Covid 19 Sci/med discussions only

[WillBrink]

Appreciate the heads-up and also appreciate your contributions to the thread.

Thanx. As the OP, as a science writer, as someone who is trying to stay on top of what's happening, as someone who is trying to supply what I think/hope is the relevant intel to share in hopes it gets shared/used by the med pros out there, I feel it's my duty to supply what I can at this time.

Right now, I think rapid sharing of relevant info will save lives.

[Adrenaline_6]

Thanx. As the OP, as a science writer, as someone who is trying to stay on top of what's happening, as someone who is trying to supply what I think/hope is the relevant intel to share in hopes it gets shared/used by the med pros out there, I feel it's my duty to supply what I can at this time.

Right now, I think rapid sharing of relevant info will save lives.

I really appreciate what you are doing Will, but the powers that be aren't even listening to other medical pros that don't goose step with their same thinking. Keep at it though.

[WillBrink]

A heady one, but very interesting read I thought. A lot to unpack there but suggest again, good host GSH status may directly impact severity of disease:

Specific to my prior and ongoing stressing of the importance oxidative stress with Covid, a highly targeted discussion on how oxidative stress may play a role in severity of disease via ACE receptors and enzymes:

Impact of Thiol-Disulfide Balance on the Binding of Covid-19 Spike Protein with
Angiotensin Converting Enzyme 2 Receptor

https://www.biorxiv.org/content/10.1...05.07.083147v2


" Under oxidative stress, the extracellular environment becomes oxidation-prone
resulting more disulfide formation on protein surfaces.12 Therefore, under severe oxidative stress,
the cell surface receptor ACE2 and RBD of the intruding viral spike protein are likely to be
present in its oxidized form having predominantly disulfide linkages. This computational study
shows that under oxidative stress, the lack of reducing environment would result in significantly
favorable binding of the viral protein on the cell surface ACE2."

[ramairthree]

This was as of April 17th.

Attachment 62306

The whole purpose of social distancing was to slow the virus' spread down enough to let hospitals build resources: PPE, beds, ventilators, etc. The plan worked.

In the first few weeks after implementing social distancing, the ICU at my fiancee's hospital was completely full with COVID-19 patients, and the PICU (which had been converted into another COVID-19 ICU) was completely full.

That had never happened in the 5+ years she had worked there. The 2017 flu season was a joke, by comparison. Eventually, the social distancing measures that were put into place stabilized this situation.

She has seen 20-40 year-old patients with strokes that are typically only seen in 75+ year-olds. Is this rare? Yes. Do some of those patients have underlying conditions or comorbidities like high blood pressure? Yes. But there is still a lot we're learning about this virus.

And we're going to find out a lot more when we open things back up.

It is very unusual for a hospital that has an ICU to have never been full in the past five years.
But she has seen a bunch of young people with strokes when the distribution of that is exceptionally rare.

Typical ICUs are at near near capacity all the time and hospitals frequently go over during surge months.
Many other viruses kill a small number of young, healthy patients.
Many other viruses cause myocarditis and cardiac output issues.
ARDS and ventilator associated lung injury are not specific to corona.
Coagulation disorders in severe
disease are not specific to corona.
When looking at the raw data, it does seem to do this at two to three times the rate of influenza. But, say, in Italy, where they don’t normally go full court press like they do here, let alone autopsies, - they are finding these in that category of patient. But they never looked pre corona at that category. There is an underlying rate we can’t subtract to truly compare. Here in the states we literally have 400 pound 40 year olds with a large saddle embolus, or a 27 year old 330 pound smoker that just had a baby last week. Exactly the patients already high risk for it and show up with them pre corona. It makes it hard to pin down how much can be blamed on corona and how much is sensationalism.

The flu is no joke. In the modern antibiotic era and era capable of doing significant fluid resuscitation for large numbers of patient, we have had outbreaks kill 100k Americans when the population was only 175 million and 200 million Americans. And it did not even really register on the national consciousness let alone shut down the country. They literally went to Woodstock during it. Depending on year and season it has burned through many a nursing home.

There has been a surge of sensationalism associated with this that is off the charts. Fear, panic, political agendas, desires for fame, etc. It’s a mess. Plus there seems to be some component of people with little lives and little accomplishment involved with nothing of significant import wanting to be swept up in something historical, life changing, important, exciting, etc. Sort of a disease related and expensive version of rescuing cats, virtue signaling, etc.

