-No, there is no evidence of 30 strains, or 8 strains or even 2 strains
of SARS-CoV2. There is currently 1 strain and the genome of the virus seems
pretty stable. If you heard information about MANY strains it is either
bulls*** or somebody is talking about phylogenetic ‘strains’ (in fact
they shouldn’t really use term strain in my opinion, but many people
does which makes it a bit more confusing for non-scientists) so changes
in the viral genome which can help us track spread around the world and
create something like viral ‘family tree’. All of those changes are very
small and does not change function of any of the viral proteins.
- When I say ‘no evidence’ means there is no evidence YET, but that can
change when we will get new data or information. Or might not change at
all. When WHO says there is ‘no evidence’ that COVID infection gives
you immunity for recurring infections it means that we don’t have that
data yet, so we cannot say if this immunity exists or not. It is very
early and that is a new pathogen. We cannot tell if the immunity exists
and how long it lasts cause not enough time has passed for us to perform
tests and get this data. But the data and research so far looks
promising, it seems that most of the people develop some level of
immunity. How long it lasts? It is hard to say, but hopefully, at least
several months as with SARS-1. I know that many of you read scary
stories from Asian countries that people are getting re-infected after
being discharged from the hospitals but:
*it is only very small number of all the people who got discharged from the hospital
*there is a chance that some of those second positives are false
positives. There is no test, which would be 100% false proof, and there
are human errors as well.
*there is a big chance that test picks up
fragments of ‘dead’ virions, which just did not get cleared out by
immune cells yet. Many of those tests were followed by tries to culture
those virions in laboratory, and they could not get ‘live’ viruses from
it so it seems that what was there was already dead.
*it might have
been just first infection which just did not get fully cleared out and
reappeared after some time, BUT most (if not all) of those cases has
either no symptoms or very mild symptoms after second positive test.
Most of the studies say that people with second positive test probably
are unable to infect others.
Also having antibodies doesn’t mean
you are not immune. I know. Confusing, but immunology is a b****. I’m
saying that as person who tortured herself by doing entire course in
immunology during my MSc degree, and now is writing DPhil partially in
immunology. Don’t do that to yourself. I think immunology is one of the
most confusing biological fields out there. Seriously, having
antibodies, not having antibodies, having one type of antibodies but no
other types of antibodies does not tell us if we have immunity to the
pathogen or not
. There are also B cells, T cells, CD4/CD8, TLRs, and
million of other super weird things which makes me cry at night.
- There were some reports about COVID-19 causing blood clots in healthy
young adults in US. I just wanted to say that morbidly obese is not
healthy. I would also argue that obese is not healthy and yes, being
obese makes you more prone to develop severe symptoms of COVID. That’s
also because of immunological stuff - inflammation and fat tissue are
quite related. Strokes and obesity are also related.
-And just
one more thing, comparing countries and measures they used to battle
pandemics really does not make sense especially when bringing extreme
examples. Like for example - Hong Kong. No, they did not ‘won’ with
COVID because they all use masks. They are very small country, which
makes it easier to control. They have previous experiences in fighting
similar epidemics (SARS-1). And last but not least, people in Hong Kong
know how to use masks. And yes, you are more prone to get infections if
you are using masks wrong. They are not silver bullet. There is no
silver bullet.
- If you feel ill, got cough, fever etc. It is
still very possible you have seasonal flu or flu-like illness. It
doesn’t mean it is COVID. It does mean though you should stay at home.
Speaking as a Rocket Scientist... medicine is hard. General Practice requires a degree of intuition and observation that would make Sherlock Holmes proud. Immunology, the study of immune systems - extremely complex systems - where our tools for investigating them are so crude - is like trying to analyse a large scale integrated circuit using a jewellers loupe and flint axe.
