COVID-19

[Archimid]

Mar 25 1000  Ahead of schedule. At least they had the "courtesy" of not reporting during market hours.

But this thing can't keep doubling every 2 days. A lot of places called for stay in place today.  A lot of place didn't. let's hope it goes back to doubling every 3 days.

Mar 25 1000
Mar 28 2000
Mar 31 4000
Apr 3   8000
Apr 6  16000

There is no reason to go any further than that. Surely people in the US will come to their senses before then.

Apr 3 7393

A slow down. That's good even if not significant. I hope this was not just a reporting problem.

I'm going to use this number as the new base. Many states have finally put stay at home advisories. Maybe doublings occur every 4 days for 2 dates and then a doubling every 5 days for 2 dates. Given the measures taken to date, the final numbers for the initial wave shouldn't be much larger than 118,288. An order of magnitude larger at most, as long as quarantine is maintained. The number will not be much smaller than that. That number excludes non-covid deaths

Apr 3 7393
Apr 7  14,786
Apr 11 29,572
Apr 16 59,144
Apr 21 118,288

Apr 7 12,841

Good. Except that hospitals are overwhelmed and people are dying at home without getting tested. 12,841 is similar to the UK numbers in that it does not include at-home fatalities. I'll be surprised if care homes for the elderly are reporting Covid cases.

[sigma_squared]

In the near term it looks like the daily death rate should flatten in the range 1,800 - 2500/day for mid to late April.   If new cases trend down will we get back to business guidance from the White House on (or even before) the end of the month?   I think so.

https://covid19.healthdata.org/united-states-of-america

Projects deaths peaking at 3,130 per day in mid-April.

Thanks for that Sigma.  My somewhat simplistic model peaks significantly lower but flatter.    Since peak deaths are effectively 'baked in' at this point I rather doubt the 3K peak at this point, but time will tell.

You're welcome. Your estimate is within the confidence interval of the IHME model (1,282 to 7,703).

This tweet shows that actual numbers are below model estimates for the few days in Massachusetts he compares, and why that might be the case:
https://twitter.com/MichaelPageWx/status/1247544126486138882

Modeling Thread: is #SocialDistancing making a difference in Massachusetts? Sort of like weather models, it's fascinating to now compare reality to the forecast, in this case from the frequently cited @IHME_UWmodel. Take a look at what the actual data shows for #COVID19

Deaths: thru April 6, the latest iteration of the model calls for 319-631 deaths in Massachusetts. So far the official count is 260, according to @MassDPH. The number doesn't even reach the low end of the uncertainty bracket.

Deaths per Day: on April 6, the model indicated the daily deaths in Massachusetts would be 78 (uncertainty range of 21-227). Actual deaths reported by @MassDPH was 29, clearly the low end of the range.

Caveats: that daily death projection seems hard to fully verify, mind you, because we don't know exactly when those #COVID19 deaths occurred, even though they are reported on a certain date. Still, we seem to have enough data to indicate we're on the low end of the range.

Takeaways: this @IHME_UW model, frequently discussed by the #COVID19 White House task force, appears to be overestimating the severity of the virus in Massachusetts, OR is underestimating the impacts of #SocialDistancing  efforts

Bottom line: this is certainly a positive. Do not take this as a suggestion that #SocialDistancing  can stop, but do look at it as proof that it's making a difference. As more data comes in, it will go into the model and will update future projections, just like weather models.

New Data: with the April 7 update now in, @MassDPH reports 356 people killed by #COVID19. The latest @IHME_UW projection for this date is 554 (range of 386-835), which offers a bit more hope that the state does in fact remain on the lower end of expectations.

[Archimid]

Social distancing works. It is a fact as true as gravity. If the people together with the government and industry can coordinate to take it a bit further we can make C19 pseudo extinct for many months, especially with the help of summer. If the vaccine folk really step on it vaccines may be ready by the end of the year, or even earlier.

[sigma_squared]

FT graphs for April 7 show:

• Progress in the worst hit areas
• Acceleration elsewhere
• The difficulty of keeping the curves flat long term, especially at a regional level

[Jim Hunt]

The IHME projection for the US has just updated, and now suggests that peak COVID daily deaths in the US will be in 8 days time:

http://GreatWhiteCon.info/2020/04/covid-19-in-the-united-kingdom/#Apr-08-PM

[dnem]

The spread of COVID-19 is based on 2 factors ..
                                   
          1. How dense the population is , and
         
          2. How dense the population is .. b.c.

It took me a few seconds to figure out what you meant

This is a very clever quip (and I stole it and put it on FB), but here in the US and all over the world, there are billions of people whose circumstances make it incredibly difficult to self isolate. But there are also a lot of people who are just too dense to.

[sigma_squared]

Social distancing works. It is a fact as true as gravity.

That also cuts the other way.

https://twitter.com/IHME_UW/status/1247841621565112321
It is crucial that US states continue to strongly adhere to #socialdistancing measures, says IHME professor @AliHMokdad. "Any scaling back or interruption of social distancing measures may change the trajectory of the epidemic dramatically for the worse."

Tweet references map from:
https://www.thinkglobalhealth.org/article/preparing-covid-19-surge-united-states
Preparing for the COVID-19 Surge in the United States
March 31, 2020

[Sigmetnow]

Wuhan on the move again as coronavirus lockdown limits ease | South China Morning Post

Trains, buses and planes have started moving tens of thousands of passengers from Wuhan as the central Chinese city, the initial epicentre of the coronavirus pandemic, emerges from an 11-week lockdown.