When looking at recent data from NYC, half the people suspected of it test negative.
And the data lines up well with my 85% minor, 15% significant, 20% of those admitted, 20% of admitted on Vent once you get down to the half tested positive. Again, half the patients they thought had corona did not.

https://www.annemergmed.com/article/...353-X/abstract

As for your death data, we know patients with short term terminal illnesses, and untested people with symptoms that might be corona are being counted. Regarding your graph, this literally includes that were about to die whether or not they had corona or not, and based on the above data possibly half the untested people they thought had corona did not. I don’t want to use the CDC for the week you graphed yet, I would like to wait about another four weeks for any lag in under reporting. I predicted the majority of deaths would be from populations statistically going to be part of the deaths even without corona, then a left shift of about a third above baseline as it took some a little early, then drop back down to and below normal a bit because some of the baseline would have died early. The numbers are actually below that now, again I expect some lag.

https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

The February numbers should be good already. And each week in February saw the exact same or less deaths as would have been expected based on the past several years. And the same with March until the very end where we see a spike. And into April, but not quite as high as I expected (133%). And then it should be a plateau period and go down. But again, I would like another month to let the mid April numbers settle in.

And the same high risk populations are still high risk. And the virus is still here. Despite a literal 50 million or so per death spent and that’s just the down payment. Out long term payment plan is brutally worse.

Nothing we are seeing from this virus is a new, unheard of medical concept not seen in other diseases. It’s propensity for some of these know things may be higher, but that is pretty murky to look at because we are missing a lot of the baseline data. So, When a hundred 80 year old Italians with a bunch of medical problems died of pneumonia last year, they did not get a full court press, level of testing, level of care, and autopsies like they did this year. So we don’t know what the baseline, non COVID pattern is compared to what they found when they did it this year. The public is also not familiar with the background rate by age and medical problems of people showing up with strokes, heart failure, and pulmonary emboli pre-C19 vs now. The real data is in these comparisons.

The flu can be pretty brutal. Corona is worse than a typical or good flu year. It seems to be on par with or worse than a modern era brutal flu year. Having corona is not a death sentence for the vast majority of people. The vast majority of people that will die from it are of advanced age, and/or have severe medical issues that made them statistically and actuarily going to die at about the same time or a little later than if they did not have it. There is also a viscous circle where the people that are at high risk for a severe corona infection, are at high risk for the severe corona complications, and independently without a corona infection, are more likely to present with those processes. If your basic age and medical condition and overall health make you high risk for heart failure, a stroke, a pulmonary embolism, etc. you are a person at high risk for a severe corona infection and at high risk for these complications with it.

And the harshest reality of it is, instead of focusing on the outliers and prophylactic measures to conserve critical medical resources, -
We have largely saved or delayed the deaths of the very advanced aged, those significantly affected by medical problems, etc. that largely make up the extremely net negative SS, SSDI, medicare, and Medicaid population that have negative impact on tax revenue and work related productivity. Instead of putting women and children first and young men to row and care for them on the Titanic life boats, we threw them overboard or left them on a sinking ship to put elderly and sick people on them.

The virus is inevitably going to do its thing and make its rounds and exact its toll. Slowing its rounds and minimizing its toll came with a down payment of tens of millions If not over 100 million dollars per life saved or, in most cases, slightly delayed. We have been bombarded with news presenting a sensationalized, fear mongering, panic inducing, fame seeking, and sometimes extreme agenda pursuing goal. Try to settle down and take a more measured look.

[WillBrink]

I really appreciate what you are doing Will, but the powers that be aren't even listening to other medical pros that don't goose step with their same thinking. Keep at it though.

I appreciate the support. There are people listening out there who are actively using such info to save lives, even if the powers that by mostly have their head up their a$$. We must fight the good fight or die trying.

[ABNAK]

It is very unusual for a hospital that has an ICU to have never been full in the past five years.
But she has seen a bunch of young people with strokes when the distribution of that is exceptionally rare.