Airborne-mediated
microbial diseases such as influenza and tuberculosis represent major
public health challenges. A direct approach to prevent airborne
transmission is inactivation of airborne pathogens, and the airborne
antimicrobial potential of UVC ultraviolet light has long been
established; however, its widespread use in public settings is limited
because conventional UVC light sources are both carcinogenic and
cataractogenic. By contrast, we have previously shown that far-UVC light
(207–222 nm) efficiently inactivates bacteria without harm to exposed
mammalian skin. This is because, due to its strong absorbance in
biological materials, far-UVC light cannot penetrate even the outer (non
living) layers of human skin or eye; however, because bacteria and
viruses are of micrometer or smaller dimensions, far-UVC can penetrate
and inactivate them. We show for the first time that far-UVC efficiently
inactivates airborne aerosolized viruses, with a very low dose of
2 mJ/cm2 of 222-nm light inactivating >95% of aerosolized
H1N1 influenza virus. Continuous very low dose-rate far-UVC light in
indoor public locations is a promising, safe and inexpensive tool to
reduce the spread of airborne-mediated microbial diseases.
...research from Columbia University Medical Center demonstrated
that single- wavelength far-UVC photons can kill bacteria and viruses
while it cannot penetrate either the human stratum corneum (the outer
dead-cell skin layer), nor the ocular cornea, nor the corneal tear-film
layer, nor even the cytoplasm of individual human cells. In particular,
the results teste both in vitro and in vivo have shown that several
far-UVC wavelengths (such as 207 and 222 nm) are as efficient as
conventional mercury containing germicidal UV lamp in inactivating both
drug-resistant bacteria (e.g. MRSA) and viruses (e.g. H1N1), but these
two far UVC wavelengths induce no damage to skin or to eyes, for a wide
range of clinical endpoints, in contrast to a conventional
broad-spectrum germicidal lamp.
Scientists have known for decades that broad-spectrum UVC light,
which has a wavelength of between 200 to 400 nm), is highly effective at
killing bacteria and viruses by destroying the molecular bonds that
hold their DNA together. This conventional UV light is routinely used to
decontaminate surgical equipment.
"Unfortunately, conventional
germicidal UV light is also a human health hazard and can lead to skin
cancer and cataracts, which prevents its use in public spaces," says
study leader David J. Brenner.
Several years ago, Brenner and his colleagues hypothesized that
far-UVC could kill microbes without damaging healthy tissue. "Far-UVC
light has a very limited range and cannot penetrate through the outer
dead-cell layer of human skin or the tear layer in the eye, so it’s not a
human health hazard. But because viruses and bacteria are much smaller
than human cells, far-UVC light can reach their DNA and kill them," said
Brenner.
Excimer lamp sources Brenner and his group
use filtered excimer lamps emitting in the 207 to 222 nm wavelength
range. For example, 207 nm light is emitted by a krypton-bromine (Kr-Br)
excimer lamp, while 222 nm is emitted by a krypton-chlorine (Kr-Cl)
excimer lamp. Brenner's group started with the 207 nm lamp, publishing results on sterilization of bacteria in 2013;1 in 2017, the results at 222 nm for bacteria were reported.2 The latest results, on sterilization of the influenza virus, were published this month (Feb. 2018) in Scientific Reports.3
We identified seasonal human coronaviruses, influenza viruses and
rhinoviruses in exhaled breath and coughs of children and adults with
acute respiratory illness. Surgical face masks significantly reduced
detection of influenza virus RNA in respiratory droplets and coronavirus
RNA in aerosols, with a trend toward reduced detection of coronavirus
RNA in respiratory droplets. Our results indicate that surgical face
masks could prevent transmission of human coronaviruses and influenza
viruses from symptomatic individuals.
These virologic results stand in contrast with those reported by Gautret et al. and cast doubts about the strong antiviral efficacy of this combination. Furthermore, in their report Gautret et al also reported one death and three transfers to the ICU among the 26 patients who received hydroxychloroquine, also underlining the poor clinical outcome with this combination.