From Wednesday, Wuhan’s 11 million residents can travel in and out of the city as long as they have a QR code to show that they are in good health and have not been in contact with people confirmed with Covid-19, the disease caused by the coronavirus.

Highways, bridges, ferries and tunnels are also open again and all roadblocks have been removed.

On Wednesday morning, traffic jams returned to the intersection near Wuhan Railway Station in congestion not seen since late January. ...

https://www.scmp.com/news/china/society/article/3078970/wuhan-move-again-coronavirus-lockdown-limits-ease

[Tom_Mazanec]

While I am in favor of the lockdown, this does bring up a pertinent point:
MORE PEOPLE DIED OF SUICIDE LAST WEEK IN TENNESSEE THAN COVID-19
https://www.shtfplan.com/headline-news/more-people-died-of-suicide-last-week-in-tennessee-than-covid-19_04072020

As we previously warned, this pandemic will bankrupt and kill more people from suicide than the virus will. When you sacrifice people’s livelihoods, you create a difficult situation of desperation for many who will see no other way out.

[vox_mundi]

Very comprehensive article on the state of testing ... worth reading

U.S. Labs Face Crisis After Crisis Despite Improvements in Testing
https://www.bloomberg.com/amp/news/articles/2020-04-07/coronavirus-testing-accuracy-and-availability-shortages-remain

Coronavirus testing has become a massive logistical failure, one that’s made it impossible to know how much the virus has truly spread.

Testing will become even more important as states attempt to lift restrictive rules that have shut down businesses and asked people to stay home for weeks, crushing the U.S. economy. A loosening of those rules, public health experts have said, will need to come with widespread testing that includes those who exhibit no symptoms, which can be followed up by more targeted quarantines while other people get back to work.

It is a picture that starkly differs from the one promoted by the White House in which anybody who wants can be tested for Covid-19. ...

[blumenkraft]

Also, Prof. Dr. Drosten said in yesterday's podcast that crucial chemical reagents needed for testing are going to run low rather soon. Very bad news...

[blumenkraft]

French hospital halts Hydroxychloroquine trial due to cardiac side effects

Link >> https://www.nicematin.com/sante/coronavirus-nous-avons-deja-du-interrompre-le-traitement-de-hydroxychloroquine-azithromycine-au-chu-de-nice-489118

[Sigmetnow]

Passengers to be evacuated from Antarctic cruise ship after almost 60% test positive for coronavirus

The Greg Mortimer, a cruise liner operated by Australia's Aurora Expeditions, departed March 15 on a voyage to Antarctica and South Georgia. Since the beginning of April, however, the ship has been stuck off the coast of Uruguay, after authorities refused to allow passengers to disembark due to the risk of coronavirus.

Of the 217 people on board, 128 passengers and crew have now tested positive for the virus.

Six passengers requiring specialized care have been transferred to medical facilities in Montevideo -- a video posted online by the Uruguayan navy showed them being transferred from ship to ship wearing full protective gear.

Passengers from Europe and America who have tested positive for coronavirus, however, will have to remain on board until they have a negative test result, after which they may be able to depart via Brazil, Aurora said.

All passengers will be retested every two or three days, according to the company's website.
…
"While our preferred plan had been to disembark all passengers simultaneously, the nature of the situation and the difficultly in securing flights has meant it is likely that the Australian and New Zealand passengers will leave the vessel before our European (UK included) and North American passengers."

Aurora said the chartered Airbus A340 will be specially fitted with medical and quarantine facilities in order to "ensure the health and safety of all on board." The company estimated the cost per passenger of at least $9,300, and said it was in discussions with the Australian government "for support with this cost as we know that it is not viable for many people."
…
Cruise ships stuck
More than a dozen cruise ships have been effectively trapped at sea due to the coronavirus pandemic, as countries refused to allow those carrying infected passengers to dock.

Australia's Department of Foreign Affairs and Trade said this month it was in direct contact with 10 cruise ships with around 600 Australian passengers on board.

"In most cases, disembarkation cannot occur unless passengers have onward flight arrangements and are able to travel directly to the airport via a so-called sanitary corridor, put in place by host countries," DFAT said in a statement. …

https://www.cnn.com/2020/04/07/americas/greg-mortimer-cruise-ship-coronavirus-intl-hnk/index.html

[dnem]

This is quite an interesting story relevant to the discussion of excess deaths not directly due to CV:
https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html

Where Have All the Heart Attacks Gone?

The hospitals are eerily quiet, except for Covid-19.

I have heard this sentiment from fellow doctors across the United States and in many other countries. We are all asking: Where are all the patients with heart attacks and stroke? They are missing from our hospitals.

Yale New Haven Hospital, where I work, has almost 300 people stricken with Covid-19, and the numbers keep rising — and yet we are not yet at capacity because of a marked decline in our usual types of patients. In more normal times, we never have so many empty beds.

What is striking is that many of the emergencies have disappeared. Heart attack and stroke teams, always poised to rush in and save lives, are mostly idle. This is not just at my hospital. My fellow cardiologists have shared with me that their cardiology consultations have shrunk, except those related to Covid-19. In an informal Twitter poll by @angioplastyorg, an online community of cardiologists, almost half of the respondents reported that they are seeing a 40 percent to 60 percent reduction in admissions for heart attacks; about 20 percent reported more than a 60 percent reduction.

