WTF :2019-nCoV NovaCoronaVirus Thread

[Umfriend]

Wow, per million you guys have almost as many deaths as we have cases.... And yeah, we test quite a bit, capacity for about 30K tests a day, about 8K used. Infection rate around 1.0%... Like in the US, our increase in cases appear to be due to younger people. I fear the resulting fatalities will now trail even longer (young -> infected -> contact with older -> infected -> ...?)
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Nice site, a lot of data that can be downloaded.

[Dr Mordrid]

Probably should have posted a link to Our World In Data, which is indeed a neat site...

https://ourworldindata.org/grapher/daily-covid-cases-deaths?country=~USA

Another is Rt.live, a CoVid-19 tracking site set up by TechCrunch

https://rt.live/

[UtwigMU]

There is an upside to this. It has motivated me to do things I couldn't get myself to accomplish before. I read somewhere that people who are more self sufficient will do better during Corona, while dependent people will do worse. So since I'm more on the independent side (work + freelance business, can cook a few different meals, savings) it's not so bad.

I passed the exam, my Red Hat cert is current again.

[Umfriend]

New data: 2nd week of increased number of cases and an estimate R of 1.3. This is a bummer, I had just registered for a real chess tournament end of August but with how the young people are being ****oles it'll probably be cancelled again. So far no new restrictions, contact tracing is still holding up (we were overwhelmed in Feb/March well into April I think).

[Dr Mordrid]

New data: 2nd week of increased number of cases and an estimate R of 1.3. This is a bummer, I had just registered for a real chess tournament end of August but with how the young people are being ****oles it'll probably be cancelled again.

Today's task force report is that almost half of our deaths are in long term care facilities, and most of the rest are people with comorbidities. Given this you'd expect the younger folks not to be such careless hypocrites, but here we are.

Then we have Gov Whitmer in MI and Gov Cuomo of NY sending recently discharged patients into long term care facilities and nursing homes, not the huge step-down hospitals set up by the Army Corp of Engineers. >1,000 beds at the Detroit LCF center Corps hospital, <20 patients.

Thousands of old and infirm folks died. Cuomo stopped his policy when the poo hit the fan, but Whitmer's policy is still in place. Now she's the subject of a recall petition, a citizens impeachment.

So far no new restrictions, contact tracing is still holding up (we were overwhelmed in Feb/March well into April I think).

When he was a candidate people responded with enthusiasm to Ronald Reagan saying "The nine most terrifying words in the English language are: I'm from the Government, and I'm here to help."

Rebellion is in our DNA, and the Feds have a long habit of botching things regardless of party. This innate distrust of the Federal govt. is paralleled by the a distrust of tech companies - for good reasons.

Given these, it's no surprise that over 50% of major political groups (Dem, Rep, and Indies) say they wouldn't participate in contact tracing done by the Feds or tech companies. No responding, no apps. It's their local health depts, which are State or County, or nothing.

[Umfriend]

The peer-reviewed Henry Ford Hospital System HCQ study results are in

https://www.detroitnews.com/story/ne...te/5365090002/

It gets more confusing by the day. Two recent articles in Nature dispute that HCQ should be expected to be beneficial to Covid-19 patients. The initial analysis was that HCQ made it harder for SARS-CoV-2 to infect cells and this was based on in vitro analysis. As I understand it, the initial in vitro tests that supported the notion that HCQ might be beneficial were performed on (as I understand it) cells derived from a certain monkey's kidney. That cell does not produce a TMPRSS2 enzyme which some/many types of lung/repiratory cells do produce. It is this enzyme that enable SAR-CoV-2 to enter these cells and that attack is not mitigated by HCQ (although, if you can at the same time suppress TMPRSS2, then it might work I guess).

https://www.scimex.org/newsfeed/chloroquine-and-hydroxychloroquine-shown-ineffective-against-covid-19

[Dr Mordrid]

It gets more confusing by the day. Two recent articles in Nature dispute that HCQ should be expected to be beneficial to Covid-19 patients.
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The thing which often kills advanced CoVid-19 patients is what's commonly called the cytokine storm, an overreaction of the immune system causing massive inflammation in the lungs.