In addition, a recent study from China in individuals with COVID-19 found no difference in the rate of virologic clearance at 7 days with or without 5 days of hydroxychloroquine, and no difference in clinical outcomes (duration of hospitalization, temperature normalization, radiological progression) (4). These results are consistent with the lack of virologic or clinical benefit of chloroquine in a number of viral infections where it was assessed for treatment or prophylaxis with sometimes a deleterious effect on viral replication (5-8).
In summary, despite a reported antiviral activity of chloroquine against COVID-19 in vitro, we found no evidence of a strong antiviral activity or clinical benefit of the combination of hydroxychloroquine and azithromycin for the treatment of our hospitalized patients with severe COVID-19. Ongoing randomized clinical trials with hydroxychloroquine should provide a definitive answer regarding the alleged efficacy of this combination and will assess its safety
Now..it's not a Double Blind study. There may be some benefit in less severe cases, though there's no good or even fair evidence of that either. It may be harmful, rather than beneficial, though again, no Double Blind studies have been done.
We can't absolutely exclude the possibility that there may be some benefit at this point. It just seems increasingly unlikely that any benefit, if any exists, is large.
The ACT will begin "actively looking" for community
transmission of coronavirus in Canberra, allowing a random sample of
ineligible people to be tested for COVID-19 each day.
Key points:
There are now 91 confirmed cases of COVID-19 in Canberra, after four more were added to the tally
A random selection of people who do not meet testing criteria will be tested at two Canberra locations
One confirmed case remains under investigation due to its unknown origin
Announcing four more cases of COVID-19 in the ACT,
chief health officer Kerryn Coleman said testing would be expanded, as
fewer returning overseas travellers and close contacts were being tested
each day.
From Monday, a random selection of people who present
at Weston Creek Walk-In Centre and the drive-through facility set up at
EPIC, but do not meet the testing criteria, will be tested anyway.
"We
are able to do this because there is a decrease in demand for testing
from returning travellers and known contacts of confirmed cases," Dr
Coleman said.
"We are actively looking for evidence of community transmission in Canberra."
More than 5,000 tests have been conducted in Canberra so far
Canberra has a population of 400,000, so this is a rate of 1 in 80. When we get a rate of 1 in 10, with retesting, we may have a handle on the situation, so can be more confident in what we're doing.
I am an ER MD in New Orleans. Class of 98.
Every one of my colleagues have now seen several hundred Covid 19
patients and this is what I think I know.
Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start.
Common are fever, headache, dry cough, myalgias(back pain), nausea
without vomiting, abdominal discomfort with some diarrhea, loss of
smell, anorexia, fatigue.
Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.
81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
Patient presentation is varied. Patients are coming in hypoxic (even
75%) without dyspnea. I have seen Covid patients present with
encephalopathy, renal failure from dehydration, DKA. I have seen the
bilateral interstitial pneumonia on the xray of the asymptomatic
shoulder dislocation or on the CT's of the (respiratory) asymptomatic
polytrauma patient. Essentially if they are in my ER, they have it. Seen
three positive flu swabs in 2 weeks and all three had Covid 19 as
well. Somehow this ***** has told all other disease processes to get
out of town.
China reported 15% cardiac involvement. I have seen
covid 19 patients present with myocarditis, pericarditis, new onset CHF
and new onset atrial fibrillation. I still order a troponin, but no
cardiologist will treat no matter what the number in a suspected Covid
19 patient. Even our non covid 19 STEMIs at all of our facilities are
getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.
Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in
the RLL so bilateral on CXR is not required). The hypoxia does not
correlate with the CXR findings. Their lungs do not sound bad. Keep your
stethoscope in your pocket and evaluate with your eyes and pulse ox.
Labs- WBC low, Lymphocytes low, platelets lower then their normal,
Procalcitonin normal in 95% CRP and Ferritin elevated most often. CPK,
D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I
would be very careful about CT PE these patients for their hypoxia.
The patients receiving IV contrast are going into renal failure and on
the vent sooner.