[Jim Hunt]

Where Have All the Heart Attacks Gone?

This extract seems pertinent?

The most concerning possible explanation is that people stay home and suffer rather than risk coming to the hospital and getting infected with coronavirus. This theory suggests that Covid-19 has instilled fear of face-to-face medical care. As a result, many people with urgent health problems may be opting to remain at home rather than call for help. And when they do finally seek medical attention, it is often only after their condition has worsened.

I was certainly hesitant before attending Bodmin Community Hospital for a pre-arranged chest X-ray last week. On my way to reception I passed a door labelled "Isolation. Do not enter". Mine was the only mask I saw during my visit.

[The Walrus]

Mar 25 1000  Ahead of schedule. At least they had the "courtesy" of not reporting during market hours.

But this thing can't keep doubling every 2 days. A lot of places called for stay in place today.  A lot of place didn't. let's hope it goes back to doubling every 3 days.

Mar 25 1000
Mar 28 2000
Mar 31 4000
Apr 3   8000
Apr 6  16000

There is no reason to go any further than that. Surely people in the US will come to their senses before then.

Apr 3 7393

A slow down. That's good even if not significant. I hope this was not just a reporting problem.

I'm going to use this number as the new base. Many states have finally put stay at home advisories. Maybe doublings occur every 4 days for 2 dates and then a doubling every 5 days for 2 dates. Given the measures taken to date, the final numbers for the initial wave shouldn't be much larger than 118,288. An order of magnitude larger at most, as long as quarantine is maintained. The number will not be much smaller than that. That number excludes non-covid deaths

Apr 3 7393
Apr 7  14,786
Apr 11 29,572
Apr 16 59,144
Apr 21 118,288

Apr 7 12,841

Good. Except that hospitals are overwhelmed and people are dying at home without getting tested. 12,841 is similar to the UK numbers in that it does not include at-home fatalities. I'll be surprised if care homes for the elderly are reporting Covid cases.

Possibly a good sign.  Deaths went from doubling every three days in mid March to five days currently. 

[dnem]

I think that explains part of it. I also think a lot of type A, hard-driving personalities are actually finding life LESS stressful. It is probably a combination of both.

"After their conditioned has worsened" would not explain this; it would have to be "after they had died."
But a lot of people with heartburn, and anxiety etc. show up at ERs worried they are having an MI. Those people are likely staying home more.

[wili]

I think there is a lot to what Jim cited.

I do also wonder if those who have some financial cushion are actually a bit less stressed from work issues, and are taking care of themselves a bit better--being extra cautious about over-exertion, etc.

But maybe that's my (rarely seen) sunny optimism coming out?

eta : D'oh! we posted at the same time, dnem...great minds...?

[gandul]

Health authorities in Spain acknowledge 15 out of 16 of contagions may be hidden, as they start a massive test campaign
https://elpais.com/sociedad/2020-04-07/mas-del-90-de-contagios-estan-ocultos.html

Which is something many of us already supposed.
This puts the probable contagions in about two millions.
This still is very far from herd immunity in a country of 45 million. Those that hope an iceberg below the tip I believe will have to be disappointed or wait many months.

On a happier note, watching local news Madrid hospitals are breathing with some free rooms, even ICUs, and admissions are under a 30% of the peak. Several hospitals are achieving more discharges than admissions now.

[Sigmetnow]

Stephen Colbert loses it over Trump's pointless, personal coronavirus tantrums

It's Tuesday, we think, and everyone's just about done with this week already. After just a couple of clips of President Trump bitching at White House reporters who asked perfectly reasonable questions about coronavirus testing, Stephen Colbert traded his home-office Late Show monologue for whimpering "What is wrong with him?" from somewhere around carpet level.

Late night hosts: They're just like us!

"You know what? Who gives a shit?" said an exasperated Colbert, interrupting himself fact-checking a snarky partisan aside. "Trump doesn't understand that no-one cares about these hissy fits any more. All of this drama no longer plays to the camera any more, sir, not even to your own supporters.

"Because it doesn't matter who you voted for — everyone just wants to know the truth, 'cause that's how you stay alive. So grow up and do your damn job."

https://mashable.com/video/stephen-colbert-trump-coronavirus-testing-who-cares/

[wili]

gandul wrote:

Health authorities in Spain acknowledge 15 out of 16 of contagions may be hidden, as they start a massive test campaign
https://elpais.com/sociedad/2020-04-07/mas-del-90-de-contagios-estan-ocultos.html

Which is something many of us already supposed.
This puts the probable contagions in about two millions.

If that is typical globally, it means there are something over 20 million cases worldwide. Probably about right. But we'll probably never know to more than an order of magnitude or two how many people contracted this thing.

On the lowering of stroke and heart attack, could the closing of bars (and restaurants) and restricted hours at liquor stores and breweries have something to do with it. I know last night, having had a very bad day, I thought about going out and getting something to drink, only to realize that it was passed 8 and the liquor stores were already closed.

[kassy]

It might be complicated to work out. The post above on low antibody levels also mentioned:

“About 30 per cent of patients failed to develop high titers of neutralising antibodies after Covid-19 infection. However, the disease duration of these patients compared to others was similar," they said.
The team also found that antibody levels rose with age, with people in the 60-85 age group displaying more than three times the amount of antibodies as people in the 15-39 age group..
[/i]

Factors in this are prior (more recent) vaccinations for other diseases possibly help to control this virus in a way which produces no antibodies in the younger part of the population.