The theory behind HCQ is that besides being an antimalarial it's also an immunosuppressant, often used to treat autoimmune diseases like lupus, rheumatoid arthritis, etc. Suppress the immune system early enough and you may be able to prevent the cytokine storm.

It's also best to use HCQ in combination therapy, and Henry Ford recommends combining it with Z-Pak (antibiotic) and steroids. It also must be given early, before the immune system goes into overdrive.

Many of the studies showing no effect give HCQ alone, or it's given after the cytokine storm has a foot hold - too little, too late.

[Umfriend]

Yes, I should be more precise as it may still serve as a therapeutic, just not as a preventative.

I am surprised that HFHS would advice HCQ + Z-Pak as their own observational study find the lowest fatalities when using HCQ alone (13% vs 20% HCQ + Z-Pak, 22% Z-Pak, 26% none of these).

Is HFHS now conducting a double-blind test as a follow-up? They were working on a preventative-use study but this is different. The July 1st study has had quite some flak and hardly any support from double-blind tests among which, certainly, at least some start with HCQ early after admission. Are they now using HCQ (w or wo Z-Pak) in Florida, Texas and Arizona? Corticosteroids appear to do well wrt. cytokine storms (and in fact, HFHS gave steroids to HCQ recipients (about 75%) far more often than none-HCQ recipients (37%)).

[Dr Mordrid]

Yes, I should be more precise as it may still serve as a therapeutic, just not as a preventative.
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Is HFHS now conducting a double-blind test as a follow-up? They were working on a preventative-use study but this is different.
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They've been running a double-blind prevention study with 3,000 volunteer first responders and medical staff.

HFH operates 5 acute care hospitals, 2 psychiatric hospitals and 1 specialty care hospital. Training, research, trauma centers, local satellite clinics everywhere, optical centers, they take patients the Canadian health system can't handle, etc. A huge system.

[Dr Mordrid]

I cannot believe Joe Biden has vetted Michigan's Gov. Whitmer as a VP candidate. Un-effing-believable...

Well, maybe it is

https://www.detroitnews.com/story/news/politics/2020/07/31/whitmer-nixes-bill-direct-covid-19-patients-away-nursing-homes/5558640002/

Gov. Gretchen Whitmer vetoes bill directing COVID-19 patients away from nursing homes

The bill was a direct challenge to the Whitmer administration's current handling of nursing homes during the COVID-19 pandemic, which has focused on caring for those with the virus in isolated spaces of existing homes.

In a letter explaining her veto, the Democratic governor said the bill, sponsored by Sen. Peter Lucido, R-Shelby Township, was based on "the false premise that isolation units created within existing facilities are somehow insufficient to protect seniors."
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News flash dimwit: without a separate negative pressure ventilation system and UV-C duct sanitizers for those rooms your "existing facilities" are infection factories and are killing people.

There should be enough votes to her veto in the State House, 1/3 of the Democratic caucus voted for the bill, and the Senate is within 1 vote.

[Umfriend]

I don't get all that complaining about Whitmer and Cuomo (but then, I find it hard to find a real good explanation of the complaints and defenses so I am ignorant and open to any position). As far as I can tell, both NY and Michigan aren't doing badly with respect to the share of nursing home deaths vs total. In MI, about 33% of Covid-deaths occurred in nursing homes. That is not that much different from, say, Texas (31%) and a bit better than Florida (37%) (https://www.nytimes.com/interactive/...ing-homes.html). As I understand it, it is not as if patients still ill and contagious are sent to nursing homes or long-term care facilities but rather patients that still need medical care during their recovery. In fact, I think with many nursing homes and the like, Corona gets/got introduced by visitors and employees.

You guys seen this (for fun): https://www.youtube.com/watch?v=RxDKW75ueIU ?

[Dr Mordrid]

The 33% number published by the state (Whitmer) is cherry picked, and published with a disclaimer they "may be low." The death count numbers published by the Social Security/Medicaid agency which pays for their care are higher, making it more like 42% plus.

