Coronavirus Crisis: Main Thread

[JackRiddler]

Suggestion to mods: maybe we can close this thread until fall?

?

Pourquoi?

[0_0]

because staying at home and saving lives seems to have gone out of the window for now with summer coming up

[norton ash]

Because it's half-time and there are big shows going on everywhere.

[stickdog99]

https://www.sciencemag.org/news/2020/06 ... unraveling

On its face, it was a major finding: Antimalarial drugs touted by the White House as possible COVID-19 treatments looked to be not just ineffective, but downright deadly. A study published on 22 May in The Lancet used hospital records procured by a little-known data analytics company called Surgisphere to conclude that coronavirus patients taking chloroquine or hydroxychloroquine were more likely to show an irregular heart rhythm—a known side effect thought to be rare—and were more likely to die in the hospital.

Within days, some large randomized trials of the drugs—the type that might prove or disprove the retrospective study’s analysis—screeched to a halt. Solidarity, the World Health Organization’s (WHO’s) megatrial of potential COVID-19 treatments, paused recruitment into its hydroxychloroquine arm, for example. (Update: At a briefing on 3 June WHO announced it would resume that arm of the study.)

But just as quickly, the Lancet results have begun to unravel—and Surgisphere, which provided patient data for two other high-profile COVID-19 papers, has come under withering online scrutiny from researchers and amateur sleuths. They have pointed out many red flags in the Lancet paper, including the astonishing number of patients involved and details about their demographics and prescribed dosing that seem implausible. “It began to stretch and stretch and stretch credulity,” says Nicholas White, a malaria researcher at Mahidol University in Bangkok.

Today, The Lancet issued an Expression of Concern (EOC) saying “important scientific questions have been raised about data” in the paper and noting that “an independent audit of the provenance and validity of the data has been commissioned by the authors not affiliated with Surgisphere and is ongoing, with results expected very shortly.”

Hours earlier, The New England Journal of Medicine (NEJM) issued its own EOC about a second study using Surgisphere data, published on 1 May. The paper reported that taking certain blood pressure drugs including angiotensin-converting enzyme (ACE) inhibitors didn’t appear to increase the risk of death among COVID-19 patients, as some researchers had suggested. (Several studies analyzing other groups of COVID-19 patients support the NEJM results.) “Recently, substantive concerns have been raised about the quality of the information in that database,” an NEJM statement noted. “We have asked the authors to provide evidence that the data are reliable.”

A third COVID-19 study using Surgisphere data has also drawn fire. In a preprint first posted in early April, Surgisphere founder and CEO Sapan Desai and co-authors conclude that ivermectin, an antiparasitic drug, dramatically reduced mortality in COVID-19 patients. In Latin America, where ivermectin is widely available, that study has led government officials to authorize the drug—although with precautions—creating a surge in demand in several countries.

Chicago-based Surgisphere has not publicly released the data underlying the studies, but today Desai told Science through a spokesperson that he was “arranging a nondisclosure agreement that will provide the authors of the NEJM paper with the data access requested by NEJM.”

Meanwhile, the questions swirling around the Lancet paper have left leaders of the halted chloroquine trials weighing whether to restart. “The problem is, we are left with all the damage that has been done,” says White, a co-investigator on a trial of hydroxychloroquine for COVID-19 prevention that was halted at the request of U.K. regulators last week. Headlines proclaiming deadly effects will make it hard to recruit patients to key studies, he says. “The whole world thinks now that these drugs are poisonous.”

more ...

Chaccour says both NEJM and The Lancet should have scrutinized the provenance of Surgisphere’s data more closely before publishing the studies. “Here we are in the middle of a pandemic with hundreds of thousands of deaths, and the two most prestigious medical journals have failed us,” he says.

