to  goldminor
April 1, 2020 9:10 pm

If they are not cooking the books, it might be the social isolation of Islam, burkas, harems, boys and girls separated etc. that make the difference. The face covers of women outside home for example would give a protection to air born viruses.

Firepig
Reply to  goldminor
April 2, 2020 1:01 am

Iranian women don’t wear full burka, they have a long coat and hijab when out, i.e., they don’t have face covers.

Scissor
Reply to  Vuk
April 1, 2020 9:04 am

All of the behaviors are qualitatively similar. The UK’s deaths will break decisively from exponential as new cases already have.

Spain and Italy are well off the exponential growth phase in both cases and deaths. Unfortunately, lives will end, as they always do. It’s certainly tragic that this Wuhan virus is causing so much pain and suffering and death.

Bryan A
Reply to  Scissor
April 1, 2020 12:14 pm

Should be calling it the Chinese Flu (Wuhan Flu or Wu Flu after the Spanish Flu)

Vangel Vesovski
Reply to  Bryan A
April 1, 2020 5:56 pm

Didn’t the Spanish Flu come from Kansas?

Analitik
Reply to  Bryan A
April 1, 2020 6:19 pm

Given that the Spanish Flu didn’t originate there but was named because of the heavy toll in that country, should CoViD-19 be called the Italian Flue, Lombardy Flu, New York Flu?

BTW, my preference is for the Wuhan Flu as it sound like a rapper group

noaaprogrammer
Reply to  Bryan A
April 1, 2020 8:11 pm

“Wuhan Flu Over the Cuckoo’s Nest”

Observer
Reply to  Bryan A
April 2, 2020 4:12 am

Most flus originate in China, so calling it “Chinese” doesn’t help identify this particular strain.

“Wuhan flu” or “Wuflu” does.

“Bat soup fever” is still my favorite, however.

Analitik
Reply to  Bryan A
April 2, 2020 4:50 am

Bat Lab fever

Phoenix44
Reply to  Vuk
April 1, 2020 9:46 am

UK deaths are still nothing remarkable. All that has happened so far is that flu and pneumonia deaths have dropped and CV deaths have increased. The data to 20th March shows total deaths running some way lower than the five year average. Like Italy, we are counting anybody who dies having tested positive as a CV death, so as we test more we will have more deaths. The same thing has happened in Italy. We still have to see whether the latest CV deaths are actually excess.

Reply to  Phoenix44
April 1, 2020 10:34 am

UK Ecess Winter Deaths Official government data

Winter season Excess Five-year
winter moving
deaths average
1998 to 1999 46810 38134
1999 to 2000 48420 34040
2000 to 2001 24790 34236
2001 to 2002 27230 29558
2002 to 2003 23930 26188
2003 to 2004 23420 26268
2004 to 2005 31570 25530
2005 to 2006 25190 25668
2006 to 2007 23540 28250
2007 to 2008 24620 27068
2008 to 2009 36330 27222
2009 to 2010 25660 27322
2010 to 2011 25960 28628
2011 to 2012 24040 24818
2012 to 2013 31150 28430
2013 to 2014 17280 28138
2014 to 2015 43720 30212
2015 to 2016 24500 33864
2016 to 2017 34410 35048
2017 to 2018 49410

Vuk
Reply to  Ben Vorlich
April 1, 2020 12:47 pm

Hi Ben
just had a quick look at your data and compared with the DJF (winter) CET (temperature) data, it appears that warmer the winter higher flu mortality.

Reply to  Ben Vorlich
April 1, 2020 1:24 pm

Interesting correlation of the two El Nino peaks occurring at peak excess death numbers.

GregK
Reply to  Phoenix44
April 1, 2020 9:12 pm

Madrid funeral directors claim they are running at 6 times normal business for this time of year.

It will be interesting to see if the overall death rate for the year shows no/some/a lot of variation from what might be expected. Has CV just compressed the normal death rate ?

Almost certainly less interesting for the participants in such a survey though.

Reply to  Vuk
April 1, 2020 10:02 am

It is worth getting the perspective of a retired English pathologist. This is one of the most sober and least alarmist articles I have read: “How deadly is the coronavirus? It’s still far from clear” I hope someone will use this as a basis for an article on this site with responses that discuss the applicability of the main points to other countries.

https://www.spectator.co.uk/article/The-evidence-on-Covid-19-is-not-as-clear-as-we-think

Reply to  Michael in Dublin
April 1, 2020 4:12 pm

This doctor has written a further easy to read article – a must read:
How to understand – and report – figures for ‘Covid deaths’

https://www.spectator.co.uk/article/how-to-understand-and-report-figures-for-covid-19-deaths-

Karl
Reply to  Vuk
April 1, 2020 10:21 am

V=

New cases in Italy and Spain are falling. If the trend continues, Italy will have only tens of new daily cases by 15 April give or take

UK cases are effectively FLAT, but are falling as a function of overall cases.

Every country is following the same rise – peak – rapid decay seen in China.

Vuk
Reply to  Karl
April 1, 2020 11:15 am

Hi Karl
“UK cases are effectively FLAT,”
Not sure what you are referring to, the infections or deaths?
Have you looked at today’s data?
“…. rapid decay seen in China.”
I would sooner believe in the Father Xmas than to the Chinese data.

Bryan A
Reply to  Vuk
April 1, 2020 12:17 pm

Yep,
Chinese data is almost as reliable as North Korean data

Reply to  Vuk
April 1, 2020 12:39 pm

Karl has been lying and flat out making up fake numbers day after day.
It is literally sickening.

Reply to  Karl
April 1, 2020 12:37 pm

What?
UK had the most new cases ever yesterday as a new peak is building.
Deaths yesterday spiked way up to by far the most ever, and deaths have more than doubled in less than five days.
Today was far worse than that in the UK…over 4300 new cases, and over 560 new deaths. That number includes a 13 year old boy and a 19 year old man.
The new deaths recorded so far for April 1st is more than double the previous peak from Saturday.

In Italy today, the number of new cases jumped up by over 700 more than yesterday.
The number of new deaths today was over 700 once again, and active cases are continuing to climb ever higher to a new record every day. The appalling death total is now over 13,000, and the more than 80,500 active cases ensures that the number will continue to climb to tragic new levels for quite some time to come, and there will be no respite for the exhausted and dwindling professionals who are caring for all those gravely ill people.

In Spain, yesterday was the second highest number of new cases to date, as a new peak has formed, and the number of active cases continues to climb rapidly.
The number of cases in that country surpassed the numbers reported by China over the weekend, And active cases as of today are well over 70,000, a new high.
They have the highest number of critical cases in the whole world, over 5800.
They have the highest number of deaths per million people in the world, a heartbreaking 2,185 out of every million people there have already died, and all those active and critical cases means the number will be getting higher and higher for a long time to come.

New deaths in Germany spiked up to the highest ever yesterday.
Total deaths there have tripled since last Friday, and active cases rose again to a new record yesterday and again today after almost stalling for one day in a row on Monday.

Active cases now a gut wrenching 56,986.

Yesterday was by far the worst day ever for new deaths in countries all across Europe, with the daily death count by far the highest ever in one country after another.

I think you are insane, Karl.

LdB
Reply to  Vuk
April 1, 2020 10:36 am

Turkey is a nightmare .. it has a steeper rate than Italy and they are saying it’s real deaths are already 3 to 4 fold that being reported but supressed because it endangers the rule of Erdogan.

John TIllman
Reply to  John Tillman
April 1, 2020 8:33 am

US intel concludes China and other countries still hiding their WuFlu data:

https://apple.news/AS3sc6KddSR-j6JDM-Ryjog

Not exactly a shocker.

Vuk
Reply to  John TIllman
April 1, 2020 8:53 am

I wouldn’t be surprise if they are hiding the Covid-19 ‘elephant’ behind the Wuhan wet market ‘circus’ curtain.

Stevek
April 1, 2020 6:25 am

It would be interesting to see this same study done recently as stay at home order in place since March 19.

I can’t seem to find good information on how the current new infections are being transmitted.

Just Eyeballing Texas, where I live, newspaper reports indicate most of new cases are coming from close contact with someone that was infected. This is good thing. I would be concerned if new cases coming from people going to grocery store or picking it up at drive through windows or from food packaging and food from drive through/takeout.

Reply to  Stevek
April 1, 2020 6:59 am

Most of the new cases are in close contacts of people known to have tested positive, because those are the majority of people who have been and are being tested.
No one knows who spread the virus all over the entire country, and similarly, no one knows who has it now and is spreading it without knowing it.
They are playing whack a mole and do not seem to realize it.

Stevek
Reply to  Nicholas McGinley
April 1, 2020 7:23 am

Thanks. Am really hoping they get some better data soon.

Gary Wescom
Reply to  Nicholas McGinley
April 1, 2020 7:49 am

Another confusing factor is without antibody tests, we don’t know what percentage of the population has already had a mild case and is no longer vulnerable. There may be areas in the country with fairly high immunity rates but we can’t know at this time.

Karl
Reply to  Nicholas McGinley
April 1, 2020 10:29 am

It would seem based upon the data above that the prevalence is between 2% and 10% .

It also seems that infection in young(er) people is surprisingly asymptomatic,

All this real-world observational data leads one to believe that:

1: Covid-19 is less contagious/infective/prevalent than influenza (2-10% versus 20-30%)
2: Covid-19 is no more deadly to healthy people than influenza A
3. Covid=19 is much less deadly to children than Influenza B
4. If you are over 70, have cardiovascular or pulmonary disease, and are infected with Influenza or a Corona virus — you will have a high mortality rate

AND — politicians scared about their chances of re-election destroyed lifetime earnings and the world economy for NO GOOD REASON

Reply to  Karl
April 1, 2020 11:57 am

In the US, present day politicians did not start shutting things down, or drop the ball when it came to getting ahead of the virus and the disease.
Bureaucrats and business owners started it by shutting things down, and bureaucrats who were trusted to be the experts on issues of public health dropped the ball in keeping ahead of the virus.
Politicians from years back made a whole bunch of bad decisions about buying supplies, and centralizing all the authority and responsibility into the hands of bureaucrats, in particular the CDC…who turned out to fail us mightily when we needed them to be very good at what they were supposed to do if we have a disease outbreak.
They are still failing us. Big time.
They are doubling down on bad decisions, and proving themselves unable to be nimble and fast on the uptake regarding how we can be protecting ourselves, and every tiny bit of what is emerging as new information about how this new virus works and the unique characteristics of the disease it causes.
Politicians are not supposed to be who we rely on to be experts in complex matters of science and medicine.
We elect politicians to make decisions.
We have experts who are supposed to know exactly what they are talking about.
Politicians did not cancel sports and concerts and amusement parks and other businesses.

Media people who are supposed to keep us informed have instead often been far more interested in using a crisis to advance their political views by trying to cast politicians they do not like in a bad light, instead of putting such things aside for now.

And some politicians have done the same thing…tried to use the whole mess for political advantage, instead of being leaders for once in their miserable worthless and petty lives.

Reply to  Nicholas McGinley
April 1, 2020 1:31 pm

Agreed.
Once the this mess settles down there should be an investigation into the FDA & CDC’s feckless handling of the COVID debacle. Not having enough test kits has crippled our health system and forced the doctors to fly blindfolded. Why did they approve only one COVID test for the entire USA? And the lack of personal protective equipment is putting the whole system at risk. We should clean house at the FDA & CDC.

kendo2016
Reply to  Nicholas McGinley
April 2, 2020 6:35 am

Has any researcher on here looked at any of the research done on corona viruses in 2013,by Chinese dr/professor Zheng li Shi ,now in Wuhan I believe . She was at university of North Carolina .it was reported in Nature, October 2013 ,& in 2015

Rustynail
Reply to  Nicholas McGinley
April 4, 2020 10:55 pm

The CDC failed the early testing. I remember a visitor that spotted a faulty test batch with a “contaminated” reagent. The guy was just on a tour of the facility. No one that worked there had a clue or didn’t care.