About half of patients continue to shed viruses after remission and need to be isolated for at least 2 more weeks, either at home or a step down facility. Those without family, the infirm, mentally ill, etc. are the patients going to long term care and nursing homes.

Where else could they go? The new law states if a nursing home or LTCF has multiple buildings one should only get CoVid-19 patients. There have also been field hospitals set up by the US Army Corps of Engineers. These are closed hotels, convention centers and arenas they've converted using prefab kits they can use most anywhere. The TCF Center in Detroit had >1,000 beds, but Whitmer only used 25. There were also centers in the suburbs, Ann Arbor, etc. Same story - unused. New York was the same, and they got a huge US Navy hospital ship which was largely unused.

This isn't political; NY's Gov. Cuomo, a Democrat, was ripped to shreds by the NY Times - his biggest media supporter. These transfers were also criticised by the nursing home owners association.

[Umfriend]

I wouldn't know where to find the SS/MA numbers (and for other states as well). From what I read, Whitmer and Cuomo get good grades from their respective states. And even if it is 42%-plus, that'd be just above the national average as I understand it. The NYT has a even-handed but inconclusive article about this (https://www.nytimes.com/2020/07/08/n...ronavirus.html). The way I see it, it may have been suboptimal but the reason was not to kill elderly (yes, some commenters on BB believe that) but to try to ensure critical care could continue to be provided by swamped hospitals. The order was issued March 25th. At that time NY already had 600 deaths and 33K cases. Now at that time (and I can't find appropriate statistics on this), there was not a lot of testing being done. It makes sense to assume, IMHO, that community spread was present already and, esp. without many and quick tests, that they were toast.

[Dr Mordrid]

I wouldn't know where to find the SS/MA numbers (and for other states as well). From what I read, Whitmer and Cuomo get good grades from their respective states.
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Cuomo reversed NY's policy May 10 to save his political ass. Whitmer is stuck on stupid.

https://apnews.com/5ebc0ad45b73a899efa81f098330204c

AP count: Over 4,500 virus patients sent to NY nursing homes

NEW YORK (AP) — More than 4,500 recovering coronavirus patients were sent to New York’s already vulnerable nursing homes under a controversial state directive that was ultimately scrapped amid criticisms it was accelerating the nation’s deadliest outbreaks, according to a count by The Associated Press.

AP compiled its own tally to find out how many COVID-19 patients were discharged from hospitals to nursing homes under the March 25 directive after New York’s Health Department declined to release its internal survey conducted two weeks ago. It says it is still verifying data that was incomplete.

Whatever the full number, nursing home administrators, residents’ advocates and relatives say it has added up to a big and indefensible problem for facilities that even Gov. Andrew Cuomo — the main proponent of the policy — called “the optimum feeding ground for this virus.”
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Cuomo, a Democrat, on May 10 reversed the directive, which had been intended to help free up hospital beds for the sickest patients as cases surged. But he continued to defend it this week, saying he didn’t believe it contributed to the more than 5,800 nursing and adult care facility deaths in New York — more than in any other state — and that homes should have spoken up if it was a problem.
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They did, same as in Michigan, but he wasn't listening. Ditto Whitmer.

[Umfriend]

Well, AFAICS, even when Cuomo's approval ratings "dropped" dramatically in May, it was still at 66%. I guess it is also possible that the reversal was inspired by the facts that cases, hospitalisations, deaths and positivity rates had declined siginificantly and that testing capacity started to increase.

Now I am not arguing that the NY Policy did not contribute to any deaths, I'll accept that it did. It may also have saved lives. No clue how it would balance out but I get no thoughtful arguments that the policy was unreasonable given the circumstances and knowledge at the time.

From the NYT article quoted above:

Nursing home administrators said the report [https://www.health.ny.gov/press/rele...rs_report.pdf] confirmed what they had been saying all along: Despite their best efforts, they were largely powerless to contain the virus. Early on, many homes struggled to get enough personal protective equipment or testing for residents and staff.

“In an area with widespread outbreaks, it was already in every facility,” said Jim Clyne, chief executive of LeadingAge New York, a group that represents nonprofit nursing homes. “And if it wasn’t, you were just lucky.”