We could still do more focused testing.

We could test populations in old age care centers. Run tests in those with very little or no cases and in those with many cases.

And of course you can do random samples of populations in different areas.

Combining on that could give us a decent picture.
   

[Archimid]

Wili, as soon as they start doing serology testing or random sampling of the population we will know if there is an iceberg of cases under the tip of hospital cases.

My bet, they may find twice the number of cases than tested, maybe 5 times but not 10 times.

Also, they will find that untested ≠ asymptomatic. there are plenty of severe cases that fall outside of the healthcare system.

[wili]

Kassy wrote: "And of course you can do random samples of populations in different areas."

I've been rather shocked that this hasn't happened in a lot of places already, but I guess scarce tests are going to healthcare providers. Makes sense, but some random sampling and analysis would leave us flying a bit less blindly.

(conspiracy warning:) Perhaps they have done such testing and are withholding the results so as not to freak people out more than they already are? Or the opposite? /conspiracy theorizing

Arch, thanks for your always-sunny optimism.   Officials in our state health department have gone on record saying that real cases are likely closer to 100 times the confirmed cases than to 10 times the confirmed case numbers. We have one of the highest rates health care systems in the country. Just sayin'

Kris Ehresmann of the MDH says there's possibly 100 times more than what have been confirmed

https://bringmethenews.com/minnesota-news/11-times-as-many-covid-19-cases-than-confirmed-mn-health-official-say-thats-a-conservative-estimate

;;;;;;;;;;;

In my ongoing effort to embarrass/humble my betters, I note that on Jan. 31, bluice wrote: "Because of 5-6 days incubation period and the fact infection can hardly spread anymore we should be very close to peak coronavirus."

To which Arch responded " +1"

At least, like blum, admit how utterly wrong you guys were.





On another front...when do 'inequities of access to health care' amount to genocide?

[kassy]

You need the extra tests and for proper results you also need time.

We are running one random sampling through the bloodbanks but i don´t think we will get results from that before the end of april. Typically they should take some months.

[Sigmetnow]

‘By December, we are going to go through this again’
A conversation with Dr. Janis Orlowski, chief health care officer of the Association of American Medical Colleges.

...Dr. Orlowski: I believe that we're going to return to a semi-normal life at the end of May — Memorial Day. But the other thing that I would say is that we have to prepare ourselves to go through a similar exercise in the fall, in the late fall. If you take a look at the 1918-1919 influenza pandemic, and if you take a look at how coronavirus is acting, this is not just the winter and spring of 2020. Probably late November, by December, we are going to go through this again.

Now, what we hope is that we have a vaccine, but there's not going to be a vaccine that's going to be ready in 6-8 months. And so the likelihood is that we're going to spend the summer months having a semi-normal life, but getting ourselves prepared to go through this again and go through it better. Be ready to stay at home. Understand what that means. Everyone get as much toilet paper as they need to have. We're going to do this again and we're going to be smarter and better at doing this. And so, let's start talking about how we make it through the next seven weeks. But then let's talk about how we're going to do it smarter, come the winter time.

https://www.politico.com/news/2020/04/08/coronavirus-when-normal-expert-health-care-172005

[Richard Rathbone]

Today's UK official figures. https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public
       Tests   People tested   Positive   Deaths
Daily   14,682   12,959     5,492   938
Total   282,074   232,708   60,733   7,097

Today's briefing shows a slight increase in hospital patients (5% total, 4% critical) with definite flattening and signs of a peak in a couple of regions. https://www.bbc.co.uk/news/live/world-52208591

Deaths are roughly double from a week ago, there's a really strong variation from day to day in how long the lag from death to report is, so today's record isn't as bad as it looks (and the figures from 2-3 days ago weren't as good as they looked). Definitely not doubling in 3 days now.

[SteveMDFP]

Convalescent serum is shaping up to be a highly effective treatment (unsurprisingly):

Effectiveness of convalescent plasma therapy in severe COVID-19 patients
https://www.pnas.org/content/early/2020/04/02/2004168117

This treatment (or any effective treatment) is a game-changer for the global trajectory of this pandemic.

Especially since rapid testing results are being rolled out, a treatment approach can be used to dramatically reduce severity and mortality of infections.  That is, when a person with serious symptoms or high risk for a bad outcome is found, that person can promptly be given an infusion.   We can anticipate a dramatically reduced severity and duration of illness, dramatically reduced deaths, and dramatically reduced demand for ICU beds and ventilators.

Supply of convalescent serum will be an initial constraint.  However, a unit of plasma can be divided among 4 recipients,  and donors can give plasma weekly.  (the red blood cells are returned to the donor, so time between donations can be much shorter than for whole blood donations, and volume donated is also larger).

The technology used is pretty low-tech.   This treatment approach has been used for a century.  Even extremely poor nations can do do donations, centrifugation, and infusions.

This treatment (or any effective treatment) can transform this pandemic from a disaster to something not much worse than a bad influenza season.

We just all need to stay alive for the next month or so for this to be widely available.