[stickdog99]

https://www.biorxiv.org/content/10.1101 ... 1.full.pdf

Abstract: In a side-by-side comparison of evolutionary dynamics between the 2019/2020 SARSCoV-2 and the 2003 SARS-CoV, we were surprised to find that SARS-CoV-2 resembles SARSCoV in the late phase of the 2003 epidemic after SARS-CoV had developed several advantageous adaptations for human transmission. Our observations suggest that by the time SARS-CoV-2 was first detected in late 2019, it was already pre-adapted to human transmission to an extent similar to late epidemic SARS-CoV. However, no precursors or branches of evolution stemming from a less human-adapted SARS-CoV-2-like virus have been detected. The sudden appearance of a highly infectious SARS-CoV-2 presents a major cause for concern that should motivate stronger international efforts to identify the source and prevent near future reemergence.

Any existing pools of SARS-CoV-2 progenitors would be particularly dangerous if similarly well adapted for human transmission. To look for clues regarding intermediate hosts, we analyze recent key findings relating to how SARS-CoV-2 could have evolved and adapted for human transmission, and examine the environmental samples from the Wuhan Huanan seafood market. Importantly, the market samples are genetically identical to human SARS-CoV-2 isolates and were therefore most likely from human sources. We conclude by describing and advocating for measured and effective approaches implemented in the 2002-2004 SARS outbreaks to identify lingering population(s) of progenitor virus.

[stickdog99]

[0_0]

New York City reports first day with no confirmed coronavirus deaths since March 11

https://www.cnbc.com/2020/06/05/new-york-city-reports-first-day-with-no-confirmed-coronavirus-deaths-since-march-11.html

[0_0]

Look guys, the scientific consensus is clear on this:

As public health advocates, we do not condemn demonstrations that call attention to the pervasive lethal force of white supremacy as risky for COVID-19 transmission (...) This should not be confused with a permissive stance on all gatherings, particularly protests against stay-home orders.

https://whdh.com/news/over-1000-health-professionals-sign-a-letter-saying-dont-shut-down-protests-using-coronavirus-concerns-as-an-excuse/

That's presumably why:

Residents of Contra Costa County, Calif. are forbidden from hosting anything more than "small outdoor social gatherings," but they are allowed to gather in "protests of up to 100," according to new coronavirus health rules promulgated this week.

https://justthenews.com/politics-policy/coronavirus/california-county-only-permits-small-outdoor-social-gatherings-allows

[cptmarginal]

https://www.biorxiv.org/content/10.1101/2020.05.01.073262v1.full.pdf

Abstract: In a side-by-side comparison of evolutionary dynamics between the 2019/2020 SARSCoV-2 and the 2003 SARS-CoV, we were surprised to find that SARS-CoV-2 resembles SARSCoV in the late phase of the 2003 epidemic after SARS-CoV had developed several advantageous adaptations for human transmission. Our observations suggest that by the time SARS-CoV-2 was first detected in late 2019, it was already pre-adapted to human transmission to an extent similar to late epidemic SARS-CoV. However, no precursors or branches of evolution stemming from a less human-adapted SARS-CoV-2-like virus have been detected. The sudden appearance of a highly infectious SARS-CoV-2 presents a major cause for concern that should motivate stronger international efforts to identify the source and prevent near future reemergence.

Any existing pools of SARS-CoV-2 progenitors would be particularly dangerous if similarly well adapted for human transmission. To look for clues regarding intermediate hosts, we analyze recent key findings relating to how SARS-CoV-2 could have evolved and adapted for human transmission, and examine the environmental samples from the Wuhan Huanan seafood market. Importantly, the market samples are genetically identical to human SARS-CoV-2 isolates and were therefore most likely from human sources. We conclude by describing and advocating for measured and effective approaches implemented in the 2002-2004 SARS outbreaks to identify lingering population(s) of progenitor virus.

I think I saw this before but didn't look at the paper. Very interesting; reading it now...

[Belligerent Savant]

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[Belligerent Savant]

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[0_0]

I am not a medical professional or even terribly well-educated medically or biologically. But I know many people who are, some of whose politics are very similar to those of us here. And uniformly they agree this is a serious fucking mess that COVID is going to kill a lot of black americans, other poor people working retail and alot of the elderly.