That failure negated the time gained from the China flight bans? The other waste of time was the centralized and exclusive testing. That failed as miserably.

John Tillman
Reply to  Stevek
April 1, 2020 8:55 am

TX the least affected of big states, with NY of course the worst hit, with NJ #2 in total deaths.

New York 1714
New Jersey 267
Michigan 259
Louisiana 239
Washington 225

California 183
Georgia 125
Illinois 99
Massachusetts 89
Florida 85

Connecticut 69
Colorado 69
Indiana 65
Pennsylvania 63
Texas 56

Ohio 55
Virginia 34

USA 4102 (including Puerto Rico and outlying territories)

dmacleo
Reply to  John Tillman
April 1, 2020 10:13 am

Maine 5 deaths out of 355 known infections.
people healed figures are fudgy.
those who had it, healed, never examined not known of course and I get slammed for saying this data point is one of the more critical points we need since it would greatly affect the mortality rate.

Bryan A
Reply to  dmacleo
April 1, 2020 12:22 pm

a definite antibody test is needed

Rustynail
Reply to  Bryan A
April 4, 2020 11:03 pm

They exist. Not sure how available or wide spread they are. Fouci said he didn’t care about antibodies; he wants “clinical trials” and a vaccine. Systematic wide spread sample testing will probably show more positive cases?

observa
April 1, 2020 6:33 am

And now for the really good news-
https://www.msn.com/en-au/news/australia/a-coronavirus-vaccine-has-never-been-done-successfully-before-chief-medical-officer/ar-BB11ZMx4
Are we to take solace that thank goodness it’s not a flu pandemic?

Stevek
Reply to  observa
April 1, 2020 7:27 am

I hope Moderna vaccine works as it is a new type of vaccine. It uses mRNA to tell the body itself to produce proteins that are suppose to resemble the virus but apparently these proteins do no harm to the body. Then the body makes antibodies for the protein and these antibodies are suppose to also kill virus if body exposed to the virus.

Basically their drug tells the body to make its own vaccine !

John Tillman
Reply to  observa
April 1, 2020 8:22 am

Vaccines against coronaviruses in birds and other mammals have been developed with varying degrees of success. Best against chicken CoVis.

From 2003, SARS-era, but still relevant:

Severe acute respiratory syndrome vaccine development: experiences of vaccination against avian infectious bronchitis coronavirus.

https://pbs.twimg.com/media/EUdKBbUX0AAZiD1?format=jpg

Reply to  John Tillman
April 1, 2020 9:51 am

There is a relatively effective vaccine for Canine Corona Virus (CCoV) for dogs. CCoV is an enteric (gut, small intestine) pathogen primarily for dogs and causes persistent diarrhea, which if not quickly cleared or the dog kept hydrated until it recovers can become life-threatening dehydration for the animal. CCoV uses a different cellular surface receptor, aminopeptidase-N (APN) for cell entry than human SARS-CoV-1/2 which is found predominately on intestinal epithelial cells apical surface and this is not a lung epithelial cell pathogen.

The immune system handles primarily respiratory/deep lung pathogens differently than pathogens that infect via gut or other sites, this is due to depending on cellular/tissue tropism (preference) of the virus. A strong type 1 cytotoxic T cell response is necessary for respiratory pathogens which an inactivated CCoV vaccine doesn’t provide, but because CCoV is not a lung pathogen it still effective at preventing CCoV disease in dogs.

John TIllman
Reply to  Joel O'Bryan
April 1, 2020 11:34 am

Thanks!

TP hoarders must think WuFlu is an enteric pathogen, as well as respiratory.

Reply to  John TIllman
April 1, 2020 1:20 pm

I have just read – on
https://www.express.co.uk/life-style/health/1263570/coronavirus-symptoms-signs-covid-19-infection-nausea-diarrhoea-vomiting
that there is some suggestion that diarrhoea may [MAY!] be a symptom for the Covid.

Auto

Ron Long
April 1, 2020 6:38 am

Interesting that they think, probably for good reason, that this is the second variant of SARS (Sudden Acute Respiratory Syndrome), which makes more sense than Covid-19. The tendency of low-symptom persons with SARS-2 walking around, touching everything, is quite alarming, and is possibly the hallmark of this pandemic. However, it sure looks like the trajectory of the virus is tending to flatten in the northern hemisphere. Those of us in the southern hemisphere, sliding into winter and the traditional flu season, are a little anxious.

Reply to  Ron Long
April 1, 2020 6:46 am

SARS 2 and COVID 19 are the same thing.

Greg
Reply to  Nicholas McGinley
April 1, 2020 7:35 am

SARS refers to the virus, COVID to the disease it causes.

Reply to  Greg
April 1, 2020 8:12 am

Isn’t it just vice versa ?

John Tillman
Reply to  Krishna Gans
April 1, 2020 8:58 am

SARS-CoV-2 is the virus and COVID-19 the disease it causes.

SARS alone indicates the syndrome identified in 2003, caused by the virus now called SARS-CoV-1.

Greg
Reply to  Krishna Gans
April 1, 2020 9:05 am

don’t take my word for it … do your own fact checking.

Reply to  Krishna Gans
April 1, 2020 9:49 am


It wasn’t critical, just really a question, because for me, Severe Acute Respiratory Syndrome is an illnes or the symptons of one, if not so, ok, did I pick it wrong.
Everywhere definitions are flying around that’s not so easy to hit the right one.

Karl
Reply to  Krishna Gans
April 1, 2020 10:33 am

YES

Severe Acute Respiratory Syndrome —Disease

COVID-19 === subtype/strain/date discovered of the VIRUS

Reply to  Greg
April 1, 2020 11:34 am

I should not have commented using the same abbreviated phrasology as Ron used.
There is only one virus that is going around now that is the subject of this pandemic.
To me, SARS, left by itself, has always meant the virus that caused the 2003-2004 outbreak.
This virus stopped spreading and has not been seen in people in over 15 years…since 2004.
OKay…zero cases of original SARS, more correctly called SARS Co-V, in teh entire world since 2004.
Then, a virus which was found in Wuhan late in 2019 popped up, causing an outbreak.
It was found to be a corona virus, related to the virus from 2004, but not very closely related.
It was found to be what is called a novel virus, meaning it is new to science, newly discovered, but not newly evolved. Geneticists look at the genome of new viruses, and how the genome of it differs from other known viruses, and then they use what are thought to be the typical rate at which such viruses mutate, and calculate when the new virus probably diverged from other related viruses that are already known to science. It is understood that there are large numbers of wild animals that have these viruses in them, in particular bats. Many related strains of bat corona virus have been isolated from animals found in the wild over the years, but it is also known that the known ones is a small fraction of what exists in the vast wild populations of bats. Other animals can and do get infected by bat viruses from time to time, and in particular, there are many animals which have been found in the wild that have strains of virus closely related to these various bat viruses. Corona viruses in general are widely dispersed and infect probably every mammal species on the planet, and they are constantly crossing over from one species to another, although it is not an every day thing…more like an occasional thing.
So there is a lot of detective work constantly ongoing, in which scientists seek out populations of wild animals and draw blood from them to see what viruses they have.
So there is a library of genetic information about various viruses, what animals have them, where they were discovered, when they were discovered, and how they are all related to each other, either closely related, or more distantly related.
The longer ago a virus crossed over from bats to another type of animal, the more different the genome is though to be from known strains of bat viruses.
It is an ongoing thing to find new caves where bats live, draw blood from them, and occasionally find new additions to the library of known viruses.
The same for other animals. The same thing is going on for all sorts of other types of viruses and bacteria and such, but we can ignore that and just focus on the section of the huge library which has bat corona viruses in it, as well as viruses found in other animals that are close genetic matches for bat viruses that are known.
Keep in mind that there are probably many…MANY…viruses that have never been discovered because they are in bats which live in places that no one has ever been to, or tested for, or both.
It is also known that occasionally a single individual animal can get infected with two virus types at the same time. They could be closely or distantly related viruses, and because of the way viruses reproduce themselves, if two viruses are inside a cell at the same time, they can exchange parts of their genetic material. This is called resortment. It leads to a new virus strain that is a cross between the two original viruses, called a hybrid.
That is another way a virus can split into two strains…either by mutating slowly over time, called genetic drift, thought to occur at a more or less steady rate of change, or by resortment, in which a virus can change suddenly by grabbing genes from another virus. A third way viruses change over time is when it moves from one species to another. This event is called a zoonosis. Since viruses use the molecules inside the cells of the host to build new copies of itself, it is often possible to tell what animal a virus has been in recently, and more distantly in time.
This sort of information is also part of the huge genetic library stored by scientists.

Getting back to the new virus that was discovered in Wuhan in late 2019, it was found to be in the same “family” of viruses that the one that caused the 2003-2004 outbreak is in.
But it is distinct, so it needs a new name…especially since it has now become very important for people to understand it, and to talk about it, and trace it as it moves around and changes over time.
It was called Wuhan virus originally, then it was given the name SARS Co-V-2 by the people who name viruses.
Because we now have SARS Co-V-2, the one from 2003-2004 was renamed SARS Co-V-1>
SARS Co-V-1 caused a disease in humans named simply SARS, short for Severe Acute Respiratory Syndrome.
It was decided to called the disease that started in Wuhan in 2019 by a name all it’s own, so we can talk about it without confusion. The geniuses that name viruses decided to call the new disease COVID-19, short for Corona Virus Disease 2019.

But the new virus and the disease it causes is not very much like the one from 2003-2004 it turns out. Because sometimes a small change in the genes of a microbe can cause a very large change in the way it infects and causes disease in humans (and also other animals but we will stick to people for now). This one has done exactly that.
Since this is now about the most important new disease in humans in our lifetime, at least in terms of the number of people and the disruption to our lives caused, they probably should have named it something that was very distinct, and maybe also not named the virus and the disease two different names. Ebola virus causes Ebola. There is another more technical name for the Ebola virus, that has the name of the place and /or the time it caused a problem for people built into the name…but most people can called it all just Ebola most of the time and then we all know what someone else is talking about.
The more important something is, the more important it is for people to not have confusion when we talk about it. So the naming virus people messed up on this one.

Okay, lets review:
The new disease we are all trying not to get, or trying not to die from if we already got it, is stupidly called COVID-19.
COVID-19 is caused by the virus stupidly named SARS Co-V-2.

Okay?
OK.
Moving right along, we had to go back and rename the virus and the disease from 2003-2004 outbreak.
Before no one was mixed up or unclear if someone said SARS.
But now they are, because the new virus was stupidly named SARS Co-V-2, and people do not like to have to type out a long name with some capital letters and some numbers and some hyphens.
And we do not like having a virus and the disease it is causing named two completely different names. It is cumbersome, especially when one has all caps, and a date built into it, and the other is some caps, and a number that has nothing to do with a specific date.
It is just the second important one with almost the same name, thanks to the jackasses who name viruses for us. Thanks jackass virus naming guys (and/or gals)! Thanks a heap!

Old virus is now SARS Co-V-1, old disease just plain SARS.

New virus SARS Co-V-2, new disease COVID-19.

There have been zero cases of old virus disease SARS since 2004. They only have it in labs.
Hardly anyone ever got infected with it.
We have been infected, most of us, with distantly related viruses in the corona virus group.
They cause one out of three common colds people have always gotten for as long as anyone knows about.

We like to shorten long names, and not have cumbersome words to type out, and unnecessarily complicated ways to talk about the names of things that we are all talking about about all day long, day after day.
So some people are using nicknames like Wu Flu, Wuhan Flu, and things like that, to talk about this new virus and new disease.
Some other people want to stick to the long and cumbersome names the virus naming people decided to bother us all with.