Basically, if you have a bilateral pneumonia with
normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and
ferritin- you have covid-19 and do not need a nasal swab to tell you
that.
A ratio of absolute neutrophil count to absolute lymphocyte
count greater than 3.5 may be the highest predictor of poor outcome.
the UK is automatically intubating these patients for expected outcomes
regardless of their clinical presentation.
An elevated
Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is
elevated watch these patients closely with both eyes.
Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.
Disposition
I had never discharged multifocal pneumonia before. Now I personally do
it 12-15 times a shift. 2 weeks ago we were admitting anyone who
needed supplemental oxygen. Now we are discharging with oxygen if the
patient is comfortable and oxygenating above 92% on nasal cannula. We
have contracted with a company that sends a paramedic to their home
twice daily to check on them and record a pulse ox. We know many of
these patients will bounce back but if it saves a bed for a day we have
accomplished something. Obviously we are fearful some won't make it
back.
We are a small community hospital. Our 22 bed ICU and now a 4
bed Endoscopy suite are all Covid 19. All of these patients are
intubated except one. 75% of our floor beds have been cohorted into
covid 19 wards and are full. We are averaging 4 rescue intubations a day
on the floor. We now have 9 vented patients in our ER transferred down
from the floor after intubation.
Luckily we are part of a larger
hospital group. Our main teaching hospital repurposed space to open 50
new Covid 19 ICU beds this past Sunday so these numbers are with
significant decompression. Today those 50 beds are full. They are
opening 30 more by Friday. But even with the "lockdown", our AI models
are expecting a 200-400% increase in covid 19 patients by 4/4/2020.
Treatment
Supportive
worldwide 86% of covid 19 patients that go on a vent die. Seattle
reporting 70%. Our hospital has had 5 deaths and one patient who was
extubated. Extubation happens on day 10 per the Chinese and day 11 per
Seattle.
Plaquenil which has weak ACE2 blockade doesn't appear to
be a savior of any kind in our patient population. Theoretically, it
may have some prophylactic properties but so far it is difficult to see
the benefit to our hospitalized patients, but we are using it and the
studies will tell. With Plaquenil's potential QT prolongation and liver
toxic effects (both particularly problematic in covid 19 patients), I
am not longer selectively prescribing this medication as I stated on a
previous post.
We are also using Azithromycin, but are intermittently running out of IV.
Do not give these patient's standard sepsis fluid resuscitation. Be
very judicious with the fluids as it hastens their respiratory
decompensation. Outside the DKA and renal failure dehydration, leave
them dry.
Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.
Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia,
etc. Except for Peep of 5 will not do. Start at 14 and you may go up to
25 if needed.
Do not use Bipap- it does not work well and is a
significant exposure risk with high levels of aerosolized virus to you
and your staff. Even after a cough or sneeze this virus can aerosolize
up to 3 hours.
The same goes for nebulizer treatments. Use MDI.
you can give 8-10 puffs at one time of an albuterol MDI. Use only if
wheezing which isn't often with covid 19. If you have to give a
nebulizer must be in a negative pressure room; and if you can, instruct
the patient on how to start it after you leave the room.
Do not
use steroids, it makes this worse. Push out to your urgent cares to stop
their usual practice of steroid shots for their URI/bronchitis.
We are currently out of Versed, Fentanyl, and intermittently Propofol.
Get the dosing of Precedex and Nimbex back in your heads.
One of my
colleagues who is a 31 yo old female who graduated residency last may
with no health problems and normal BMI is out with the symptoms and an
SaO2 of 92%. She will be the first of many.
I PPE best I have. I
do wear a MaxAir PAPR the entire shift. I do not take it off to eat or
drink during the shift. I undress in the garage and go straight to the
shower. My wife and kids fled to her parents outside Hattiesburg. The
stress and exposure at work coupled with the isolation at home is
trying. But everyone is going through something right now. Everyone is
scared; patients and employees. But we are the leaders of that emergency
room. Be nice to your nurses and staff. Show by example how to tackle
this crisis head on. Good luck to us all."