I do think the class detest (neigh genocide FAIAP) and 1% exceptionalism it enables is disgusting.
I do think way too many people are going to be harmed and die unnecessarily.
I do think big medical is profiting.
I do the think the rich are getting richer.
I do think Gates et al are sickening opportunuists.
I do think COVID is being *used* dramatically

But ....

This:

The masks are a visual way to spread fear in everyday life and imo are also very symbolic: to keep your mouth shut.

I find hair-pullingly frustrating to read on RI.

I wear a mask as a measure of common decency because I spend alot of time in neighborhoods where high risk people live. And my mouth is anyting but shut. I've written letters to my local editor and spoken to endless people.

If Americans had worn masks uniformly from the get go - and to be frank, they didn't do so because our asshole authorities didn't want to mass produce them - there would likely be no pandemic. So, great to link wearing a fucking mask-that-you-can-absolutely-still-speak-through to repression but ironically it's non-use was also one of the very critical mechanisms for creating the whole current mess.

I don't see it going both ways.

Please, please, please, please wear masks if you are, like most of us, in a place where there is reported community transmission.

Many people are vulnerable to the virus. You may be a carrier and not know it.

This is just as true as lockdown etc is destroying lives of the vulnerable independently of the illness.

If in 1-2 years, new evidence really vindicates your muzzle statement, I'll be the first to apologize.

good news:

Asymptomatic spread of coronavirus is 'very rare,' WHO says
PUBLISHED MON, JUN 8 2020
William Feuer & Noah Higgins-Dunn

KEY POINTS
Government responses should focus on detecting and isolating infected people with symptoms, the World Health Organization said.
Preliminary evidence from the earliest outbreaks indicated the virus could spread even if people didn't have symptoms.
But the WHO says that while asymptomatic spread can occur, it is "very rare."

Coronavirus patients without symptoms aren't driving the spread of the virus, World Health Organization officials said Monday, casting doubt on concerns by some researchers that the disease could be difficult to contain due to asymptomatic infections.

Some people, particularly young and otherwise healthy individuals, who are infected by the coronavirus never develop symptoms or only develop mild symptoms. Others might not develop symptoms until days after they were actually infected.

Preliminary evidence from the earliest outbreaks indicated that the virus could spread from person-to-person contact, even if the carrier didn't have symptoms. But WHO officials now say that while asymptomatic spread can occur, it is not the main way it's being transmitted.

"From the data we have, it still seems to be rare that an asymptomatic person actually transmits onward to a secondary individual," Dr. Maria Van Kerkhove, head of WHO's emerging diseases and zoonosis unit, said at a news briefing from the United Nations agency's Geneva headquarters. "It's very rare."

Government responses should focus on detecting and isolating infected people with symptoms, and tracking anyone who might have come into contact with them, Van Kerkhove said. She acknowledged that some studies have indicated asymptomatic or presymptomatic spread in nursing homes and in household settings.

More research and data are needed to "truly answer" the question of whether the coronavirus can spread widely through asymptomatic carriers, Van Kerkhove added.

"We have a number of reports from countries who are doing very detailed contact tracing," she said. "They're following asymptomatic cases. They're following contacts. And they're not finding secondary transmission onward. It's very rare."

If asymptomatic spread proves to not be a main driver of coronavirus transmission, the policy implications could be tremendous. A report from the U.S. Centers for Disease Control and Prevention published on April 1 cited the "potential for presymptomatic transmission" as a reason for the importance of social distancing.

"These findings also suggest that to control the pandemic, it might not be enough for only persons with symptoms to limit their contact with others because persons without symptoms might transmit infection," the CDC study said.

To be sure, asymptomatic and presymptomatic spread of the virus appears to still be happening, Van Kerkhove said but remains rare. That finding has important implications for how to screen for the virus and limit its spread.

