Coronavirus Pandemic (COVID-19) (SARS-CoV-2) [2020]

Cases in Texas are exploding.

Total cases through May 31st was only 64,287, Total cases for the month of June was: 94,223
The month of June alone was 146.6% more than all the cases before June 1st.


Last seven day's case increases are 10,351, 9,765, 9,782, 9,979, 10,028, 5,318, 3,449

First day that cases exceeded 2000 was June 10th.
First day that cases exceeded 3000 was June 17th.
First day that cases exceeded 4000 was June 20th.
First day that cases exceeded 5000 was June 23th.
First day that cases exceeded 6000 was June 30th.
First day that cases exceeded 7000 was July 1st.
First day that cases exceeded 8000 was July 1st.
First day that cases exceeded 9000 was July 7th.
First day that cases exceeded 10000 was July 7th.


The numbers of cases in Texas for each week since June 1, 2020 are :

June 1-7 : Total Cases 10,691 - Average of 1,527 per day
June 8-14 : Total Cases 12,876 - Average of 1,839 per day - 20% higher than the previous week
June 15-21 : Total Cases 22,271 - Average of 3,182 per day - 73% higher than the previous week
June 22-28 : Total Cases 37,127 - Average of 5,304 per day - 67% higher than the previous week
June 29-July 5 : Total Cases 46,511 - Average of 6,644 per day - 25% higher than the previous week
July 6-11: Total Cases 55,223 - Average of 9,204 per day - 39% higher than the previous week - Only six days for the week so far
 
Good podcast.


Since the beginning of the Coronavirus pandemic, Pulitzer Prize-winning science writer Laurie Garrett has been the most blunt and forthright analyst warning the public about how destructive the virus will be. She has been sounding the alarm on our lack of preparedness for a pandemic since her 1994 book, "The Coming Plague." Her warnings were not heeded. The United States has now bungled it's response and we are hitting record-high numbers of new cases. She joins Michael for a discussion about all aspects of the pandemic, including the disastrous decisions by President Trump and President Xi, what myths have persisted about the virus, whether schools might open in the fall, why the economic impact has not yet reached bottom, and the social and psychological effects we will be dealing with for many years. We need to hear the unvarnished truth if we are going to find our way out of this. Garrett says we should call this what it is, a plague, and she offers a way out should anyone want to listen.
 
Same of the latest estimates suggest 0.5-1% mortality rate, which is still 5-10x flu. However there are also nasty side effects and the blood-clotting that the virus causes also causes strokes, heart and brain, with sometimes severe long lasting or permanent effects and disability.
Diseases often have complications, but are these on a large scale, or a tiny fraction of outliers?

More importantly, the number of people needing respirators must stay under the capacity of medical staff and equipment, or the death toll starts rising quickly, as was seen in Italy. This is what the lockdown must do.
Indeed. But if lockdown is having other massive social impacts and isn't tenable for more long periods, then the degree of management perhaps should be herd immunity, controlling the rate of spread but not fearing the vast majority of people being infected. Present lockdown is at the rate of trying to stop the disease altogether, and that's not going to continue as lockdowns are eased.

Is a matter of risk assessment really. We have a list of possible risks. Then we have to determine the likelihood and where the best response lies.

Furthermore, critically we do not know if people even get properly immune after infection or for how long (Corona viruses can mutate very quickly which is one of the reasons the common cold is so persistent.)
Until there's real reason to think otherwise, it should be taken that this disease will work the same as every other pathogen based disease, especially within the same family. Memory T-cells will develop which will have a faster and more effective disease response than the new-disease untrained response.

We see exactly this in tribes of humans who have been isolated deep in jungles. First contact can result in up to 50% dying from basic respiratory infections, contracted from people who are seemingly perfectly well. Once the species has adapted to the new pathogen, it loses its edge. That mortality is pushed down from 50% to more like 0.1%, and is generally localised to certain demographics.

I think you can say that regardless of what happens, countries that acted with the right response at the right time (ie as soon as possible) all look to come out of this mess a lot better than those that didn’t.
Regards the disease, yes, those who acted fastest got the best results regards disease impact. We had no better information and quick, solid lockdowns was the right decision. The economic situation is a harder one to call at this point. And here's where it gets tricky, because the social and economic pressure is for a return to normal to fix that damage, but the disease is far from passed. Should a country go into lockdown for another few months until a vaccine is produced, or should we accept more infections that could be avoided through more stringent protections because the cost of lockdowns outweighs the wins in saved lives?

The scale of impact is key to making the right choice here, and the antibody results so far indicate the disease is far less impactful than initial fears.
 
Nothing. isolate.