So…now instead of automatically knowing exactly what someone means when they discus a virus and a disease, we have all had to have a whole bunch of little help sessions to clear it all up. Thanks to virus naming people, who may be almost as smart as astrophysicists who play with magnets by shoving them up their noses.
I am just glad magnets are not made of zinc.

To circle all the way back to the beginning of this long winded explanation, when I replied to Ron a few hours ago, I said SARS 2 when I meant SARS Co-V-2, since he had used that nickname.
And I called COVID-19, COVID 19, because Ron had used that hyphen saving nickname, and I saw no need to correct him, thinking everyone would know what I was talking about…but should not have thought that, because thanks jackass virus naming people, whoever you are.

John Tillman was exactly right.
Greg and me, in our first reply to Ron and to me respectively, used a shortcut and were not precisely correct…because thanks virus naming people!

OK?
Otay!

Reply to  Nicholas McGinley
April 1, 2020 1:38 pm

Many thanks!
“Keep in mind that there are probably many…MANY…viruses that have never been discovered because they are in bats which live in places that no one has ever been to, or tested for, or both.”
Indeed.
The wiki-thingy says that there are about ‘1,200’ different species of bats actually know.
So, yes, I am sure you are right.

Auto

Reply to  Nicholas McGinley
April 1, 2020 1:48 pm

Okay ! 😀
Well explained, Thanks !

Paul in Longmont
Reply to  Nicholas McGinley
April 2, 2020 6:44 am

Note that Chinese Wet markets have been re-opened, business as usual. Maybe that is because the virus didn’t come from the wet markets. This video (~1 hr) contains a short (~7min) video from China touting China’s discovery of over 2000 new viruses in the last year or so (at ~16 min). It also references a paper from South China University of Technology that proposes another explanation.
https://www.youtube.com/watch?v=tYTHI55NqfY

paper referenced in the video:

https://img-prod.tgcom24.mediaset.it/images/2020/02/16/114720192-5eb8307f-017c-4075-a697-348628da0204.pdf

another paper on the comparison of Horseshoe Bat Coronaviruses with the earliest cases of Human Coronavirus from Wuhan. Horseshoe Bats were never sold in the Wuhan wet market and live over 900 km from Wuhan. Apparently, the Chinese have been studying them for some time now. Note the similarity between SARS-CoV BJ01 and BAT SARSr-CoV HKU3-1:

https://www.researchgate.net/publication/338998831_A_pneumonia_outbreak_associated_with_a_new_coronavirus_of_probable_bat_origin

Reply to  Paul in Longmont
April 2, 2020 9:59 am

re: “Maybe that is because the virus didn’t come from the wet markets.”

A leap in logic; ‘They’ simply see _no_ problem now.

Read: “Regie’s Blog – BIRTH OF A VIRUS” (This was gone-over a MONTH back now https://wattsupwiththat.com/2020/02/27/cdc-covid-19-possible-us-case-of-chinese-corona-virus-from-an-unknown-source/#comment-2928578 )

The following excerpted from: https://regiehammblog.wordpress.com/2020/02/27/birth-of-a-virus/

As I watched my neighbor put her dog’s poop in a single-use plastic baggy, I thought about split pants in China.

When my wife and I got off the plane, 18 years ago, to adopt our first daughter, we were taken aback by the split pants. Split pants are (or at least were, back then) pants the children wear that are open in the crotch area. That allows them to … [use your imagination -_Jim]

Either way, I distinctly remember my brand new Nike slip-ons (probably made not far from where I was standing) sloshing into a mix of urine and who knows what else, and continuing to do so for the next three weeks.

As I started feeling the cough coming on, I remember one of the women in our group saying, at one of the airports (as she too, stepped into urine) “The people in this country probably have built up antibodies inside them our bodies have never even thought about.”
——————–
Read the rest at the link above.

Reply to  Nicholas McGinley
April 2, 2020 2:45 pm

I am not gonna comment much on the reports of the virus being created in a lab and released by accident or on purpose, for the simple reason I do not see how it is more that speculations and suppositions.
Anything factual, I will look at it very carefully.
Most virologists have gone on record saying there is nothing unusual about this virus from a genetic perspective…new viruses are found all the time in animals.
I expect if the virus was created in a lab and released…there are intelligence and army research labs that will be the ones to be able to inform us…if they choose to do so.
Anytime anything bad happens, there are no shortages of people who instantly decide it is a plot or on purpose or some other dark on purpose thing.
But I know there are deadly viruses in animals, and they get into human beings all the time.
Read about the history of rabies to learn more about that…it happens many times every year all over the world that some deadly virus goes from animals to people.
There are entire publications that have dozens of articles every month about them…all over the world, all the time.
I am not doubting it, not jumping on any bandwagons though.
I am going to remain rational and fact and evidence bound while this crazy crap is flying around.
Situation is bad enough just sticking to what can be shown by evidence.

Reply to  Nicholas McGinley
April 2, 2020 2:58 pm

In those virology papers i do not see anything new…those are months old.
As for virology research in China and elsewhere…of course they are studying viruses. Everyone is.
Why would any country not be researching viruses?
If they were not, there would be no information about the comparative genealogy and phylogeny of these viruses, let alone how to create tests or anything else.
How would anyone know how to create vaccines, or tests for the antibodies, or even viral RNA tests in such a short time?

rbdwiggins
Reply to  Nicholas McGinley
April 1, 2020 10:09 am

SARS-2 is the virus identification… COVID-19 stands for COrona VIrus Disease 2019

Greg
Reply to  Ron Long
April 1, 2020 8:36 am

Those of us in the southern hemisphere, sliding into winter and the traditional flu season, are a little anxious.

Don’t over heat living space and keep RH > 50%.

this year was very calm for flu this year in Europe. No idea whether that is an indicator for the antipodes.

Reply to  Greg
April 1, 2020 9:23 pm

“don’t OVERHEAT living space”? All the reports I’ve seen suggest that cooler temperatures promote colds and influenza . One suggestion I recall is that the standard 20C thermostat setting is too low. I’ve been sniffling along all winter with the thermostat at 15C, and am having trouble sleeping at 20C now.

What’s your idea of “overheating”, and where did you find it?

noaaprogrammer
Reply to  otropogo
April 1, 2020 10:24 pm

Raising body core temperature – as in a sauna or hot tub – followed by a cold shower or rolling in the snow as some of the Finnish people do – is supposed to help your innate immune system to more effectively fight this virus. (I saw this online explained by some doctor — just google the key phrases: “raising body core temperature” and “innate immune system.”)

Rustynail
Reply to  Ron Long
April 4, 2020 11:18 pm

There is a video of a woman going through a computer section in a store and systemically touching every keyboard and lid in two rows. She seemed to be in a trance.

Scissor
April 1, 2020 6:39 am

It’s too bad that a similar study on the asymptomatic population wasn’t done concurrently. It seems like at the time of the study, the cat was out of the bag.

Kevin kilty
April 1, 2020 6:53 am

Good link, Charles, the more I read the more I learn, though I don’t know where the learning will lead.

For weeks here it looked as though COVID19 was being delivered randomly through cosmic rays or something because we had just isolated cases here and there over a hundred thousand square miles except for a cluster at a rest home sort of in the middle of nowhere. I had figured that this pointed to transmission through travellers on highways . Now it’s beginning to get more structure and looks like community spread in the more populated places.

Many people around here speak of a strange ILI that passed through in late February/Early March. It was mild, and people expressed symptoms within about 24 hours of contact with someone else who had it. We had no COVID19 test kits here until March 5, but when I took a child in to a clinic to get tested for influenza on March 2, I did notice the staff were taking unusual precautions.

Phoenix44
Reply to  Kevin kilty
April 1, 2020 10:13 am

I suspect its been around weeks longer than we think and has spread very widely. I can’t see how it cold have spread across the UK so completely in Winter so quickly, from a limited number of original sources. A doctor friend of mine in France had a very bad flu (unusual for him in early January), I had asymptomatic swollen lymph nodes soon after, my partner had a dry cough a week after that and my daughter had a few days off work feeling rotten a few days later. All anecdotal, but that would mean it was in France soon after Christmas.

My rough estimate of the infection rate is based on UK deaths. Say 300 deaths in a day of people who tested positive. Normal daily deaths are around 1,500 (age adjusted). So if none of the 300 were “excess” the infection rate amongst a reasonably random sample of people was 300/1500 = 20%. SAy 100 deaths were excess, then the infection rate is 13%.

Dodgy Geezer
April 1, 2020 6:53 am

So this study (though limited and small) provides support for the hypothesis that mild or asymptomatic sufferers are probably spreading the disease.

Therefore the South Korean approach of identifying and quarantining sufferers is unlikely to close the disease down effectively. But we do have claims that their approach IS successful. So what is happening?

One possibility is that the South Korean approach is very aggressive – testing a wide number of possible contacts – such that it equates to small-scale mass testing, and therefore removes many asymptomatic carriers. Another is that the South Koreans are actually practising a mild version of social distancing, given the excessive news stories, and hence are suppressing spread without government intervention…

Steven Mosher
Reply to  Dodgy Geezer
April 1, 2020 7:59 am

“Therefore the South Korean approach of identifying and quarantining sufferers is unlikely to close the disease down effectively. But we do have claims that their approach IS successful. So what is happening?

One possibility is that the South Korean approach is very aggressive – testing a wide number of possible contacts – such that it equates to small-scale mass testing, and therefore removes many asymptomatic carriers. Another is that the South Koreans are actually practising a mild version of social distancing, given the excessive news stories, and hence are suppressing spread without government intervention…”

Korea does contact tracing and Mass testing of FACILITIES.
Asymptmatics number about 20%

here is how it works.

1. Employee comes down with Covid. the ENTIRE company is tested, all their relatives are tested,
all their close contacts are tested,
2. Church person comes down with it. the entire church is tested. The infected persons travel history
is posted, if you crossed paths with them and are nervous, go get a test.
3. Nursing homes? 100% tested, regardless.
4. Hospitals? Same thing.

examples

” From Manmin Central Church in Guro-gu, Seoul, 10 additional cases were confirmed. The current total is 33 confirmed cases (church members = 27; family members and other contacts = 6) since 25 March. Investigation into places visited by new confirmed cases and contact tracing are underway.”

“From Uijeongbu St. Mary’s Hospital in Gyeonggi Province, 7 cases (inpatients = 4; staff/workers = 3) have been confirmed since 29 March. One patient who was in inpatient care on the 8th floor during 16-25 March was confirmed on 29 March, which prompted investigation into the contacts in the 8th floor ward, which found 6 additional confirmed cases. The 8th floor ward has been temporarily shut down. Testing is underway for around 200 healthcare staff and patients.”

“In Daegu, a total of 2,368 caregivers working in 61 hospital-grade healthcare institutions are under investigation. Approximately 97% of them have been tested as of today. All 2,118 test results returned so far have been negative.”

“Also in Daegu, a total of 2,415 inpatients admitted to 16 mental health hospitals are undergoing investigation. Approximately 67% of them have been tested as of today. All 273 test results returned so far have been negative.”

“From Asan Medical Center is Songpa-gu, Seoul, 1 inpatient has been confirmed with COVID-19. Epidemiological investigation is underway. The patient had visited Uijeongbu St. Mary’s Hospital during 25-26 March. Investigation into the places visited by the patient and contact tracing is underway. Healthcare staff and family/caregivers who had come in contact with the confirmed case have been placed under self-quarantine. The 43 inpatients will be placed in cohort quarantine.”

“Analysis of chains of transmission of confirmed cases within the last 2 weeks have found that 35.0% are imported cases; 34.9% are hospitals/nursing homes; 6.3% are other clusters; and 6.6% are under investigation.”

Josh Postema
Reply to  Steven Mosher
April 1, 2020 8:23 am

What are the false positive and false negative rates for all these tests?

PMHinSC
Reply to  Josh Postema
April 1, 2020 10:57 am

Josh Postema April 1, 2020 at 8:23 am
“What are the false positive and false negative rates for all these tests?”