[Bruce Steele]

@MRC-Outbreak estimates between 1% and 15% of populations in eleven European countries have contracted Covid already.

https://mobile.twitter.com/trvrb/status/1247609742714753024

SteveMdfp, The study you linked shows a much higher percentage of antibodies in recovered patients than the two thirds with high antibody counts in the study I linked yesterday.
From your link.
“The neutralizing activity against SARS-CoV-2 was evaluated by classical plaque reduction test using a recently isolated viral strain (1). Among the first batch of CP samples from 40 recovered COVID-19 patients, 39 showed high antibody titers of at least 1:160, whereas only one had an antibody titer of 1:32. This result laid the basis for our pilot clinical trial using CP in severe patients.”

[kassy]

I cannot find the direct quote in the paper (by ctrl F) but they are possibly looking at different subpopulations with this one being from older hospital patients?

[Bruce Steele]

They are different results in the two studies , age or severity of infection may confer different antibody levels. For the purpose of collecting serum there seem to be plenty of recovered Covid patients with high antibody levels to harvest but for “herd immunity “ those patients with low or non detectable levels  with need scrutiny .

[Archimid]

;;;;;;;;;;;

In my ongoing effort to embarrass/humble my betters, I note that on Jan. 31, bluice wrote: "Because of 5-6 days incubation period and the fact infection can hardly spread anymore we should be very close to peak coronavirus."

To which Arch responded " +1"

At least, like blum, admit how utterly wrong you guys were.

Hub? China successfully contained the infection when we called it.  It was obvious. It was also understood then that if infections flared out anywhere else the problem would continue.

I have to apologize for many things, one of them is for my initial bet of less than 10k fatalities. I thought that the US was going to wake up and take charge of the infection. Instead the US and most of Europe panicked and didn’t shutdown or masked.

I and many here accurately called it when China got a handle on their outbreak. I will not apologize for that. I even said it a bit further down from the “+1”  that:

As long as there isn't an outbreak anywhere else, we should be good. The threat of Covid-19 for 2020 in the US is over by April, May at most. For the rest of the world varies according to their climate

The mad “die for the economy” response of the west truly surprised me.

[Sam]

Convalescent serum is shaping up to be a highly effective treatment (unsurprisingly):

Effectiveness of convalescent plasma therapy in severe COVID-19 patients
https://www.pnas.org/content/early/2020/04/02/2004168117

This treatment (or any effective treatment) is a game-changer for the global trajectory of this pandemic.

Especially since rapid testing results are being rolled out, a treatment approach can be used to dramatically reduce severity and mortality of infections.  That is, when a person with serious symptoms or high risk for a bad outcome is found, that person can promptly be given an infusion.   We can anticipate a dramatically reduced severity and duration of illness, dramatically reduced deaths, and dramatically reduced demand for ICU beds and ventilators.

Supply of convalescent serum will be an initial constraint.  However, a unit of plasma can be divided among 4 recipients,  and donors can give plasma weekly.  (the red blood cells are returned to the donor, so time between donations can be much shorter than for whole blood donations, and volume donated is also larger).

The technology used is pretty low-tech.   This treatment approach has been used for a century.  Even extremely poor nations can do do donations, centrifugation, and infusions.

This treatment (or any effective treatment) can transform this pandemic from a disaster to something not much worse than a bad influenza season.

We just all need to stay alive for the next month or so for this to be widely available.

There are a number of caveats.

1) There need to be enough donors
2) It needs to be shown to be effective (as yet unproven)
3) There needs to be sufficient testing capability (a severe and very serious limitation)
4) The donors and recipients must be matched for plasma type.

Plasma donation and receipt work differently (backward from) whole blood.

Type AB is a universal donor for plasma. Type O is a universal receiver.

The normal cross reactivity issues with blood should not apply. E.g. for me - I can only receive whole blood from about 1 person in 7,600. I have an extremely rare blood type. For plasma, I should be able to receive from almost anyone.

People with other blood types have other issues. Someone with type AB+ blood can receive whole blood from almost anyone (there are rare exceptions), but plasma only from people who are type AB.

[sigma_squared]

It might be complicated to work out. The post above on low antibody levels also mentioned:

“About 30 per cent of patients failed to develop high titers of neutralising antibodies after Covid-19 infection. However, the disease duration of these patients compared to others was similar," they said.
The team also found that antibody levels rose with age, with people in the 60-85 age group displaying more than three times the amount of antibodies as people in the 15-39 age group.

This tweet has a good observation on the study:
https://twitter.com/afshinfarzan/status/1247902798299066368
Afshin Farzaneh-Far, MD PhD

Preprint from China with implications for potential vaccine?

Antibodies to SARS-CoV2 spike protein measured in 175 recovered patients

30% failed to develop high titers of Abs

10 patients had no detectable Ab

Elderly had significantly higher titers

https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v1.full.pdf

[Includes chart below]

Of course this says nothing about Abs to other components of the virus eg nucleocapsid protein

Translating from doctor-speak, I believe this says the study was only looking for antibodies against the spike protein of COVID-19. There may be antibodies to other components of the virus that confer immunity.

As others have said, this was a diagnostic study, while the convalescent plasma was a treatment study, albeit with only 10 cases. The Globe and Mail article I posted earlier describes the effort to extend this to thousands of patients with proper controls and statistical power.

Here's another article on the treatment trial:
https://www.nbcnews.com/health/health-news/plasma-treatment-being-tested-new-york-may-be-coronavirus-gamechanger-n1178436

Plasma treatment being tested in New York may be coronavirus 'game changer'
One of the first recovered patients to donate his blood plasma said he feels "blessed" he is now healthy and can volunteer his antibodies to help others.