And if you are dying and not recovering; go to the hospital.
And if you are asked to take HCQ or other experimental treatments, it’s up to you.
IMHO doing nothing is not acceptable.

The protocol developed using HCQ-AZ or other antiviral drugs requires treatment as early as possible in the virus replication phase.
If someone is in the risk group then should look for treatment as early as possible.
The treatment is complex and need to be done early and initially in a hospital environment (exams, anamnesis, etc..) for definition of the treatment for the specific pacient´s case.

Also Medicine scholars here teach that randomized tests are not needed when:
- there is a statistically significative diference between possible outcomes
- the possible outcome is of high severity
- the outcome could happen in a short period of time
- the treatment is applied during a short period of time
- the lack of randomized tests
- the lack of options available

The use of antiviral drugs early (virus replication phase and early inflamation phase) is followed by corticoids (inflamation phase) and eventually anticoagulants (advanced inflamation phase and ICU) is part of a treatment protocol that reduced fatalities to less than 2% recently in Spain.

The doctor Marina Bucar Barjud works in Madri, Spain and is Science Coordinator of the Saragoza University´s Hospital.
Interview (portuguese language).
 
IMHO doing nothing is not acceptable.

The protocol developed using HCQ-AZ or other antiviral drugs requires treatment as early as possible in the virus replication phase.
If someone is in the risk group then should look for treatment as early as possible.
The treatment is complex and need to be done early and initially in a hospital environment (exams, anamnesis, etc..) for definition of the treatment for the specific pacient´s case.
I agree something should be done. Where we differ is our approach.

I know that there is currently no cure for COVID-19. Treatments are being made entirely on the fly by anyone, whomever is willing to try. There are all sorts of treatments and HCQ is just one of them. It is currently the Wild West or treatments and people are willing to sign up for anything on their death beds, doctors are desperate to reduce the number of deaths and find something that works.

There are 3 things that I know are needed to make a cure:
A) funding
B) resources/talent
C) patients that can trial the vaccines

I don’t know all the treatments, I don’t know which experimental anti viral drugs or vaccines that are available, but I do know this:
If I take 1 Drug or treatment I cannot take another. Treatments are likely to interfere with each other and we don’t know mixing 2 experimental solutions could result in death.

Onto the main point:
You are already convinced that HCQ works. So much so that it has become your only solution as soon as you get infected. You are ready to take it.

but I could get infected and another doctor who has had success with say steroids and anti inflammatory/ anti coagulant drugs. Maybe there is an antiviral based on COVID and not malaria.

there are a slew of treatments that are available but often not advertised. I know this because there are a great deal of many people suffering from a great number of ailments and diseases and cancers etc.

so if a doctor is prescribing me that, but I’ve already decided on HCQ well that’s a problem because that other drug could also save my life.

So I don’t like supporting the HCQ argument until it’s solid because I don’t want funding and resources and patients to go there when nothing is proven; I want them to go towards real solutions and that also involves a lot of trial and error. And all I see at this moment with HCQ is that some people will get better, it’s no where close to a guarantee for survival, but it’s a guarantee that somebody will get extremely wealthy on prescribing malaria drugs To quite frankly uncharted territory for this world for the first time ever.
 
I think the HCQ question will be answered by places like Brazil dishing them out as a preventative, not based on a real scientific basis (confirmed trial), but a plausible scientific notion, some empirical evidence, and a limit to what solutions are available to them.

Potentially someone could run a trial looking into HCQ at the earliest phase. I guess we ought to avoid overlooking this option in pursuit of other options, but I think Science is trying to 'move on' now. It didn't help that the drug was over-stated at first and then had catastrophic results in the first tests and non-result in the numerous subsequent tests.

It's difficult really. As pascal says, it's as much the protocol as the drug. The right drug at the wrong time is a fail. You need to find the right drug at the right time, and we need to know that amongst the noise of the many trials in a rather frantic search. On the one hand, we don't want to waste time on dead ends. On the other, we don't want to overlook an easy win that got lost in the noise of ineffective early investigations.
 
I think the HCQ question will be answered by places like Brazil dishing them out as a preventative, not based on a real scientific basis (confirmed trial), but a plausible scientific notion, some empirical evidence, and a limit to what solutions are available to them.

Potentially someone could run a trial looking into HCQ at the earliest phase. I guess we ought to avoid overlooking this option in pursuit of other options, but I think Science is trying to 'move on' now. It didn't help that the drug was over-stated at first and then had catastrophic results in the first tests and non-result in the numerous subsequent tests.