Since many are reported as being non symptomatic, how is a “false positive” determined?

DocSiders
Reply to  Josh Postema
April 2, 2020 4:26 am

The WHO test has 30% false positives and 20% false negatives…the reason the CDC refused to use that test.

So most of the world is being tested with a test having a 50% error rate. And this test is sending 20% (infected people) back home to infect the rest of the population.

Dodgy Geezer
Reply to  Steven Mosher
April 1, 2020 8:29 am

So the South Koreans ARE testing large section of their population. From that data we ought to be able to make more informed guesses about the epidemic spread.

It looks as if it is less common in a population than I thought might be the case. Also it looks as if it is less transmissible than I thought…

kevin roche
Reply to  Steven Mosher
April 1, 2020 8:36 am

do you have a source with total testing numbers and positive results for all of South Korea, I am having trouble finding that. Has there been a widespread testing of the general population. Be interesting to know what portion of the population has been “exposed”, very hard to know, and what percent of those exposed actually become infected. some percent of exposed people don’t become infected. Be interesting to know why. Anyway, even getting a sense of what the infected rate in the general population is would be useful and an antibody study would be very useful to determine how many people may have been infected without being symptomatic or having mild symptoms. Is S. Korea doing any signficant antibody testing?

Phoenix44
Reply to  Steven Mosher
April 1, 2020 9:51 am

The South Koreans are fooling themselves. The timeline is simply not credible, and the testing not accurate enough (maybe only 70%) There is no way that there were not infections in South Korean 2-4 weeks earlier than they think. It seems more likely that the large increase in people visiting the doctor with flu-like symptoms were actually CV infections. We will see when we get an antibody test, but my bet is that Taiwan, Japan and South Korea all look great because their infection has already largely passed through in late December and January when everyone was thinking about flu.

Tom Abbott
Reply to  Steven Mosher
April 1, 2020 1:23 pm

““Analysis of chains of transmission of confirmed cases within the last 2 weeks have found that 35.0% are imported cases”

Imported from where, China?

It’s nice to have a guy reporting from the scene. Thanks, Steven.

April 1, 2020 6:54 am

What no one is doing is testing to determine how well the results of nasal swab testing does at identifying who has been infected with the virus.
Many people put into quarantine because of contact with known carriers of the virus, tested negative for a number of days before finally testing positive.
I am not sure what the longest period of time has been between exposure and testing positive, but it is clear that this happens, and they need to stop d!cking around by ignoring that the swab tests to not reveal who actually has the virus.
In the case of the cruise ship in Japan, all the way back at the beginning of February, people were being found who tested negative for, in some cases, long intervals of days before testing positive.
But there are still people responsible for public health pretending this does not happen, or else are unaware of the relevant information.
It is mind boggling.

Reply to  Nicholas McGinley
April 1, 2020 7:51 am

The more tests you take, the bigger the probability becomes that you will have a false positive result.

Rocketscientist
Reply to  Finn McCool
April 1, 2020 9:05 am

Are the tests administered daily until you get a positive result and then declare the patient has contracted the disease and must be quarantined?
Are any tests conducted after the initial positive result that might indicate a previous false positive?

Reply to  Rocketscientist
April 1, 2020 11:08 am

Rocketscientist
I only know about probabilities and stats. To know a bit more about the diagnostics process you can watch this:
https://www.youtube.com/watch?v=PWzbArPgo-o
There would seem to be a lot more involved in diagnosing the disease than poking a stick up your nose.
In terms of statistical analysis, it is well known that screening is not a very effective and can cause more harm than good.
A good example is Kit Yates book ‘The maths of life and death’ is:
Probability of a woman over 50 having breast cancer is 0.4%
Probability she test positive for breast cancer is 90%
Probability that she incorrectly test positive is therefore 10%
The probability that a woman with a positive result actually has breast cancer is 3.5%
If you are unfamiliar with Bayes Theory, this answer can seem unintuitive.

Reply to  Nicholas McGinley
April 1, 2020 10:16 am

In the case of the cruise ship in Japan, all the way back at the beginning of February, people were being found who tested negative for, in some cases, long intervals of days before testing positive.

Multiple tests create multiple risks. Medical personnel suit up elaborately for doing swabs and likely even to triage the mildly symptomatic people coming into the hospitals, but with the shortages being reported, they don’t dispose of face shields and gowns. Personal protective gear is being re-cycled – masks being assigned one per week with instructions to keep in a paper bag. And despite the helpers and watchers and disinfectants and hand sanitizers and modern knowledge of washing, the health personnel, hospitals, clinics and ambulances are undoubtedly become significant purveyors of these viruses.

Although multiple tests seem like an imperative to determine community spread, they also raise risks of introducing flu to COVD-19 patients or COV to flu sufferers. The first response to a nasal swab is to sneeze. The first response to a throat swab – to cough. Are the testers putting on new latex gloves between each of these tests?

20 % of first responders in NY are “out” with the virus. 15% of police are out. How many are they infecting before they take leave?

I want to be an advocate of multiple tests – and testing everyone, but more and more to me it just seems like the horse is out of the barn.

Reply to  Bill Parsons
April 3, 2020 5:14 am

I do not think the testing gives enough information for anyone to be thinking it will actually solve anything.
Containment is not happening.
Testing people with anything but close to 100% fidelity risks more harm than good, in addition to the risks you mention, Bill.
The person who does not have it could get it during the process, and the people doing the test might get it, although not if they are very careful.
But it uses a lot of PPE and time and money, and if there are failures and false tests on top of the fact a person testing negative might get infected afterwards…by an hour, a day, two days, a week…plus all the tests say nothing about people not tested, and virus on the lining of the nasal cavity means what to begin with?
The whole response is so lame and haphazard and random, that I see no sign of any overall strategy, and very poor tactical response as well.
Going forward, people at some point will want to be able to tell who is immune, because anyone not immune may be infected, no matter what a test says not based on immunity.
So there should be a plan for everyone to get tested and get an ID badge to prove immunity, and policy could be based around that.
Or a cure could be found…an antiviral that works after someone get pneumonia.
But the way things are, imagine what might start to happen to someone walking around with a cold…a regular cold, or allergies?
Already in New York an old woman was shoved and hit on the head because she came within a distance some young woman thought was too close.
The old woman was killed from the hit to the head. The young woman who killed her…charged with disorderly conduct and released.
IOW…in this short of a span of time, with no evidence the person killed was infected, was should have been homicide is now barely even a crime if it was because of someone getting closer than social distancing sensibilities.
How long until someone is doused with gasoline and set on fire because they sneeze on someone?

rbabcock
April 1, 2020 7:14 am

After going through the Italian results for March 30, this really is a huge issue for people with co-morbidities, but for relatively healthy people not so much. Even older healthy people are coming out the other end OK. It really appears the emphasis needs to shift to allow the virus to run its course in the healthy population and protect best we can the unhealthy ones.

Summer in the NH will have an effect on its spread along with continued heightened personal hygiene, testing and self isolation if you get it. We all (globally) have to get back to some sense of normal or the cure will be worse than the disease. Hopefully some of the treatments will also have an impact on severity as well.

Italian data: https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_30_marzo_eng.pdf

BTW, it appears the virus “incubates” in the human body for up to 5 days before presenting symptoms primarily by not triggering the human innate immune response. This response can be artificially triggered by getting the core body temperature elevated (sauna/hot water baths) and followed by cold water baths/showers. The results from a sanitarium that used these methods on the 1918 flu reduced the number of patients developing pneumonia from 20% untreated to 6% and 2% depending on whether they were inpatient or outpatient.

So if you feel like you might have it try getting your body temperature up with hot baths, a sauna if you have one or even getting into bed with hot towels and plenty of covers until you sweat.

icisil
Reply to  rbabcock
April 1, 2020 7:20 am

It’ extraordinary how much mortality is concentrated in the heavily polluted Lombardy region.

icisil
Reply to  icisil
April 1, 2020 8:07 am

At least 90% of the mortality is in Italy’s industrialized north, which has the worst air pollution in Europe.

Greg
Reply to  icisil
April 1, 2020 9:28 am

Air pollution may be a factor, like smoking is. More likely is the 300,000 strong Chinese population which they failed to restrict entry for when this was at its peak in China.

Someone should ask why not.

Reply to  Greg
April 1, 2020 9:51 am

re: “Air pollution may be a factor”

Does it would seem that the virus could be a constituent components of particulates in the air (like dust)? This also raises other questions …

References:
(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1563832/
Particle diameters ranged from 50 to 150 nm, excluding the spikes, with mean particle diameters of 82 to 94 nm.

(2) https://thewirecutter.com/blog/can-hepa-air-purifiers-capture-coronavirus/
The virus that causes COVID-19 is approximately 0.125 micron (125 nanometers) in diameter.
.

Phoenix44
Reply to  icisil
April 1, 2020 9:54 am

It really is not that bad. Nothing like say London in earlier flu epidemics in the 1960s – probably only a quarter of the levels back then.

Italy is old, it has lots of smokers and ex-smokers, and seems to have had rapid infection of the sick/elderly via hospitals.

Bindidon
Reply to  icisil
April 1, 2020 12:02 pm

icisil

” … is concentrated in the heavily polluted Lombardy region. ”

One more time, absolute nonsense, produced by an ignorant crackpot.

Instead of guessing and producing lies, what about looking at

https://aqicn.org/map/europe/

Here are two snapshots for you, generated a few minutes ago:

– Lombardy
https://drive.google.com/file/d/1oVUBkOIih74JBt-w-5vkgcWEaNDbyK_w/view

– Czechia
https://drive.google.com/file/d/1LZ-tqwbCV_76sNX3Qy93XF3yjbobY_eE/view

Does Czechia not look perfectissimo?

I hope you are intelligent enough to understand why the country looks so ’empty’… in comparison with two years ago, where you saw during the winter lots of labels with values over 150!

How is it possible to write things one knows NOTHING about?

J.-P. D.

icisil
Reply to  Bindidon
April 1, 2020 1:00 pm

What are you rambling about? I’m not guessing, I’ve read that Lombardy’s air quality is the worst in Europe. Not now, of course, because everything is shut down. But lung damage from air pollution is cumulative and doesn’t immediately go away when the skies clear.

sycomputing
Reply to  Bindidon
April 1, 2020 7:24 pm

How is it possible to write things one knows NOTHING about?

Du bist ein guter Leher!

icisil
Reply to  rbabcock
April 1, 2020 7:32 am

“After going through the Italian results for March 30, this really is a huge issue for people with co-morbidities, but for relatively healthy people not so much.”

Same in NYC

https://pbs.twimg.com/media/EUdKBbUX0AAZiD1?format=jpg

John Tillman
Reply to  icisil
April 1, 2020 8:14 am

Thanks!

rbabcock
Reply to  icisil
April 1, 2020 12:58 pm

Actually those with no co-morbidities that went critical might very well have been smokers or former smokers. This would include vaping and smoking weed. The 45 to 65 year old age group would likely include a lot of former smokers. Just my opinion.

Greg
Reply to  rbabcock
April 1, 2020 7:50 am

Figure 4 shows, for COVID-19 positive deceased patients, the median times, in days, from the onset of
symptoms to death (9 days), from the onset of symptoms to hospitalization (4 days) and from
hospitalization to death (5 days). The time from hospitalization to death was 2 days longer in those who
were transferred to intensive care than those who were not transferred (6 days vs. 4 days).

That 5days may explain what I found in Italian data, the growth curves of cases and deaths match closest with a lag of 5 days. I’d guess that most of the tests are done on admission to hospital.
comment image

Fortunately both Italy and Spain ( and Belgium and Netherlands ) are over peak COVID now. Number of new cases dropping, finally out of the exponential growth phase.