"What we really want to be focused on is following the symptomatic cases," Van Kerkhove said. "If we actually followed all of the symptomatic cases, isolated those cases, followed the contacts and quarantined those contacts, we would drastically reduce" the outbreak.

not my words, but the words of WHO source: https://www.cnbc.com/amp/2020/06/08/asy ... ie8l25w3sA

[JackRiddler]

Seattle coronavirus survivor gets a $1.1 million, 181-page hospital bill

Health care workers applaud Michael Flor upon his release from Swedish Issaquah last month Pushing the wheelchair is Dr. Anne Lipke, Flor’s critical care doctor. (Ken Lambert / The Seattle Times)

Danny Westneat By Danny Westneat
Seattle Times columnist

June 12, 2020 at 4:53 pm
Updated June 12, 2020 at 6:55 pm
https://www.seattletimes.com/seattle-ne ... ital-bill/


Remember Michael Flor, the longest-hospitalized COVID-19 patient who, when he unexpectedly did not die, was jokingly dubbed “the miracle child?”

Now they can also call him the million-dollar baby.

Flor, 70, who came so close to death in the spring that a night-shift nurse held a phone to his ear while his wife and kids said their final goodbyes, is recovering nicely these days at his home in West Seattle. But he says his heart almost failed a second time when he got the bill from his health care odyssey the other day.

“I opened it and said ‘holy [bleep]!’ “ Flor says.

The total tab for his bout with the coronavirus: $1.1 million. $1,122,501.04, to be exact. All in one bill that’s more like a book because it runs to 181 pages.

Michael Flor battled with coronavirus for 62 days at Swedish Issaquah. His stay makes him the longest coronavirus patient at a Swedish hospital. (Ramon Dompor / The Seattle Times)

The bill is technically an explanation of charges, and because Flor has insurance including Medicare, he won’t have to pay the vast majority of it. In fact because he had COVID-19, and not a different disease, he might not have to pay anything — a quirk of this situation I’ll get to in a minute.

But for now it’s got him and his family and friends marveling at the extreme expense, and bizarre economics, of American health care.

Flor was in Swedish Medical Center in Issaquah with COVID-19 for 62 days, so he knew the bill would be a doozy. He was unconscious for much of his stay, but once near the beginning his wife Elisa Del Rosario remembers him waking up and saying: “You gotta get me out of here, we can’t afford this.”

Just the charge for his room in the intensive care unit was billed at $9,736 per day. Due to the contagious nature of the virus, the room was sealed and could only be entered by medical workers wearing plastic suits and headgear. For 42 days he was in this isolation chamber, for a total charged cost of $408,912.

He also was on a mechanical ventilator for 29 days, with the use of the machine billed at $2,835 per day, for a total of $82,215. About a quarter of the bill is drug costs.

The list of charges indirectly tells the story of Flor’s battle. For the two days when his heart, kidneys and lungs were all failing and he was nearest death, the bill runs for 20 pages and totals nearly $100,000 as doctors “were throwing everything at me they could think of,” Flor says.

In all, there are nearly 3,000 itemized charges, about 50 per day. Usually hospitals get paid only a portion of the amount they bill, as most have negotiated discounts with insurance companies. The charges don’t include the two weeks of recuperating he did in a rehab facility.

Going through it all, Flor said he was surprised at his own reaction. Which was guilt.

“I feel guilty about surviving,” he says. “There’s a sense of ‘why me?’ Why did I deserve all this? Looking at the incredible cost of it all definitely adds to that survivor’s guilt.”

There also are special financial rules that apply only to COVID-19. Congress set aside more than $100 billion to help hospitals and insurance companies defray the costs of the pandemic, in part to encourage people to seek testing and treatment (including those with no insurance). As a result, Flor probably won’t have to pay even his Medicare Advantage policy’s out-of-pocket charges, which could have amounted to $6,000.

The insurance industry has estimated treatment costs just for COVID-19 could top $500 billion, however, so Congress is being asked to step up with more money.

The writer David Lat got a $320,000 bill for his COVID-19 treatment, and also ended up paying nothing. Yet he heard from dozens of cancer and leukemia patients who have been hit with big bills or co-pays during this same time period.

It’s like we’re doing an experiment for what universal health coverage might be like, but confining it to only this one illness.