It's difficult really. As pascal says, it's as much the protocol as the drug. The right drug at the wrong time is a fail. You need to find the right drug at the right time, and we need to know that amongst the noise of the many trials in a rather frantic search. On the one hand, we don't want to waste time on dead ends. On the other, we don't want to overlook an easy win that got lost in the noise of ineffective early investigations.
Sure but if you start with HCQ preventative. Then you’ve lost the ability to see the other treatments through.

and therein lies the issues. Many drugs could have a similar preventative effect, they just aren’t marketed.
 
I agree something should be done. Where we differ is our approach.
...
Well, we differ not in approach but vision of the situation.
I am talking about a tatical ad hoc set of protocols to minimize the COVID-19 effects.
You are talking about a final solution/cure.
Both things has to be done/worked simultaneously.

Also having a protocol doesnt mean every doctor has the experience or resources to apply it.
Thinks are complex and that is why we need doctors!!
This is the 5W/1H is so important as the protocol.

HCQ-AZ are both old drugs well know by many doctors´ experience. They kown how to use it, preventions, etc. etc. etc...
Also are cheap and widelly available. I think it is better than prescribe aspirin and oseltamivir.

See the figure that there are other options:covid-19-phases.jpg

Thanks god for the good doctors around the world fighting this pandemic
 
Sure but if you start with HCQ preventative. Then you’ve lost the ability to see the other treatments through.
Yep. There are no perfect solutions. Either somewhere like Brazil chances HCQ and maybe they save millions of lives, or maybe it interferes with other treatments and costs millions of lives, or they don't, and maybe millions of lives that could have been saved by HCQ aren't. But we can't possibly know and the situation is too significant to be cautious and apply proper evaluations. It's like the ad hoc treatments given in hospitals against the first patients before there was any knowledge, only on a global scale. As a doctor, you could only do your best with those first patients based on observations and best guesses. Across thousands of doctors trying their best and pooling their knowledge, better solutions were uncovered and treatment has improved and is improving.

That's the best possible here. Throw shit at the problem and see what sticks. ;) Brazil's going with HCQ as an early treatment - okay, let's see how that pans out. UK has rejected HCQ and is going with Dex - okay, let's see how that pans out.

Edit: I'll add that the only bad move, the dumb one, is to go against evidence. So if HCQ has been shown not to work with those on ICU, don't bother with it. Anyone saying, "it might still work!" is doing harm. The NCQ treatment isn't repeating something already disproven. If it does become disproven, it should be ditched.

Also, if it does work as a preventative, we'll never hear the end of it from Trump.
 
Well, we differ not in approach but vision of the situation.
I am talking about a tatical ad hoc set of protocols to minimize the COVID-19 effects.
You are talking about a final solution/cure.
Both things has to be done/worked simultaneously.

Also having a protocol doesnt mean every doctor has the experience or resources to apply it.
Thinks are complex and that is why we need doctors!!
This is the 5W/1H is so important as the protocol.

HCQ-AZ are both old drugs well know by many doctors´ experience. They kown how to use it, preventions, etc. etc. etc...
Also are cheap and widelly available. I think it is better than prescribe aspirin and oseltamivir.

See the figure that there are other options:View attachment 4276

Thanks god for the good doctors around the world fighting this pandemic
I don’t disagree with leveraging HCQ as a preventative solution. I’m taking about the opportunity cost of using HCQ. There might be better preventative solutions. @Shifty Geezer puts it well, apply it where it works and where it doesn’t it doesn’t. Brasil has banked on HCQ as a preventative solution a choice has been made, whether good or bad I cannot judge nor do I judge. But I caution myself or others from using that decision made as necessarily prescribing HCQ as the best or right solution.

it is a solution and I am happy it appears to somewhat work in specific scenarios - but that doesn’t mean I would rally support behind it until it as a solution is head and shoulders above others.
 
The full set of protocols is here.
Portuguese language.

In Brazil things are confuse because people mixed politics and pandemics.
The worst thing that could happens, but I will not discuss politics details here since it is not a politics forum.

But after some state governors and mayors rejection to almost all Ad Hocs treatment, always saying that Science has not proven anything, they are under extreme pressure and starting to use HCQ-AZ, Ivermectine, and whatever is available.

Also Doctor Badaro (major Infectologist) informed that 40% of deaths are not COVID-19 but are officially counted and suspicious of COVID-19.

Crazy stuff are happening/surfacing.
 
A problem with that chart is the treatments are are grouped under the timeline as one contiguous blob. They should be localised to the phases where they are useful. But I don't know the context of the diagram.
It is a continues blob because the doctor may apply it depending on the situation, specially Remdesivir.

Really complex situation.
 