It references the study:
https://ccpp19.org/index.html
National COVID-19 Convalescent Plasma Project

[wili]

Tom, at this point, your sources claim of an increase in suicides above covid deaths is anecdotal at best. It's based on two days of data. Suicides often happen in clusters. Suicide has long been a leading cause of death, taking over a thousand lives a year in Tennessee (by official numbers) for most of the last decade or so.

Also, of course, Covid is just getting started in that state. Give it time...it'll catch up :/

I do expect that people will resort to this extreme in various circumstances, but I think it's too early to show conclusive evidence that that is happening yet, even with very careful and thoroughgoing study, and this limited anecdote is not that!

Arch, cases per day more than doubled from when bluice made that claim to peak, sooo he called it a long way from peak in those terms.

[Archimid]

I think governments should be implementing plasma transfusions programs really hard. This is not a revolutionary treatment but it is most likely a viable treatment.  Plasma transfusions is old medicine fraught with dangers, but antibodies are antibodies. C19 antibodies will lower the viral load in many patients.

 The problem is that the rest of the antibodies a person has will be included with the plasma, and they will also react with the recipient. A good crossmatch should avoid most adverse reactions but there are a lot of dangers inherent to blood transfusion.

[blumenkraft]

I even said it a bit further down from the “+1”  that:

As long as there isn't an outbreak anywhere else, we should be good. The threat of Covid-19 for 2020 in the US is over by April, May at most. For the rest of the world varies according to their climate

Wait! So what you are saying here is that you couldn't possibly imagine that there are airplanes, or just people for that matter, going in and out of the region before the virus was considered dangerous? Do i get that right?

[SteveMDFP]

They are different results in the two studies , age or severity of infection may confer different antibody levels. For the purpose of collecting serum there seem to be plenty of recovered Covid patients with high antibody levels to harvest but for “herd immunity “ those patients with low or non detectable levels  with need scrutiny .

Yes, I looked over the two studies, yours:
https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v1
and this newer, hopeful one:
https://www.pnas.org/content/early/2020/04/02/2004168117

The two use substantially different definitions of effective antibody titres (concentration).  The one you found looked for specific antibodies against a few specific antigens, and also used " a safe and sensitive pseudotyped-lentiviral-vector-based neutralization assay."  I don't yet understand how a lentivirus can be used to accurately assess effective anti-coronavirus antibody levels.

This newer (optimistic) study assessed the convalescent serum in a more straightforward and robust way:  at what concentration does the immune serum neutralize Covid virus?

Failing to find effective antibody responses in recovered individuals is very peculiar and very unexpected.  I can think of only a few special cases where this might be found.

My conclusion is that the pessimistic trial used poor methodology.  I remain very optimistic about the effectiveness of immune serum.  We have over a century of history of effective use of this method.

[Steven]

While I am in favor of the lockdown, this does bring up a pertinent point:
MORE PEOPLE DIED OF SUICIDE LAST WEEK IN TENNESSEE THAN COVID-19
https://www.shtfplan.com/headline-news/more-people-died-of-suicide-last-week-in-tennessee-than-covid-19_04072020

Once again you're linking to an extreme right-wing propaganda site.  Moreover, that story is based on a video from 27 March and doesn't take into account the increase in coronavirus deaths that occurred in the meantime.

https://covidtracking.com/data/state/tennessee

[Sam]

I think governments should be implementing plasma transfusions programs really hard. This is not a revolutionary treatment but it is most likely a viable treatment.  Plasma transfusions is old medicine fraught with dangers, but antibodies are antibodies. C19 antibodies will lower the viral load in many patients.

 The problem is that the rest of the antibodies a person has will be included with the plasma, and they will also react with the recipient. A good crossmatch should avoid most adverse reactions but there are a lot of dangers inherent to blood transfusion.

Be careful what you wish for. That is how the Hep C pandemic came about - the largest single catastrophe of allopathic disease transmission known.

An explosion of Hep C, Hep B, and a dozen other diseases could result. Most of those can be detected via screening. And standard sterilization techniques should eliminate them. “Should” being the operative word. However, a lot of other infections cannot be easily detected. A lot aren’t even identified.  Neither are a whole host of immune factors. The explosion of autoimmune diseases a year or ten later will be startling, and devastating.

Caution is warranted.

Sam

[Archimid]

Wait you are saying here is that you couldn't possibly imagine that there are airplanes, or just people for that matter, going in and out of the region before the virus was considered dangerous? Do i get that right?

You get that wrong. I imagined the airplanes and passengers infecting western countries, but I also imagined western governments testing, contact tracing and isolating, together with social distancing and universal masking.  Basically the things that we have to do now to reopen I thought we were going to do last month and avoid tens of thousands of deaths.

Caution is warranted.

Blood transfusions are dangerous, last resort medicine. They also save countless lives each year.

[Tom_Mazanec]

It is obvious that this lockdown will hurt the economy badly. It is also obvious that this will increase suicides. While it won’t be as many as the covid deaths, it will be a factor.