Media still doing their best to have a bidding game for higher [something] today [somewhere] rather than reporting the most significant development since this thing left China.
comment image

Scissor
Reply to  Greg
April 1, 2020 8:18 am

Your analysis of the Italy situation seems correct.

I keep think that U.S. peak is upon us, but then new daily case numbers spoil that. The good news, however, is that new cases are out of the exponential growth phase.

Greg
Reply to  Scissor
April 1, 2020 9:25 am

I see no reason to suggest US is either at peak or out of exponential growth. Rather the exponential has changed. It maybe argued that that is consistent with the NYC shutdown having a visible impact , though the slow down could have started a couple of days BEFORE 20th March. With noisy data it is impossible to determine when the change actually started.

comment image

the doubling time has dropped from earlier 2.3 days to 5.8 days but it still looks pretty straight on the log plot, so it’s still exponential.

I doubt you will see the top of the curve for at least another week, if we can compare to EU states.

John Tillman
Reply to  rbabcock
April 1, 2020 8:10 am

Thanks for the data. I had seen only the age 78 headline.

Reinforces numbers from elsewhere. Younger people do die from or with the WuFlu virus, but mainly the disease is lethal to the old and already unwell. Healthy immune systems can handle infection, especially the young, with lots of free T-cells.

icisil
Reply to  John Tillman
April 1, 2020 8:48 am

I think we’ll find that most of the younger healthy (looking) people ending up in ICUs and dying have co-factors like vaping, smoking, alcohol abuse, latent TB (immigrants), etc.

JimW
Reply to  rbabcock
April 1, 2020 8:29 am

Anecdotal support for that idea? I was in northern Thailand during Chinese New Year, loads of Chinese there including from Wuhan. Nobody was reported with any symptoms. It was very hot during the day and bloody cold at night. Wonder if all our immune systems were kicked into action?

icisil
Reply to  rbabcock
April 1, 2020 2:03 pm

On the situation in Italy:

Severe pneumonias appeared before coronavirus did
Many E European nurses caring for patients fled before lockdown, forcing patients into hospitals

Scroll to end of page to April 1, 2020

https://swprs.org/a-swiss-doctor-on-covid-19/

ren
April 1, 2020 7:25 am

São Paulo reports 136 deaths and Rio de Janeiro has 23 fatal cases.

Scissor
Reply to  ren
April 1, 2020 8:21 am

Another city with terrible air pollution, much of it due to gasohol.

icisil
Reply to  Scissor
April 1, 2020 8:50 am

Educate me on that, please

icisil
Reply to  John Tillman
April 1, 2020 9:59 am

Thanks.

Lovely. Acetaldehyde. Found in cig smoke, some e-cig vape, and pot smoke. A cause of popcorn lung that has similar symptoms to coronavirus illness.

icisil
Reply to  John Tillman
April 1, 2020 2:12 pm
icisil
Reply to  John Tillman
April 1, 2020 2:14 pm

Popcorn Lung: A Dangerous Risk of Flavored E-Cigarettes

https://www.lung.org/blog/popcorn-lung-risk-ecigs

Greg
Reply to  Scissor
April 1, 2020 9:56 am

So many confounding factors such speculation is rather pointless. I would have thought that burning alcohol was a lot cleaner than oil derived fuels, (especially diesel) unless you are worried about “dirty CO2”.

Rio’s flavelas are poor, dirty and over-crowded. You could probably think of a dozen factors other than air pollution.

Vaping is an interesting one, globally. I wonder if stats are including vappers as smokers. I know someone locally who had heavy flu recently who is a vapper. Her family who do not smoke/vap were not ill.

Reply to  Greg
April 1, 2020 10:17 am

re: ” I would have thought that burning alcohol was a lot cleaner than oil derived fuels,”

The vapor pressure of alcohol blends (w/gasoline) is an issue too leading to “evaporative emissions from vehicles”.

https://www.sae.org/publications/technical-papers/content/861557/

John Tillman
Reply to  ren
April 1, 2020 8:27 am

Brazil’s current COVID-19 death rate is 1.0 per million population.

David S
April 1, 2020 7:29 am

More letter soup. Just keep adding more letters to the name to confuse everyone. Really? Just call it what the MSM started calling it back in January, CHINA FLU.

Reply to  David S
April 1, 2020 1:56 pm

David S
The Covid did come from China; some folk don’t like to be reminded of that.

https://insidecroydon.com/2020/03/28/residents-association-issues-apology-for-chinese-virus-tweet/#more-79268

Local to me.

Auto

BernardP
April 1, 2020 7:31 am

Most asymptomatic cases (and some cases with mild symptoms) will go undetected, because people who don’t have symptoms won’t get tested.

These asymptomatic cases will not be subjected to quarantine and will continue to spread the virus.

An eventual vaccine will only come in 12 to 18 months. Like all flu vaccines, it will not be 100% effective. Not everyone will get the vaccine. Other potential treatments, such as chloroquinine, will only be used on symptomatic cases.

The Coronavirus has already spread too much, will continue to spread, and will not be contained, even if all symptomatic cases are identified and quarantined, which is unachievable.

Thus, despite massive efforts and disproportionate economic costs, the world as a whole seems to be moving towards forced herd immunity.

ren
Reply to  BernardP
April 1, 2020 8:35 am

It’s obvious.

Reply to  ren
April 1, 2020 2:43 pm

Bernard and Ren are both correct.
Epidemiologists have known for a very long time that there is one chance to contain an outbreak of a new disease.
That chance is right at the beginning, when there is a chance to trace every contact.
What exact constitutes “the beginning” varies, depending on numerous factors, such as (#1)how easily a person can pass on the disease to other people, (#2) how quickly people get sick after they are infected, and (#3)how many people who get infected wind up becoming sick.
So…
(#1)
This disease spreads easily.
Bad.
It means anyone who has it can spread it to more people, and each of those more people can do the same.
Bad bad bad.

So…
(#2)
This disease takes a long time between when someone gets the virus into their body, and when they start to feel sick.
Bad.
This means that the first person who had it, and then spread it, will not show up in a hospital for a long time, and that means all the people that person might have spread it to, are harder to track down, if anyone is even trying.
Bad Bad Bad…many times bad.

So…
(#3)
This disease only makes some of the people who get the virus into their body get sick, and some of the ones who get sick only get a tiny bit sick.
Bad, because…
This means some of the people who have the virus will never show up in a hospital at all, and so they will keep going to work, and keep doing whatever people do who are not sick.
Very bad, because…
Not so bad if the people who have it, but do not get sick from it, also cannot spread it.
But…
It is actually extremely terrible if some of the people who have it, but do not get sick from it, are spreading it even though they are not sick, because no one will know anything about it, especially if no one is trying to track down everyone the first person, all the way back at the beginning, was or may have been in contact with.
Which it turns out they were spreading it.
And it turns out that, in most places, no one was trying to track down people who may have it and be spreading it…not even that first person.
In most places, no one was even doing much looking, despite plenty of red flags.
Bad…
Terribly bad…
Very extremely terrible and bad…
Not terrible for the person who is having a mild case, but very terrible from the stand point of being able to find everyone who has a virus so they can be told to stay home and not go near other people.
If anyone was looking.
And in most places, the people we have hired and whom we trust to be watching out for our health and safety, did very little at the beginning, when it would have made some difference, if they did what they know they have to do when a new disease starts spreading…they need to catch it early and track down people with the virus very proactively and smartly.
These people who have the job of watching out for public health have been warning everyone that we will have a new disease someday, and they have always known everything about how important it is to be smart and quick if and when it happens.
They were not smart, and they were not quick.
They are still not being smart, and are still not being quick.
They failed us, at the one thing they all have known for a very long time would be the most important part of their job they would ever have.
And they have always known that they were the only ones who could do anything to prevent a new disease from spreading all around the world if a new one popped up.
And they have always known a new one would pop up that would be spread very easily…it is just a matter of time.
There have been movies and books about it for years and years, and warnings from them all for years and years.
But even now, having failed us, they are sitting around being stupid, and telling people things that are not true, then making excuses for themselves.
They have failed us, and everyone should be very clear about that.
They have no plan.
They are not paying attention to important clues about the virus.
They are spewing malarkey about what we can do to protect ourselves.
Everyone should be very clear on that, and keep it all in mind when we hear them speaking to us.
Bad at their jobs.
Bad at their science.
Bad at communicating.
Bad at being smart.
Bad at being quick.
And showing no sign of learning…anything.
Doubling down on stupid.
Not politicians…we do not elect them to be virologists and public health experts.

Can anyone think of a single public health expert who can even give anyone a single “I told you so”?

There are many more viruses to come.
New ones.
Old ones that mutate.
The best thing anyone can say is…this one is not killing a huge percentage of people, nor is it making everyone who gets it sick.
So it could have been worse, but it aint hardly over.

BernardP
Reply to  Nicholas McGinley
April 1, 2020 5:18 pm

Why are public health and political leaders still acting like the virus can be contained?

When will we hear someone in a position of power declare that this is a runaway infection that will have tu run its course?

Could it be that it’s now only a matter of politics and optics: Nobody wants to be accused of not having tried everything possible and impossible, at any cost.

observa
Reply to  BernardP
April 2, 2020 8:50 am

I must confess the line seemed to be we must flatten the curve so the medical system can cope until we get a vaccine. Then along came the Chief Medical Officer in Oz to announce to date there has been no such vaccine for any coronavirus and it all seemed to go through to the keeper (catcher for baseball fans).

Was he really just reiterating the conventional wisdom that so far with all our clever medical science nobody has come up with a cure for the common cold which has implied no defence available either. Along comes a new coronavirus from Gaia seemingly channelling Charles Darwin and the survival of the fittest and the brains trust figure let’s starve the young hosts to kill this thing .

They won’t mind a bit of inconvenience if we print them lots of money seeing they’re all a bit short of income holed up and this will all be for the best. Hey if there’s too much air pollution and CO2 around we’ll need to print lots more for windmills solar panels and EVs to help with the breathing and a two pronged approach is always better than one. Seems pretty logical and why hasn’t this been thought of before?

Reply to  BernardP
April 2, 2020 12:26 pm

“Could it be that it’s now only a matter of politics and optics: Nobody wants to be accused of not having tried everything possible and impossible, at any cost.”

This is surely part of what is going on.
No one really knows what to do.
It is too late, much to late, to get ahead of it.
It will have to run it’s course…no matter what we do, a virus has it’s own agenda.
We can protect ourselves, and those we are responsible for.
We should be wearing masks and other protective barriers when in contact with the public, and disinfect ourselves when we get home.
If no one in your home is infected, the virus is not in your house.
Try to keep it that way.
Wash clothes and spray shoes before you walk into the house with them…enter through the laundry room and strip and put them in the wash on hot water.
Wash your hands three times when you get home, then take a hot shower.
Spray all packages with Lysol before you bring them into your home.
Stay clear of other people as much as possible when outside.
If you are young and healthy, you have not much to worry about…except you may get a few weeks of viral pneumonia if you get a very high amount of virus all at once.
Try to avoid that.
But the very young have low chance of a bad outcome.
Stay well rested.
Sleep enough…this is one of the best ways to make sure your immune system is strong.
Take vitamins and minerals, every day.
Taking 10,000 milligrams of one vitamin or mineral supplement is not a cure for anything, but you need to have no deficiencies to be healthy and have a strong immune system.
Vitamin C is not toxic and excess will just be passed in urine.
But vitamin D can be toxic in extreme amounts.
Get plenty of sun if you can…20 minutes on bare skin a day is all you need…but no sunscreen…it prevents UV light from reaching the cells which make vitamin D.
After 20 minutes, the vitamin is being destroyed as fast as it is getting made, so more sun does no good after about 20 minutes.
Best to get it on as much skin as possible, so wear shorts or a bathing suit or take off your shirt.
Wear a mask, make one if yo do not have one.
You cannot keep every particle out of your mouth and nose that way, but it is probably not necessary to keep every particle out, just the big ones and just most or many of them.
And realize you will be very unlikely to die if you are not old and frail…but that is n reason to not worry about it.
No need to panic…that never helps.
Just be smart and stay away from sick people.
I suspect there are some sick people who will not stay inside.
Some people are no doubt spreading it on purpose.
But the vast majority of people are probably not infected, and most of those who are do not know it.
In the end, everyone will probably wind up having to get exposed.
A vaccine is not going to be available for many months to over a year, if ever.
That is simply a medical reality.
We should get good data on some of the treatments very soon.
Tomorrow, April 3rd, is the date that Gilead should get the first data on clinical trials if they found enough patients.
With tens of thousands in most large countries positive, I am wondering why the chloroquine data is so crappy.
I suspect it is because the good data is not looking as great as the hucksters are saying.
The report from Belgium does not look very hopeful on malaria drugs.
>
Masks.
Every medical person knows they need to have them, so do not believe anyone who says they have no value.
Clinical data says the opposite.