Our data suggest the possibility of extended duration of viral shedding
in faeces, for nearly 5 weeks after the patients' respiratory samples
tested negative for SARS-CoV-2 RNA. Although knowledge about the
viability of SARS-CoV-2 is limited,the virus could remain viable in the environment for days, which could
lead to faecal–oral transmission, as seen with severe acute respiratory
virus CoV and Middle East respiratory syndrome CoV
Mutation accumulation in SARS-CoV-2 strains as of 26Mar20 from nextstrain.org/ncov
The picture above shows the length of the genome (0 to 29,000 bases)
and the bars above show how many mutations have been detected at a given
nucleotide. The long, color coded bars underneath represent the protein
produced by that section of the virus.
Now, the analysis, by someone who knows their onions.
Overall, we’re seeing what you would hope to see in a virus, a lot of
broad, non-specific mutation locations. This means there is no
particular pressure on the virus to change an aspect of its proteins
rapidly.
Overall, we’re looking at wonderful news for
people developing treatments and vaccines. While this virus is mutating,
it’s not showing anything dangerous or anything that can prevent
treatments from working in the near future. The virus will continue to
spread, but we’ll continue to monitor it; as the virus accumulates more
isolated differences, we’ll even be able to tell where a case was from
based on its unique sequence.
There is concern about the ability of this disease to reinfect
someone after they recover from an initial bout of COVID-19. I am no
virologist and can’t say it won’t happen in the future, but for now it
looks like that isn’t possible. While there have been some reports of
reinfection in people, it could be that they had false negative test
results or just hadn’t quite recovered as much as they thought they had,
leading people to be readmitted to the hospital. A trial performed in
monkeys showed no signs of a second infection after the monkey was
initially exposed, which is great news for us.
A summer marked by hazardous air quality and bushfire smoke may have
cost 31 Canberrans their lives, according to a new study published in
the Medical Journal of Australia.
The study did not analyse pre-existing conditions but measured what
public health experts describe as “excess deaths”, or the factor by
which observed mortality rates exceed expected mortality rates when
major risks like heatwaves, bushfires, pandemics, famine or war are
present.
The study estimated that in the ACT, 229 people were admitted to
hospital – 82 for cardiovascular problems, and 147 for respiratory
problems – while 89 people attended the emergency department because of
asthma-related issues.
There were a total of 417 estimated excess deaths because of the
bushfire smoke and 4,456 hospitalisations and emergency department
visits across NSW, Queensland, Victoria and the ACT.
Between October 2019 and February 2020, the concentration of PM2.5 –
fine particles that irritate the respiratory system – exceeding the 95th
percentage of historical daily averages was recorded by at least one
air-quality monitoring station on 94 per cent of days.
More than a third of Canberra’s summer was spent with air quality
levels above hazardous as bushfire smoke blanketed the ACT. Canberra
regularly had the world’s worst air quality levels on days throughout the 2020 bushfires.
The air quality in Canberra reached 22 times the hazardous threshold
on New Year’s Day, dragged across from the South Coast by unrelenting
easterlies.
And now to the fast moving situation regarding COVID-19.
One person who was diagnosed with the COVID-19 virus has made a full recovery and is now out of self-isolation.
An ACT Health spokesperson confirmed the good news early this afternoon. The person was first diagnosed on 12 March.
“This person has now shed the virus and is no longer required to self-isolate,” the ACT Health spokesperson said.
However, the number of confirmed cases of COVID-19 in the ACT in the
past 24 hours continues to rise, with a further nine people testing
positive.
This brings the ACT’s total to 53 people with the virus.
The new cases include six males and three females, aged between 21 and 83.
“ACT Health is undertaking thorough contact tracing but can confirm
that eight of the cases are linked to overseas travel, including cruise
ships, and one is a close contact of a confirmed case,” ACT Health said
in a statement.