[sigma_squared]

More about ventilators. Very good video.

https://www.medscape.com/viewarticle/928156

Do COVID-19 Vent Protocols Need a Second Look?
After treating patients with COVID-19, a New York city physician suggests ventilator protocols may need revisiting

John Whyte, MD, MPH: Hello. I'm Dr John Whyte, chief medical officer at WebMD. Welcome to "Coronavirus in Context." Today we're going to talk about whether we're managing coronavirus correctly; do we need to think about a change in our treatment regimens? My guest is Dr Cameron Kyle-Sidell. He's a physician trained in emergency medicine and critical care, and he practices at Maimonides in Brooklyn, New York. Welcome, Dr Sidell.

Cameron Kyle-Sidell, MD: Thank you very much. Thank you for inviting me.

Whyte: You've been talking a lot about the number of patients, the percentage of patients dying on ventilators. When did you first notice this trend?

Kyle-Sidell: In preparation of opening what became a full COVID-positive intensive care unit, we scoured the data just to see what was out there—those who have experienced it before us, primarily the Chinese and the Italians; it was hard to find exactly, like the rate of what we call successful extubation—meaning, someone was put on a ventilator and taken off. And that data are still hard to find. I imagine there are a lot of people still on ventilators. But from the data we have available, it appears to be somewhere between 50% and 90%. Most published data puts it around 70%. So, that's a very, very high percentage in general, when one thinks of a medical disease.

Whyte: You've been talking on social media; you say you've seen things that you've never seen before. What are some of those things that you're seeing?

Kyle-Sidell: When I initially started treating patients, I was under the impression, as most people were, that I was going to be treating acute respiratory distress syndrome (ARDS), similar in substance to AIDS, which I saw as a fellow. And as I start to treat these patients, I witnessed things that are just unusual. And I'm sure doctors around the country are experiencing this. In the past, we haven't seen patients who are talking in full sentences and not complaining of overt shortness of breath, with saturations in the high 70s. It's just not something we typically see when we're intubating some of these patients. That is to say, when we're putting a breathing tube in, they tend to drop their saturations very quickly; we see saturations going down to 20 to 30. Typically, one would expect some kind of reflexive response from the heart rate, which is to say that usually we see tachycardia, and if patients go too low, then we see bradycardia. These are things that we just weren't seeing. I've seen literally a saturation of zero on a monitor, which is not something we ever want and something we actively try to avoid. And yet we saw it, and many of my colleagues have similarly seen saturations of 10 and 20. We try to put breathing tubes in to avoid this very situation. Now, these patients tend to desaturate extremely quickly, so these situations have occurred. Still, what we're seeing—that there was no change in the heart rate—is just unusual. It's just something that we are not used to seeing.

Also referenced in this tweet:
https://twitter.com/drjohnm/status/1247592524094586880
John Mandrola, MD

This may be one of the most important pieces of content @medscape has ever published. What if we are doing it wrong in the treatment of #COVID19? What if @cameronks is correct?  https://medscape.com/viewarticle/928156

[wili]

"It is also obvious that this will increase suicides"

It is possible, not obvious. And it wouldn't have to if, like most other civilized societies, we actually took care of our citizens with free at use health care and supported them financially in times of need.

(The long term suicide rate in the US is about 14/ 100k, while for The Netherlands it's under 10, even though assisted suicide is basically legal there. Yet they have a robust support system both as to health and financial assistance. )

In any case, strokes and heart attack seem to be way down, and I suspect auto accidents and related deaths are way down as well...so, what's the trade off?

[kassy]

They will die later.

There are a whole bunch of reasons why US suicides are higher. Much more unforgiving system economically and also easy access to weapons. I would no be here if i had access to a gun during my severe depression.

[vox_mundi]

CDC Removes Guidance on Drugs Touted by Trump to Treat Coronavirus
https://amp.cnn.com/cnn/2020/04/08/health/cdc-coronavirus-hydroxychloroquine/index.html

The US Centers for Disease Control and Prevention has removed from its website guidelines for doctors on how to prescribe two antimalarial drugs that President Donald Trump has touted as potential treatments for the novel coronavirus.

Trump has been pressing federal health officials to make the drugs -- hydroxychloroquine and chloroquine -- more widely available, despite little reliable evidence that they are effective at treating the virus.

The updated CDC guidance, published Tuesday, is shorter and no longer gives dosage information about the drugs.

... go with your gut - just wing it - like the Chaos King

https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html

---------------------------------



-----------------------------------

[SteveMDFP]

I think governments should be implementing plasma transfusions programs really hard. This is not a revolutionary treatment but it is most likely a viable treatment.  Plasma transfusions is old medicine fraught with dangers, but antibodies are antibodies. C19 antibodies will lower the viral load in many patients.

 The problem is that the rest of the antibodies a person has will be included with the plasma, and they will also react with the recipient. A good crossmatch should avoid most adverse reactions but there are a lot of dangers inherent to blood transfusion.

Be careful what you wish for. That is how the Hep C pandemic came about - the largest single catastrophe of allopathic disease transmission known.

An explosion of Hep C, Hep B, and a dozen other diseases could result. Most of those can be detected via screening. And standard sterilization techniques should eliminate them. “Should” being the operative word. However, a lot of other infections cannot be easily detected. A lot aren’t even identified.  Neither are a whole host of immune factors. The explosion of autoimmune diseases a year or ten later will be startling, and devastating.

Caution is warranted.

Sam

All of this is seriously overblown.  Fresh-frozen plasma (FFP) is very commonly administered for a range of conditions, including the many causes of hemorrhage.  Serious reactions are rare, transmission of pathogens is very rare, and I've never heard of a late autoimmune reaction.  Risks from such therapy is minuscule compared to the risk of Covid infection in high-risk individuals.