The worst thing that could happens, but I will not discuss politics details here since it is not a politics forum.
It’s hard for this not to be political, I mean climate change shouldn’t be political either but it is.

Like for myself I talk from a place of safety, my country has very low numbers for COVID, we put in hard measures right away. So generally speaking most people here feel very safe, we have very low daily case numbers for the country. So my opinions come from a place where generally speaking we are open to exploring a great deal of many options to save lives.

but if I were in say Brazil or Texas or Florida, right now you’re probably thinking more about the higher chance you could get COVID and now you are looking for solutions and you’re willing to bank on one at this point in time.

Hope that makes sense.
 
This is some scary stuff.

Dani Oliver

2 days ago, 19 tweets, 5 min read

Hey, so, I got #Covid19 in March. I’ve been sick for over 3 months w/ severe respiratory, cardiovascular & neurological symptoms. I still have a fever. I’ve been incapacitated for nearly a season of my life. It's not enough to not die. You don’t want to live thru this, either. 1/
I am not unique. Support groups have sprung up all over the internet because medical science doesn’t know what to do with the hundreds of thousands of Covid patients who don’t get better in the (utter and complete bullshit, and they know it) CDC guidelines of 2-6 weeks. 2/
The CDC is also refusing to add widely-reported, terrifying symptoms to their lists. So here’s a grab bag of what patients like me are experiencing, so you know: Extreme tachycardia. My heart rate was once 160 while I was sleeping. Chest pain, like someone’s sitting… 3/
...on your sternum. Back and rib pain like someone’s taken a baseball bat to your torso. Fatigue like you’ve never felt before in your life. Fatigue like your body is shutting off. Fatigue so bad that it would often make me cry because I thought it might mean I was dying. 4/
GI problems, diarrhea to severe acid reflux. I had diarrhea every day for two+ months. Unbearable nausea. Also: Inexplicable rashes. For me, little broken blood vessels all over my body. For many of us, a constant shortness of breath that doctors can’t find an explanation for. 5/
Neurological symptoms. I had delirium & hallucinations. Many report tingling all over their body, an internal “buzzing” or “vibrating.” Also, insomnia & chronic hypnic bodily jerks. One symptom so weird that I thought it was just me, but it turns out it’s so many of us… 6/
was waking up in the middle of the night, gasping for breath. I also experienced tremors while trying to sleep, like someone was shaking the bed. Also: many report a “hot head.” Mine literally radiated heat, despite not hitting a high fever. Then, there’s the confusion… 7/
The “brain fog.” I couldn’t read or make sense of text at times. I couldn’t remember words. I’d stare at my partner at a loss for what I needed to communicate, or how to do it. Also: thickening of the blood, clotting. Weird, inexplicable changes to the menstrual cycle. 8/
Everyone knows the lung stuff already, so I won't elaborate. But it doesn’t just go away. I wake up every morning & when I breathe in, it feels like someone is crinkling plastic in my chest. And these are just the symptoms. I’m not even touching the physical damage done… 9/
...to patients’ organs and bodily systems. I’m also not touching the mental component of this, which is compounded by the very virtue of not knowing if it’ll eventually kill you. But long-term covid sufferers all report the same thing: that the recovery is non-linear. 10/
You’ll wake up feeling better and assume, like would be true for the flu or a cold, you’re on the mend. But then... you get worse. & then you're feeling better again! & then you’re bedridden, worse than before. It makes no sense. You start to think you’re losing your grip... 11/
or maybe it’s all in your head. It isn’t. Thousands & thousands are experiencing these cycles. At some point, I realized that this was causing a trauma response in my body, which only seemed to worsen recovery. And I’m someone who’s learned over the years how to tend to... 12/
their mental health needs pretty well. This experience is a whole other ball game. It is terrifying what it did to my mind. There are parts of the experience I am well aware I've blocked out in order to function, and times my partner has to remind me of things I've shut out. 13/
There's so much we don't know — including if these physical damages are permanent or, for some, will lead to chronic illness. But one thing we do know is this isn’t the fucking flu. Those of you taking risks (yes, you in masks, as well), please, please weigh them against... 14/
...experiences like mine. It's not "well, a tiny fraction of people die, and most people are better in two weeks." This is simply untrue. So many of us have suffered for months. Ask yourselves: is going to get a coffee, or getting a haircut worth being debilitatingly ill... 15/
...for 4+ months of your life? Or, is it worth condemning someone else to this experience? Tending to your critical needs (grocery, medicine) is a necessary risk. So is fighting for the lives of others (protesting, organizing). But I promise you, the risk is too great... 16/
...for a birthday party. Or a fucking bar night. Or visiting your fav restaurant. Good lord, I cannot stress this enough. Please. Wear a mask. Stay home as much as you can. And know that the recovery times associated with this illness are wrong. That people are suffering. 17/
If you made it this far, thanks for reading. Please tell others about long-term Covid patients.