Greg
Reply to  BernardP
April 1, 2020 9:04 am

S.Korea won the best strategy award for initial containment. This avoided economic shut down but does mean they will probably have a continued rumbling levels of infection for the rest of the year and risk a flare up in non immune pop. if they drop their guard too quickly.

Over all that probably handled this better than any other country.

US won last years Pandemic Oscars with an amazing 89% score but just found out that oscar results are rigged and don’t mean anything.

Europe are now coming out of exponential growth phase and need progressively start lifting restrictions sector by sector ASAP to avoid economic implosion. A large proportion of the ‘herd’ will already have had contact and be immune. Continuing wide confinment is insane.

Europe gets to be the crash test dummy of how and when to get out of shut down.

PS Don’t use those Russian masks, they are laced with smallpox and novichok 😉

Reply to  Greg
April 1, 2020 9:14 am

re: “S.Korea won the best strategy award for initial containment.”

Where does Taiwan and Japan show up on that scale?

For reference: https://world.wng.org/2020/03/how_taiwan_fended_off_the_coronavirus

Phoenix44
Reply to  Greg
April 1, 2020 9:59 am

I simply don’t believe the South Korea claims. There is no way their first infections were as late as they think. The Chinese couple from Wuhan who were identified in Italy landed there on 21st January. If the infection began in Wuhan as early as November (as some claim), then it was in South Korea by December. The Koreans have been tracing a couple of clusters and some late infections. My bet is they missed the main event in December/January completely.

William Astley
Reply to  BernardP
April 1, 2020 9:18 am

That is the point. Covid19 is a paradigm change.

It is not possible now to eliminate the virus using isolation, in specific regions.

There are now a large number of cases in regions where there are a large number of people and the government does not have absolute control of the population.

For example New York, London, LA, and Paris where there are masses of people in cities that are designed for mass transit.

In those regions there will always be new cases. Vaccines are a year a way. Isolation for a year does not work.

We have just be focusing on the next 6 weeks.

The increased deaths are also not acceptable, except the deaths are old people and the unemployed people are young people….

So in the developed countries we are going to keep isolating until cases are low and then we are going to be forced to restart the country …. to avoid economic collapse.

The economic costs and the social cost, caused by extreme isolation, are not sustainable. The estimates are a third of the small US businesses are facing bankruptcy, if the isolation is left on.

So, we need some other methods to slow the spread, such as mandatory use of masks in public places and temperature checks to look for sick people.

Also the virus is starting to spread uncontrollably in Africa and India.

In those countries/region people will starve if they were forced to stay in isolation for let say a year.

They will suffer the deaths to develop herd immunity.

Reply to  William Astley
April 2, 2020 9:44 am

William Astley,

RE: “The economic costs and the social cost, caused by extreme isolation, are not sustainable. The estimates are a third of the small US businesses are facing bankruptcy, if the isolation is left on.”

6 million filed for unemployment in u.s. yesterday. I only hope they could do it online.

April 1, 2020 8:18 am

Anybody read, translate French? What are the various categories they describe on this chart?

https://www.mediterranee-infection.com/covid-19/

Bob boder
Reply to  _Jim
April 1, 2020 8:51 am

google does

Greg
Reply to  Bob boder
April 1, 2020 9:35 am

Exactly, you should be able to guess most of the terms ! IHU are the public university hospitals , ie the major training and treatment centres where most cases get treated.

1524 cases treated with hydroxychloroquine + azythromycine , after 3 days testing only 1 death.

Reply to  Greg
April 1, 2020 2:52 pm

3 days?
Were all 1524 about to die if they did not take it?
How many got worse?

Reply to  Bob boder
April 1, 2020 10:01 am

re: “google does”

(a)Wanted second opinion. (b) terms are embedded in an image, they are not text (this also means innate xlate by a browser is not possible). (c) context matters, something Google xlate is not set up yet to ‘entertain’.

John Tillman
Reply to  _Jim
April 1, 2020 9:18 am

It says that only one patient treated for more than three days with the combo of hydroxychloroquine and azythromicin died, out of 1524 treated (time not specified).

The tables are deaths per million in the 15 hardest hit countries and number of cases in the world.

Reply to  John Tillman
April 1, 2020 9:32 am

Thanks John. I deduced the 1 fatality “out of 1524 treated” (for hydroxychloroquine and azythromicin treatment) stat but wasn’t 100% sure of the others. Between the abbreviations for the facilities involved e.g. APHM (Assistance Publique Hopitaux de Marseille, Hôpitaux Universitaires de Marseille?) and IHU (Institut Hospitalo Universitaire (IHU) Méditerranée Infection) and the French it gets “complicated”

Rich Davis
Reply to  _Jim
April 1, 2020 10:10 am

I think that the other relevant data is that there were 17 deaths among 2663 patients who tested positive. (Caveat: Not clear if we’re comparing patients at similar stages of disease for similiar periods of time). If these 2663 were followed to the point of recovery (or death) and likewise the HCQ-treated have also recovered or died, then that implies a fatality rate of 0.6% without treatment and 0.07% with treatment.

A 10-fold improvement.

Rich Davis
Reply to  Rich Davis
April 1, 2020 10:24 am

Were the treated patients high-risk, low-risk? Anyway not likely randomized, certainly not double-blind.

Anecdotal evidence that it may work well.

In my mind justification that we should allow compassionate use.

Greg
Reply to  _Jim
April 1, 2020 9:47 am

IHU Mediterranee Infection is the hospital in Marseilles where Prof Didier Raoult put the combined treatment together.

Of 20k patients tested, 2k positive. 17 deaths
cf 1 death from 1500 treated with hydroxychloroquine + az

Nevada may like to recall their governor and sack his medical team .

Reply to  Greg
April 2, 2020 12:33 pm

I think this is not the case.
Where are those numbers reported?

Reply to  Nicholas McGinley
April 2, 2020 12:40 pm

Do you undergo a “brain change” on a daily basis Nicholas McGinley?

Reply to  _Jim
April 3, 2020 5:21 am

Raoult is a quack and a liar, and you are a credulous naif, Jim.

Reply to  Nicholas McGinley
April 3, 2020 6:42 am

re: “Raoult is a …”

HWGA.

A multi-credentialed, honored, accomplished individual denigrated by – an unknown internet nobody.

Good job, NM.

A couple things a ‘nobody’ like yourself doesn’t consider (b/c, well, you’re nobody AFAIAC) is he has associates, and staff, and collaborators in his research papers.

Did you notice any of that, NM?

Reply to  _Jim
April 1, 2020 10:45 am

Thanks for the link. As I understand it :

FYI : AP-HM stands for : Assistance Publique – Hôpitaux de Marseille (Marseille’s Public Hospitals)

As of today – April 1 – at the AP-HM and the IHU Méditerranée Infections :
– total tested : 51902
– tested patients of the APHM and IHU Méditerranée Infections : 20008
– cases : 2663
– deaths : 17

From those cases, at the IHU Méditerranée Infections (where Didier Raoult’s team works) :
– patients treated with hydroxychloroquine and azythromycine : 1524
– treated deaths : 1 (according to Prof Didier Raoult, the patient was a 84 years old man).

– non treated patients : 2663 – 1524 = 1139
– non treated deaths : 16

I don’t know if the 1524 treated patients were randomly selected from the 2663 positive cases.

Apparent death rate ratio : 21.4

astonerii
April 1, 2020 9:11 am

I just looked at the most recent age related numbers out of Italy…

Looking at the death rates in Italy as of March 29th, 4.83% of all deaths were aged 0-59. 95.17% were aged 60+.

We have burned 2 trillion dollars in stimuless, and according to economists we will burn 7.25 trillion or so in lost production for social distancing. If we expect to see 2 million deaths without social distancing, and 140,000 with it, that is 1.86 million saved lives.
$5,000,000 per saved life. The stimuless itself is $1.075,000 per saved life.
The vast majority of which will be people who are out of the workforce.
What is worse? The disease or the cure?

LdB
Reply to  astonerii
April 1, 2020 10:46 am

Depends if you are one of the dead or not.

William Astley
Reply to  astonerii
April 1, 2020 11:49 am

In reply: So what is worse?

It depends who you ask and when you ask. Ask young people your question in a year or two.

Morally and politically there was no alternative to isolation.

Initially, we had almost all wishfully hoped the virus would die out and we did not know how contagious it is.

We did not have time to develop a effective strategy in lieu of group isolation.

… and we did not understand how serious and permanent the economic damage would be, from simultaneous internal and external isolation of all countries in the world. The end of world tourism and the shutdown of large sections of the economy, every country.

The covid isolation has caused world-wide economic destruction (the end of large scale world tourism, is only one example) not a slowdown.

Stimulus spending will not bring back the companies that have gone bankrupt. So we are time limited to come up with an effective alternative to almost complete country isolation. The longer we must keep complete isolation, the worse the problem will be.

We and every other country is going to face 30% unemployment until the group isolation ends and high unemployment for years due to the destruction of companies and the loss of the activity, world tourism.

Reply to  William Astley
April 2, 2020 12:30 pm

So what are you suggesting anyone to do?
No one thinks what is happening is good, but no one knows how to stop it.
Suppose some leaders go on TV and tell everyone to go back to work, get back on planes, open up the stadiums and play ball, go to the stores and shop, go to the park and talk to a crowd of people…
Who is gonna do it?

What is the suggestion?
I am not being snarky…I would like to hear anything helpful anyone can think of.

icisil
April 1, 2020 9:14 am

Bill Parsons, here’s the info you asked for about medical treatment immunity

https://www.phe.gov/Preparedness/legal/prepact/Pages/COVID19.aspx

Bill Parsons
Reply to  icisil
April 1, 2020 12:00 pm

Thank you. They’ll need this immunity.

Interesting that while New York is only 30th on the ranking of states with most medical malpractice suits, it leads the pack wrt total payouts:

30. New York

Malpractice suits per 100,000 residents: 19.3
Total payout: $711.7 million (4.22 percent decrease)

BTW, I’m in favor of individual doctors taking any “countermeasures” against the Coronavirus that are legal and reasonable in their own estimation. Even if it’s off label. But maybe there are things people can do at home before they even appeal to the medical establishment.

A recent Medcram suggests hydrotherapy could serve to reduce hospitalizations for pneumonia. No need for prescription.

Reply to  Bill Parsons
April 1, 2020 10:38 pm

Doctors are allowed to prescribe any medication to any patient if that doctor, in his or her own judgement, feels it is appropriate to do so.
This is called “off label” usage.
It applies to all doctors, all the time, and all drugs that are FDA approved for anything.
The rules for using drugs that have not been approved for anything by the FDA are different.
But central to any medical intervention is what is called informed consent.
This means that a person given a drug or treatment must be given ALL known information that is relevant to the treatment, and also be known to be able to understand all of that information to a degree which makes certain they are fully aware of all the possible risks as well as the benefits of the treatment they will receive.
The clinical trial process is far more formalized that what is typical for ordinary care situations.