ACT Health said there is still currently no evidence of community transmission in the ACT.
There have been 3219 negative COVID-19 tests in the ACT to date.
There are currently three
COVID-19 patients in the Canberra hospital. All are in a stable
condition. The rest are isolating at home with ACT Health support.
Aside from not adhering to an intent-to-treat design, here’s where the study is truly revealed to be crap.....
But like Chicken Soup, it can't hurt, right? Welll..not usually... but sometimes it does hurt.
Hydroxychloroquine (trade name Plaquenil) is a derivative of
chloroquine (trade name Aralen), a common antimalarial drug. Indeed,
some of you reading this might well have taken chloroquine as
prophylaxis to prevent malaria
while traveling to tropical regions where the disease is endemic. It is
also used to treat amoebic liver abscesses when other drugs used for
such infections are not working. These drugs also mildly suppress the
immune system, which is why they are used as part of the treatment of
some autoimmune disorders, such as lupus erythematosis or rheumatoid
arthritis.
One thing that should be understood is that these are not
entirely benign drugs. They have a number of side effects and adverse
reactions. In addition to more mild side effects, such as nausea,
headache, loss of appetite, and diarrhea, there are two more severe
potential side effects. One is that long term use of these drugs can
damage the retina and lead to macular degeneration, which is why
patients taking these drugs long term need regular ophthalmological
examinations. They can also affect the heart by prolonging the QT interval and also lead to drug-induced torsade de pointes, a potentially lethal ventricular tachycardia.
The other drug in the combination, azithromycin
(trade names Zithromax, Azithrocin, and others), is a common
antibiotic, used to treat a number of infections, ranging from ear
infections, to strep throat, pneumonia, and a number of sexually
transmitted infections, including chlamydia and gonorrhea. It’s commonly
prescribed as a “Z-Pak,” to be taken for five days, and it’s widely prescribed.
It can also be used to treat malaria. It has few adverse side effects,
but it shares one with hydroxychloroquine: QT-segment prolongation.
Indeed, the FDA issued a warning
in 2013 that azithromycine “can cause abnormal changes in the
electrical activity of the heart that may lead to a potentially fatal
irregular heart rhythm.” The warning further cautioned that people with
certain pre-existing conditions are at particular risk, such as those
with QT interval prolongation, low potassium or magnesium levels, a
slower than normal heart rate, or those who use certain drugs to treat
abnormal heart rhythms.
A number of doctors on Twitter were alarmed at the suggestion that
two drugs that can affect heart rhythm be taken together without much
stronger evidence that they were effective....
Actually, I am a Rocket Scientist.
Also hormonally odd (my blood has 46xy chromosomes anyway) and for most of my life, I looked male, and lived as one, trying to be the best Man a Gal could be. Anyway, in May 2005 that started changing naturally for reasons still unclear, and I'm now Zoe, not Alan : happier and more relaxed not to have to pretend any more.
UPDATE - reason now identified as the 3BHSD form of CAH.
This blog, written by a rocket scientist, is a fascinating collection of information, both personal and scientific, regarding intersex, transsexualism and related psychosocial and psychosexual issues. ... It is erudite and heartfelt. Just read the posts about the passport issue. You won't know whether to laugh, weep or crawl into a ball and rock gently in a corner - an amazing person. - David --- The reason I so appreciate bright, perceptive people - as opposed to ideologues whose intelligence does little to illuminate - is that they manage to both instruct and learn with a certain grace. Among such rarities in the transblogosphere is Zoe, whose direct speech and clear humanity always make her worth reading, even if one doesn’t always agree with her every conclusion. - Val --- The following is a request for permission to archive your A.E.Brain blog site which we have wanted to do for several years... The Library has traditionally collected items in print, but it is also committed to preserving electronic publications of lasting cultural value.... Since (1996) we have been identifying online publications and archiving those that we consider have national significance.... We would like to include A.E.Brain blog site in the PANDORA Archive... -Australian National Library