“Suffering from the novel coronavirus as opposed to cancer shouldn’t make a difference in terms of your financial burden,” Lat wrote, in Slate. “What you pay as a patient shouldn’t depend, in essence, on whether your disease has a good publicist.”

Flor said he’s hyper-aware that somebody is paying his million-dollar bill — taxpayers, other insurance customers and so on. “Fears of socialism” have always stopped us from guaranteeing full health care for everyone, he said. But there’s also the gold-plated costs here, twice as expensive per capita as anywhere else in the world.

“It was a million bucks to save my life, and of course I’d say that’s money well-spent,” he says. “But I also know I might be the only one saying that.”

Danny Westneat: dwestneat@seattletimes.com; Danny Westneat takes an opinionated look at the Puget Sound region's news, people and politics.

[JackRiddler]

(Accidentally posted something meant for another thread here, which caused WRex's comment, below. Have meanwhile moved it to its rightful place, here.)

[Wombaticus Rex]

^^Wrong thread or what? Grateful for the read, though.

I don't think closing this thread is a good idea because things have already been heating up again for two weeks and the roller coaster will only continue to accelerate from here as we lurch through Summer and into The Big One. Anecdotally, almost everyone I have made small talk with since May has been a fountain of giddy relief that "things are getting back to normal," which would be more dizzying if I wasn't already decades into living with cognitive dissonance & overall alienation every day.

People think they're informed simply because they're consumers, simply because they have IV drips of video or text content to sell them the sensation of situational awareness. And invariably they're blindsided, shocked, by every new development in the real world. There is no solution to this, only acceptance and/or monetization. Human nature won't change, an easy bet since it hasn't.

The two most important variables for Summer 2020, near as I can ken, are the extent of seasonal variation and the political calculus of Lockdown II: Reloaded. Clearly, seasonal variation isn't going to save us from a summer outbreak, but surely it will exist to some extent. Even if SARS2 is some kind of bioweapon variant engineered for sheer virulence, it's still subject to mutation in the wild, and it's still subject to the same basic physics of transmission I was jabbering about back in March.

So, the summer re-opening wave -- our second of three in 2020, Earth is a bountiful planet full of wonder -- is going to be shaped more by human behavior than the kind of nightmare math that was driving the initial wildfire from November through February. And, you know, humans are dumb as shit, especially in bulk.

Globally, international travel will be re-opening at scale, and this will drive novel outbreaks. More locally to the United States (and our useless peanut gallery to the North) there's been endless criticism of our fat, lazy and burger-centric President, but he's never driven the response at any point. I've shared this link too much already, but read it: the actual responsibilities -- and resources! -- are attuned to the state level.

The closures and the re-openings have been driven by governors, not by the current actor in the West Wing. All of them are coming to grips, at varying rates of speed and apprehension, with the brick wall they're hurtling towards as their revenues dwindle to nothing just as another fiscal years looms ahead. The Federal Government will bail them out, but inefficiently and too late -- such is their specialty, after all. So, they have to make hard, dumb choices.

That's all inevitable, set in stone, less a prediction than a description of where we are now. The really interesting variable, again, is how coordinated the next lockdown will be, and how much political appetite there is to lose an election by saving millions of lives. I don't have high hopes on either account but hope to be wrong. We have seen attempts at regional coordination, we have also seen them fall by the wayside due to the constraints of elections: every governor is only accountable to their own voters and they have to comport themselves as the sovereign leaders of their own states.

I'm interested to see how public polling shakes out, I know there are some big sample / detailed question projects going right now. I suspect that a lot of Americans will be opposed to another lockdown, especially during the beautiful days of July and August. There's an informed minority who have been taking this seriously all along, surely, but they're taking care of their own no matter what their governor is selling to the cheap seats.

It's not so much that "you either understand the risk or you don't" -- more accurate to say that you either understand the risk or you can't. This whole arc has been a very clear unmasking of who can understand exponential functions and who cannot. And, that latter category is most people, period.

And a lot of them vote.