People who do not have any knowledge of how trials are different from ordinary care are almost certain to have no idea or the number of steps taken to make sure that whatever happens, the outcome advances medical knowledge.

When people have exaggerated information about the risks and benefits of a treatment, or the lack thereof, along with exaggerated information about the illness a treatment is meant to treat, this is as far away from informed consent as I can imagine.
At this point in time in this country, and in others ones I would guess, laypersons may have a hugely exaggerated understanding of the specific risk of this disease to themselves.
Those same people may have a hugely mistaken idea regarding the safety of a drug or drugs.
They may additionally have a hugely mistaken understanding of the possible benefit if a drug or drugs.
And they may be being treated by people who have by all appearances become indistinguishable from snake oil salesmen: Self aggrandizing, self-interested, highly biased, egotistical, intemperate, and injudicious purveyors of an agenda.
We have people who are supposed to be medical professionals posing smugly on the covers of magazines, going on national television bragging about themselves.
Everyone here ought to know very well what happens to a person’s judgement once they have put their professional reputation on the line by becoming braggadocious bigmouths who have made claims which greatly exceed the evidence, and done it while standing in front of the whole world making expansive claims.
And in this situation there are not only actual lives literally hanging in the balance, but big fat lawsuits waiting for them if they turn out to be wrong or to have made unjustified claims and promises that ultimately prove to be false and unwarranted.
So what room have people like Zelenko and Oz left themselves to back away if they have been overzealous?
What is their off ramp?
They are painted into a corner, and such people in such circumstances can be counted on to remain locked into biased advocacy.

This is not how medicine is done, and it is not how people behave who have the best interest of their patients in mind.
Practicing medicine like this is very certain to turn out very badly in the long run.
Most experimental drugs fail.
Most carefully designed trials give results that have to be carefully parsed, and are almost never clear cut and almost never home runs.
But what I am really wondering about, and is not making sense to me, is how, since hydroxychloroquine was accepted as standard of care in all hospitals in Belgium, Italy, Netherlands, over two weeks ago, why are deaths so high and still climbing?
Switzerland and France have both apparently taken the malaria drugs off of their treatment guidelines.
All of them are summarized in a version updated yesterday, here:
https://epidemio.wiv-isp.be/ID/Documents/Covid19/COVID-19_InterimGuidelines_Treatment_ENG.pdf

In any case, I sure hope the people saying this is a bunch of nothing get their wish. I am wondering why so many people are dying still though.

I do know one thing…every time the medical task force in Belgium has updated the verbiage in their official treatment guidelines, it matches up even more closely with everything I have been saying.

“IMPORTANT:
At the time being, the use of investigational or off label medicinal products to treat patients suspected or confirmed COVID 19 should be restricted to hospital use or delivered by hospital teams. We just do not know their clinical efficacy so far. They should therefore not divert health professionals from the optimal supportive care that still provides the highest probability of favorable outcome. Also patients should be each time adequately informed about the uncertain efficacy and respective toxicities of the drugs, and give consent (oral or signed according to the institutions).”

“Chloroquine and hydroxychloroquine inhibits replication of SARS-CoV-2 in vitro. Chloroquine
inhibits the virus at concentrations (EC50 = 1.13 µM, equivalent to 360 ng/mL) that cannot be
achieved in human plasma ”

“This study, which has meanwhile been published, suggests that SARS-CoV-2 positivity in
nasopharyngeal secretions (measured by RT-PCR) is significantly decreased at day 6 after inclusion
(i.e. day 10 after symptom onset) in hydroxychloroquine-treated COVID-19 patients (n=26) versus
patients who received supportive care only (n=16 external controls). However, several major
limitations (small sample size, non-homogeneous compared groups [differences in viral loads, in
number of days since onset of symptoms and in quality of follow-up], and rather late HC
administration, close to the expected time of viral clearance), make these observations rather
weak [16]. In general, the current evidence therefore does not imply a translation of
(hydroxy)chloroquine in vitro activity to clinically relevant outcomes. Many previous clinical
studies of these compounds in other virus infections showed disappointing results. Results of
ongoing clinical trials of chloroquine/ hydroxychloroquine efficacy in the treatment of SARS-CoV2 are eagerly awaited, before STRONG recommendations can be provided for or against the use of
these drugs.”

“Immunomodulatory agents are a varied group of drugs that may have a (protective) role in the
second phase of the disease, including the cytokine release syndrome, which seems driven by
immunological mechanisms rather than direct viral pathogenicity. ”

“NB: tocilizumab and other interleukins (6 or 1) blockers:
Some Chinese, Italian and (very limited) Belgian clinical experience (unpublished) suggest a favorable effect in the most critical patients suffering from persistent and overwhelmed inflammation resembling cytokine release syndrome (CRS). At this moment however, this class of
drugs should only be used in clinical trials or within Belgian/international cohort studies if possible. The drug could be considered on an individual basis in patient with persistent inflammation (i.e. elevated IL-6, CRP, D Dimers, ferritin,..) and ARDS requiring mechanical ventilation without evidence of bacterial superinfection/sepsis.”

Over two weeks in, they are not ready to say malaria drugs are useful for more than reducing cytokine release syndrome, and that in the most severe cases, IL6 blockers should be used instead of hydoxychloroquine.
They stopped even mentioning Z-pak.
No mention of zinc.
Chloroquine works in cell cultures only at concentrations impossible to achieve in a person’s bloodstream.

I am just going to say once…I an no doctor, but I reached identical conclusions about what was prudent as medical task forces guiding care in Switzerland, Netherlands, Belgium, Italy, and France, by reading all of the material I was able to find on my own two to three weeks ago (hard to believe how fast the time is going by), and stated right here, over and over, despite a large number of people arguing with me, and I knew I was reading the literature properly and reaching logical conclusions.
The medical task forces over there have only as of yesterday, arrived at some of the data points I was repeating forcefully here…weeks ago.

ren
April 1, 2020 9:48 am

The data suggested that by the end of February more than 43,000 people in mainland China had tested positive for the coronavirus but had no immediate symptoms. They were not included in the official tally of confirmed cases.
Chang Jile, director of the commission’s Disease Prevention and Control Bureau, said on Tuesday that the government would step up screening and investigation of asymptomatic cases.
“With effect from April 1, we will include reports of asymptomatic cases, any status change and how they are being handled, as part of our daily outbreak updates to address public concern,” Chang said. “We will strengthen our work in monitoring, surveillance, quarantine and the treatment of asymptomatic carriers, and do sampling in key areas to investigate and analyse these carriers.”
https://www.scmp.com/news/china/society/article/3077753/china-include-symptom-free-coronavirus-carriers-national-figures

Phoenix44
April 1, 2020 10:02 am

If I read this correctly, 7 had CV, none had flu, but over 100 had symptoms? So what was the cause of those? Just ordinary colds or what? It seems to me, with the vast majority of test being negative but conducted on people with symptoms deemed bad enough to be tested, that there’s a bunch of stuff running around that we have no inkling of!

Rich Davis
Reply to  Phoenix44
April 1, 2020 10:27 am

Or false negatives are high?

Reply to  Phoenix44
April 1, 2020 10:33 am

I wasn’t sure I read this correctly. They seem to have passed on the opportunity to relegate ALL the symptomatic people in a given community to one group or another, with most of the people reporting (undiagnosed) “flu-like symptoms”. O.k. 5% had COVID. Why not find out what the most prevalent sickness in the community was?

Reply to  Phoenix44
April 1, 2020 10:42 am

There’s always the quite common Rhinovirus and Adenovirus colds running around too.

Greg
Reply to  Joel O'Bryan
April 1, 2020 12:52 pm

You gotta watch out for those rhinoviruses running around, they can really put you on your back. A charging rhino can even over turn a truck.

ren
April 1, 2020 11:00 am

The Chinese are very much afraid of the second wave, and for good reason.

Tom Abbott
April 1, 2020 2:02 pm

I think all the doomsaying should be put on pause for a couple of weeks until we find out if some of these drugs can be game-changers. If hydroxychloroquine can serve as a preventative and/or cure the Wuhan virus disease, then society can return to normal.

We ought to know something very soon, one way or another. The premature handwringing here and on television is getting extremely tiring. Talk about rash speculation! People flying off on all sorts of tangents.

Settle down and wait a couple of weeks. There’s plenty of time to panic over the economy.

I had to turn Laura Ingraham’s show off last night, she was ranting so much about all sorts of possibilities and conspiracies. Even Rush Limbaugh has gone over the edge pushing conspiracy theories about nefarious government control, and he equates the virus computer models to climate change computer models and thinks the virus models are no good because the climate models are no good. He is sitting there scoffing at Dr. Fauci’s figures.

This isn’t the time for ranting. The public policy is set. We’re going to do this for the next month barring a medical breakthrough, so get used to it, and start complaining when all hope is lost. That time is not now.

Reply to  Tom Abbott
April 1, 2020 4:22 pm

re: ” Even Rush Limbaugh has gone over the edge … ”

Maybe you don’t listen closely enough, or long enough? He has complaints along different lines …

You realize, transcripts for his shows are available for later review? Can you find for me the ‘conspiratorial’ part:

Transcript archives:
https://www.rushlimbaugh.com/archives/

Tom Abbott
Reply to  _Jim
April 2, 2020 6:17 am

I listend to his show. I know what I heard. I don’t need to listen to his rant again, which I considered completely out of character for him, at certain points. You are welcome to your opinion.

This kind of over-the-top rhetoric by him and Laura Ingraham is not helpful to anything, and that goes for all the other ranters out there, too. Ranters are agitating people when people don’t need to be agitated. And I don’t care who is doing it. if it’s Rush, I’m going to call him on it, even though I love him dearly. Some of his comments were off-base, imo. Harmful, not helpful.

Reply to  Tom Abbott
April 2, 2020 6:34 am

So, you can’t point to what it was that “set you off”. Pretty typical of somebody who did not get the point of whatever he was talking about.

Over the top rhetoric – he was probably quoting some democrat, but, again, you weren’t listening closely enough to tell.

I’m beginning to think that you have some preset notions, a bias, on this, that colors your perception.

DEALING with adult topics – guaranteeing a country and hobbling its economy – I reckon these may be topics about your present pay and comprehension grade.

Tom Abbott
Reply to  _Jim
April 3, 2020 8:55 am

“So, you can’t point to what it was that “set you off”. Pretty typical of somebody who did not get the point of whatever he was talking about.”

Well, I can point out what set me off. What’s typical here is your insulting manner.

I think the point where I was set off was when Rush said something to the effect that “The doomsayers always win.” He was conflating the dishonesty of the Climategate Charlatans and their computer models to the numbers Dr. Fauci was presenting. He was characterizing Dr. Fauci as a “doomsayer”. He was casting doubt on the integrity of the people heading up the Coronavirus task force, including Dr. Fauci and was implying Dr. Fauci had some nefarious purpose for hyping the Wuhan virus crisis. Rush was implying Trump was a victim of Dr. Fauci’s misleading numbers and statements. Rush was indulging in conspiracy theory.

Rush doesn’t understand the difference between the bogus Climategate computer-generated temperature models and the computer models used to project virus infection. He thinks they are both bogus. He is half right.

So there you go, take it or leave it. Agree or not. Insults roll off me like water off a duck’s back.

Reply to  Tom Abbott
April 3, 2020 1:54 pm

re:

I think the point where I was set off was when Rush said something to the effect that “The doomsayers always win.” He was conflating the dishonesty of the Climategate Charlatans and their computer models to the numbers Dr. Fauci was presenting. He was characterizing Dr. Fauci as a “doomsayer”. He was casting doubt on the integrity of the people heading up the Coronavirus task force, including Dr. Fauci and was implying Dr. Fauci had some nefarious purpose for hyping the Wuhan virus crisis. Rush was implying Trump was a victim of Dr. Fauci’s misleading numbers and statements. Rush was indulging in conspiracy theory.