Plasma is as carefully screened for pathogens as are whole blood transfusions.  Transmission of pathogens is very rare.

As for A/B/O blood type incompatibility, this concern is also overblown.  First, it's easy to test before infusion.  Second, reactions from such incompatibility are usually mild.

"Because plasma contains ABO antibodies, ideally, fresh-frozen plasma should be of the same ABO type as the recipient. If ABO type-specific plasma is not available, plasma of a different ABO group may be used as long as it does not have high titers of anti-A or anti-B."
https://www.sciencedirect.com/topics/medicine-and-dentistry/fresh-frozen-plasma

[Archimid]

If the plasma is proven effective, as I hope it will, it is very likely worth the risks.

The risks:

Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion associated circulatory overload (TACO) was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion related acute lung injury (TRALI/possible TRALI), anaphylactic, and hypotensive reactions were noted in 0.08%, 0.02%, and 0.02% of transfusion episodes. Minor reactions, including febrile non-hemolytic and allergic, were noted in 0.62% and 0.29% of transfusion episodes, with 30–50% reported to the transfusion service.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559198/

[Sam]

I think governments should be implementing plasma transfusions programs really hard. This is not a revolutionary treatment but it is most likely a viable treatment.  Plasma transfusions is old medicine fraught with dangers, but antibodies are antibodies. C19 antibodies will lower the viral load in many patients.

 The problem is that the rest of the antibodies a person has will be included with the plasma, and they will also react with the recipient. A good crossmatch should avoid most adverse reactions but there are a lot of dangers inherent to blood transfusion.

Be careful what you wish for. That is how the Hep C pandemic came about - the largest single catastrophe of allopathic disease transmission known.

An explosion of Hep C, Hep B, and a dozen other diseases could result. Most of those can be detected via screening. And standard sterilization techniques should eliminate them. “Should” being the operative word. However, a lot of other infections cannot be easily detected. A lot aren’t even identified.  Neither are a whole host of immune factors. The explosion of autoimmune diseases a year or ten later will be startling, and devastating.

Caution is warranted.

Sam

All of this is seriously overblown.  Fresh-frozen plasma (FFP) is very commonly administered for a range of conditions, including the many causes of hemorrhage.  Serious reactions are rare, transmission of pathogens is very rare, and I've never heard of a late autoimmune reaction.  Risks from such therapy is minuscule compared to the risk of Covid infection in high-risk individuals.

Plasma is as carefully screened for pathogens as are whole blood transfusions.  Transmission of pathogens is very rare.

As for A/B/O blood type incompatibility, this concern is also overblown.  First, it's easy to test before infusion.  Second, reactions from such incompatibility are usually mild.

"Because plasma contains ABO antibodies, ideally, fresh-frozen plasma should be of the same ABO type as the recipient. If ABO type-specific plasma is not available, plasma of a different ABO group may be used as long as it does not have high titers of anti-A or anti-B."
https://www.sciencedirect.com/topics/medicine-and-dentistry/fresh-frozen-plasma

Unfortunately - not overblown - in my case. I have an underlying autoimmune disease that has left me with a hyperactive immune system. I am doubly weak D, and weak e through a very unusual antigen, as well as Co(a+b+). For whole blood transfusion, fatal transfusion reaction is a distinct likelihood. I seem to also have an unusual HNA. It is not something I am willing to gamble with given any alternative.

Broad use of plasma (IF IT ACTUALLY WORKS TO TRIGGER AN IMMUNE RESPONSE) makes possible sense in patients with COVID. Doing so willy nilly in those without the virus risks unnecessary injuries.

In the case of Hep C, the physicians thought they knew what they were doing. They didn't. The result was millions of cases of Hep C that then propagated world wide, through IV drug use, sexual contact and for 30% of cases - no known mechanism of transfer.

In the 1950s and 1960s, millions of people were inoculated with Polio vaccine that unknown to those who developed it was contaminated with Simian Virus 40. I lost friends to that. They died of brain cancers in their 40s. I am in that cohort. And I may well have received the tainted vaccine. I likely did. If I did, I was lucky. I survived it.

Blood is complex. There are myriad factors involved that we do know. And there are myriad factors that we do not know. Blood transfusions are routine, as are plasma, platelets and other factors. These have been tremendous in their saving of lives. They have also cost lives in the process because of things we did not know.

There are many unknowns involved. Jumping to answers can be quite dangerous. Caution is in order.

That said, for those with serious illness from COVID the calculus is quite different. The risk is worth taking. For the general population, NO.

Sam

[SteveMDFP]

If the plasma is proven effective, as I hope it will, it is very likely worth the risks.

The risks:

Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion associated circulatory overload (TACO) was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion related acute lung injury (TRALI/possible TRALI), anaphylactic, and hypotensive reactions were noted in 0.08%, 0.02%, and 0.02% of transfusion episodes. Minor reactions, including febrile non-hemolytic and allergic, were noted in 0.62% and 0.29% of transfusion episodes, with 30–50% reported to the transfusion service.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559198/

I really don't mean to be rude, but I don't think you understand this article.  The article is discussing "blood transfusions."  A plasma transfusion is *very* different.  No red blood cells, nor white blood cells, are transfused.  A plasma infusion is far, far safer.

Now, if you can find an article showing the hazards of fresh-frozen plasma, that would be relevant.