The responses to this thread are overwhelming, & so kind, & I'm so sorry if I can't get to your DMs right away. So many people with similar experiences. Check out @edyong209's Atlantic piece, which links to some of the support groups. You are not alone.
COVID-19 Can Last for Several Months
The disease’s “long-haulers” have endured relentless waves of debilitating symptoms—and disbelief from doctors and friends.

https://www.theatlantic.com/health/...-coronavirus-longterm-symptoms-months/612679/
 
I was going to skip a few days on the troublesome states, but the Florida numbers today...

Florida is at 269,811 with +15,300 new cases. Their increase on Saturday was +10,360. They started this surge with only 57,447 cases on June 2, 2020.
Arizona is at 122,467 with +2,537 new cases. Their increase on Saturday was +3,038.
Georgia is at 116,926 with +2,525 new cases. Their increase on Saturday was +3,190.
 
Ohio's testing is at 23.3K for the day.
Ohio is at +1378 new cases, with Cuyahoga County at +229 new cases.
Test Positivity rate is around 5.91% for these new tests.

Here is the trends which is using reported date and not arbitrary and incorrectly identified user reported onset date. This graphic is resized by ~ 75% and taken from the State's Current Trends page: https://coronavirus.ohio.gov/wps/portal/gov/covid-19/dashboards/current-trends

upload_2020-7-12_17-3-56.png

Here is the raw data for the last few days, filling in the limited data that is available:

upload_2020-7-12_17-3-26.png

Code:
Date; Total Tests; New Tests; Tests per 1M Population; Total Cases; Cuyahoga County Cases; Hospitalizations; Total Deaths; New Cases; New Hospitalizations; New Deaths
2020-06-22;    656,318;    16,327;    56,148;    45,537;    5,734;    7,292;    2,704;    729;    50;    4
2020-06-23;    667,077;    10,759;    57,069;    46,127;    5,820;    7,379;    2,735;    590;    87;    31
2020-06-24;    680,687;    13,610;    58,233;    46,759;    5,964;    7,447;    2,755;    632;    68;    20
2020-06-25;    696,200;    15,513;    59,560;    47,651;    6,111;    7,502;    2,772;    892;    55;    17
2020-06-26;    718,086;    21,886;    61,433;    48,638;    6,287;    7,570;    2,788;    987;    68;    16
2020-06-27;    741,353;    23,267;    63,423;    49,455;    6,429;    7,624;    2,804;    817;    54;    16
2020-06-28;    753,246;    11,893;    64,441;    50,309;    6,571;    7,681;    2,807;    854;    57;    3
2020-06-29;    770,860;    17,614;    65,947;    51,046;    6,694;    7,746;    2,818;    737;    65;    11
2020-06-30;    784,362;    13,502;    67,103;    51,789;    6,831;    7,839;    2,863;    743;    93;    45
2020-07-01;    788,403;    4,041;    67,448;    52,865;    7,013;    7,911;    2,876;    1,076;    72;    13
2020-07-02*;    789,704;    1,301;    67,560;    54,166;    7,013;    8,038;    2,886;    1,301;    127;    10
2020-07-03*;    824,481;    34,777;    70,535; 55,257;    7,392;    8,084;    2,903;    1,091;    46;    17
2020-07-04;    844,675;    20,194;    72,262;    56,183;    7,571;    8,111;    2,907;    926;    27;    4
2020-07-05;    865,069;    20,394;    74,007;    57,151;    7,724;    8,172;    2,911;    968;    61;    4
2020-07-06;    877,688;    12,619;    75,087;    57,956;    7,883;    8,249;    2,927;    805;    77;    16
2020-07-07;    892,731;    15,043;    76,374;    58,904;    8,048;    8,383;    2,970;    948;    134;    43
2020-07-08;    911,905;    19,174;    78,014;    60,181;    8,277;    8,489;    2,991;    1,277;    106;    21
2020-07-09;    931,834;    19,929;    79,719;    61,331;    8,518;    8,570;    3,006;    1,150;    81;    15
2020-07-10;    955,697;    23,863;    81,760;    62,856;    8,786;    8,701;    3,032;    1,525;    131;    26
2020-07-11;    979,149;    23,452;    83,767;    64,214;    8,979;    8,770;    3,036;    1,358;    69;    4
2020-07-12;    1,002,463;    23,314;    85,761;    65,592;    9,208;    8,842;    3,058;    1,378;    72;    22
 
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