Hearing, like seeing is 90% perception (look up “cognitive hearing science”.) Here is an excerpt from the ‘triggering’ segment that day, from this transcript: https://www.rushlimbaugh.com/daily/2020/03/30/doomsayers-always-win-even-when-the-optimists-are-right-hypothetically/

RUSH: I just have one more thing to say about models. It’s undeniably true, and it’s one of the things that frustrates me about them. The doomsayers always win. Do you realize this? The doomsayers always win in a psychological sense. “What do you mean, Rush?” Well, let me explain it to you. I’m glad you asked.

If it’s bad — if it is as bad as they say — they will say, “I warned you. I told you it was going to be 100,000 dead, 200,000 dead. I told you!” If it isn’t as bad as they say, if it doesn’t end up being as bad as they predict, they then say, “It’s only because we warned you to do what was necessary to avoid the threat.”

They are never wrong.

The doomsayers are never wrong; they always win. They’ve got an answer for everything. The realists, like me… I’m the mayor of Realville. I am Mr. Literal. This program is Realville. I am the mayor, governor, president, whatever. I’m an optimist. I can’t help it. I have the optimist gene. We never win up against the doomsayers.

If that turned out to be right [200,000 dead], the doomsayers would still say that I was reckless and that I endangered lives and that lives were saved only by the doomsayers who warned everybody not to listen to the optimists, and that’s why modelers… I don’t care whether it’s health models, whether it’s climate models, economic models. They always play the doom card.

They always play the worst-case-scenario card, and they never lose. The people who lose are those who’ve had their livelihoods ruined because of the doomsayers. But, boy, you contradict the doomsayers and say, “I don’t think it’s this bad. I don’t think a hundred thousand, 200,000 people are gonna die.”

(angrily) “Who are you to dispute Dr. Fauci? Who are you! What do you mean?” “Well, I’m an eternal optimist, and I just don’t believe…” “Well, that’s recklessly…” So, you can’t say it. The optimist and the realist have to shut up, ceding the argument to the doomsayers, and that’s where we are here, and that’s what I don’t like about this.

They will get credit for having warned everybody in advance. The fact that the economy’s been shellacked and destroyed? “Ah, an insignificant byproduct to the saving of lives.”

Again, hearing, like seeing (I can speak ‘seeing’ perception: I was seeing strange things at night when my vision was obscured by really bad cats, before corrective surgery a couple years back) is 90% perception; I submit that is the case here too.

Tom Abbott
Reply to  _Jim
April 3, 2020 9:29 am

Rush is on there now lobbying for the opening of the U.S. economy. I guess that’s why he is upset with Dr. Fauci and his computer models because Dr. Fauci, from Rush’s point of view, if the one holding up restarting the economy.

Rush and others who are hyping the “destruction” of the economy because of this pause cited today’s jobs report where 700,000 jobs were “lost” last week as if this is some kind of surprise. These figures are meaningless. It’s like playing Fantasy Footaball although we are playing Fantasy Economy. The facts are, there are about 160 million Americans with jobs. The pause in the economy has paused probably half of that number if not more. So just because last week was the period when 700,000 of those people applied for unemployment should not be a surprise to anyone. The jobless numbers are in the millions. The good news is if we get the economy going soon enough, all these “lost” jobs will no longer be lost as these people go back to work. The new headline can be: U.S. sees new job numbers of 80,000,000 last week!

The relief program passed by Congress last week has enough money in it to keep most of America’s 160 million workers and the businesses they work for financially solvent until the end of June. So the economy can essentially resume what it was doing three months ago as soon as we can get back to work. I hope it doesn’t take until the end of June because some things are deteriorating as we sit, but my hope is these new treatments and tests we are seeing will allow us to go back to work before then. We should have a lot of anectdotal evidence that these drugs can blunt this virus over the next several weeks. We are getting more every day. And with new, fast antibody tests, we can focus our attention on where the problems are.

If we get back to work before the relief money runs out, we will be in good shape. Those who are hyping a possible economic crisis are premature and should lower the rhetoric and keep the conspiracy theories to yourselves for a few weeks until we see how the curve of the infection is doing and how the new treatments and tests are going to work out. Give the public a break on the economic fearmongering. They have enough to worry about without having useless speculation thrown in their faces..

Now Rush is continung to cast doubt on the virus computer models, again.

Rush, when you cast doubt on Dr. Fauci’s numbers, you are casting doubt on Trump. I know that’s not what you intend, but think about it. Is Trump a fool (Democrats don’t answer that)? Don’t you think he can figure out if Dr. Fauci is gaming him or not?

kevin roche
Reply to  Tom Abbott
April 3, 2020 9:44 am

I don’t know where you are getting your jobless numbers from, but 10 million people filed for unemployment in the last two weeks, and based on ADP layoff numbers and the typical lag actual job losses are 20 million.

Reply to  Tom Abbott
April 2, 2020 11:49 am

I have not been able to listen to any of those people in weeks.
I had previously looked at clips of their telecasts almost every day.
I do not have TV, so it is not a matter of turning it off, but of going to websites that have their clips of shows.
I agree…they are not helping.
They can do and say what they want, and anyone who does not want to hear it…we know what we do.
Same as anywhere else…we do not watch, do not listen, do not read it.

niceguy
Reply to  Tom Abbott
April 2, 2020 3:40 pm

Modeling in medicine is just as bad as modeling in climate.

Reply to  niceguy
April 3, 2020 5:34 am

The bulk of people that have it do not know it, and are nonetheless able to spread it.
This is true of many diseases, more than has generally been known or even studied, but in this case it makes a bigger difference.
Read the story of Typhoid Mary to get some insight into how hard it can be to keep someone from spreading a disease.
No one tries to figure out who gave them a cold or the flu…I think because everyone knows it is useless…an exercise in futility and what difference does it make anyway?
Viruses are invisible, and no one knows how many have it…so modelling seems like just playing with numbers and charts to me.
People change behavior and the transmission cycle changes, but in other places the virus moves into a population and the cycle starts there.
One animal had it last fall in some city in China.
The genie can never be put back in the bottle.
In any case, even good climate models will not tell anyone what their weather will be.

kevin roche
Reply to  Nicholas McGinley
April 3, 2020 5:41 am

Actually modeling in medicine and health care is pretty good, because we have very large sets of real world data to probe for associations. The problem here is that there isn’t a lot of that actual data yet on conronavirus disease, but as it accumulates, “models” or more accurately, very likely associations, will be pretty clear. We already can be pretty certain that the virus’ lethality is related to age and to underlying conditions. So you could be much more surgical in your mitigation measures, but then again, we would be expecting politicians to exercise more judgment and intelligence then they likely have.

niceguy
Reply to  kevin roche
April 4, 2020 8:01 pm

Modeling of what? Radiation? Alcohol? Salt? Saturated far? Unsaturated fat?

Tom Abbott
April 1, 2020 2:31 pm

Dr. Oz is currently reporting on a clinical trial of hydroxychloroquine by the Chinese that has just been completed and he is excited about the results, which show reductions in several parameters in treated individuals verses untreated individuals.

More to come on this.

Dr. Oz also said he got some information on patients in a Chinese hospital who were taking hydroxychloroquine to treat their lupus or arthritis disease. There were 80 of them in a hospital where everyone else was getting infected and none of these patients caught the Wuhan virus.

It was suggested that perhaps it would be a good idea to get some information on the millions of people who are taking these drugs for lupus or arthritis or for other things and compare that population to the population of those infected by Wuhan virus.

We may have a large population of people who don’t have to worry about the Wuhan virus because they are taking a medicine that prevents them from being infected.

Reply to  Tom Abbott
April 1, 2020 11:06 pm

“Dr. Oz also said he got some information on patients in a Chinese hospital who were taking hydroxychloroquine to treat their lupus or arthritis disease.”
He got some information?
That sounds somewhat less than hard data.

“There were 80 of them in a hospital where everyone else was getting infected and none of these patients caught the Wuhan virus.”

Everyone else was getting infected?
Everyone? Really?
In no place has everyone become infected.
And less than half of the infected people in any group we have good data on became sick after getting infected.
So that is exaggeration squared.
Par for the course for Oz.
Nothing concrete, with every possible spin exerted to the fullest extent.

None of the lupus patients “caught” the virus?
First group it is all, when we know it was not all.
Then it is none.
What kind of medical language is “caught”?
Is it not more likely they simply had asymptomatic cases?
All 80?
Why is no one else seeing numbers anything like that?
There are people overseeing these results, and would have been ethically bound to step in the instant it was clear one treatment had even a statistically significant improvement in outcome, let alone a result anything close to 100% for hydroxychloroquine.
There are hospitals all over the planet who have had full ICU wards and people on cots for over a month, and hundreds dying a day and that is only the ones dying in hospitals.
Including many doctors and nurses dying.
Are we really supposed to believe this is still happening if those malaria drugs were a miracle cure?
That every place with people dying day after day in every larger numbers and many more lingering for 5 weeks or more on respirators and oxygen, but these pills everyone in the world has known about for weeks now can cure everyone who takes them?
Just think about it a little more.

niceguy
Reply to  GregK
April 1, 2020 11:06 pm

Anti-“antivaxxers” (there are no such things as antivaxxers, actually):
“Don’t ask for vitamins, don’t buy “supplements”, you can’t “boost” your immunity. It isn’t even a thing. It’s an unscientific idea. It’s a silly quest. It’s dangerous.”

Also anti-“antivaxxers”:
“That vaccine will boost your immunity”.

don rady
Reply to  niceguy
April 3, 2020 1:33 pm

there is some good reasoning, granted no scientific proof, that zinc and elderberry can help prevent.

niceguy
Reply to  niceguy
April 4, 2020 8:19 pm

The mantra of anti “anti-vaxxers” is that “vaccine is toxic” is conspitard.

Well, until now, masks were bad, now they are good, according to the medical establishment “inter agency consensus”.

So, was that a mask conspitardcy?

Reply to  GregK
April 1, 2020 11:15 pm

A vaccine that has a weak effect and is for a bacteria, prevents a virus from infecting or killing people, decades later?
And vitamin C IV infusion cures everyone.
And malaria drugs work 100%.
And yet every day, the number of people dying in the world goes higher and higher.
Guess we best fire all the simpletons and murderers who are caring for patients all over the entire planet once this is over, and get some herbal therapists to man the ER’s of the world from now on.
Who knew?

ren
April 1, 2020 11:00 pm

Dramatic daily increase in fatalities in the UK.
https://www.worldometers.info/coronavirus/country/uk/

Reply to  ren
April 1, 2020 11:17 pm

All across Europe that.

Reply to  ren
April 2, 2020 11:55 am

With a very few exceptions, deaths are spiking up again, as are new cases.
And active cases are reaching ever higher levels almost everywhere.
IOW, new people are becoming sick faster than people are recovering.
So the crisis grows yet.
One caveat…some of the ever increasing “case” figures are related more to increasing testing than to new infections.
But we really have no way to track “new infections”, because no one knows those numbers…only who is positive and negative when tested…and as a percentage, few of any population have ever been tested, even once.
The people showing up for testing are people who are sick and worried and go in to be tested, or are contacts of people who have tested positive.
>
>
>

Masks.
We need to stop telling people not to wear masks…to keep virus in, and to keep it out.

John Tillman
Reply to  Nicholas McGinley
April 2, 2020 2:13 pm

In probable spillover from NY, VT has suffered 16 deaths attributed to WuFlu. Sanders is not the only dangerous immigrant from NY.

That’s 26 deaths per million. For NY, it’s 114, NJ, 40, LA 59, Michigan 34, MA 18, but CA only 5, FL under 5 and TX 2. States with GOP governors, like FL and TX, far excel Democrats, including dozens of times better than Cuomo.