Typical ICUs are at near near capacity all the time and hospitals frequently go over during surge months.
Many other viruses kill a small number of young, healthy patients.
Many other viruses cause myocarditis and cardiac output issues.
ARDS and ventilator associated lung injury are not specific to corona.
Coagulation disorders in severe
disease are not specific to corona.
When looking at the raw data, it does seem to do this at two to three times the rate of influenza. But, say, in Italy, where they don’t normally go full court press like they do here, let alone autopsies, - they are finding these in that category of patient. But they never looked pre corona at that category. There is an underlying rate we can’t subtract to truly compare. Here in the states we literally have 400 pound 40 year olds with a large saddle embolus, or a 27 year old 330 pound smoker that just had a baby last week. Exactly the patients already high risk for it and show up with them pre corona. It makes it hard to pin down how much can be blamed on corona and how much is sensationalism.

The flu is no joke. In the modern antibiotic era and era capable of doing significant fluid resuscitation for large numbers of patient, we have had outbreaks kill 100k Americans when the population was only 175 million and 200 million Americans. And it did not even really register on the national consciousness let alone shut down the country. They literally went to Woodstock during it. Depending on year and season it has burned through many a nursing home.

There has been a surge of sensationalism associated with this that is off the charts. Fear, panic, political agendas, desires for fame, etc. It’s a mess. Plus there seems to be some component of people with little lives and little accomplishment involved with nothing of significant import wanting to be swept up in something historical, life changing, important, exciting, etc. Sort of a disease related and expensive version of rescuing cats, virtue signaling, etc.

When looking at recent data from NYC, half the people suspected of it test negative.
And the data lines up well with my 85% minor, 15% significant, 20% of those admitted, 20% of admitted on Vent once you get down to the half tested positive. Again, half the patients they thought had corona did not.

https://www.annemergmed.com/article/...353-X/abstract

As for your death data, we know patients with short term terminal illnesses, and untested people with symptoms that might be corona are being counted. Regarding your graph, this literally includes that were about to die whether or not they had corona or not, and based on the above data possibly half the untested people they thought had corona did not. I don’t want to use the CDC for the week you graphed yet, I would like to wait about another four weeks for any lag in under reporting. I predicted the majority of deaths would be from populations statistically going to be part of the deaths even without corona, then a left shift of about a third above baseline as it took some a little early, then drop back down to and below normal a bit because some of the baseline would have died early. The numbers are actually below that now, again I expect some lag.

https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

The February numbers should be good already. And each week in February saw the exact same or less deaths as would have been expected based on the past several years. And the same with March until the very end where we see a spike. And into April, but not quite as high as I expected (133%). And then it should be a plateau period and go down. But again, I would like another month to let the mid April numbers settle in.

And the same high risk populations are still high risk. And the virus is still here. Despite a literal 50 million or so per death spent and that’s just the down payment. Out long term payment plan is brutally worse.

Nothing we are seeing from this virus is a new, unheard of medical concept not seen in other diseases. It’s propensity for some of these know things may be higher, but that is pretty murky to look at because we are missing a lot of the baseline data. So, When a hundred 80 year old Italians with a bunch of medical problems died of pneumonia last year, they did not get a full court press, level of testing, level of care, and autopsies like they did this year. So we don’t know what the baseline, non COVID pattern is compared to what they found when they did it this year. The public is also not familiar with the background rate by age and medical problems of people showing up with strokes, heart failure, and pulmonary emboli pre-C19 vs now. The real data is in these comparisons.

The flu can be pretty brutal. Corona is worse than a typical or good flu year. It seems to be on par with or worse than a modern era brutal flu year. Having corona is not a death sentence for the vast majority of people. The vast majority of people that will die from it are of advanced age, and/or have severe medical issues that made them statistically and actuarily going to die at about the same time or a little later than if they did not have it. There is also a viscous circle where the people that are at high risk for a severe corona infection, are at high risk for the severe corona complications, and independently without a corona infection, are more likely to present with those processes. If your basic age and medical condition and overall health make you high risk for heart failure, a stroke, a pulmonary embolism, etc. you are a person at high risk for a severe corona infection and at high risk for these complications with it.

And the harshest reality of it is, instead of focusing on the outliers and prophylactic measures to conserve critical medical resources, -
We have largely saved or delayed the deaths of the very advanced aged, those significantly affected by medical problems, etc. that largely make up the extremely net negative SS, SSDI, medicare, and Medicaid population that have negative impact on tax revenue and work related productivity. Instead of putting women and children first and young men to row and care for them on the Titanic life boats, we threw them overboard or left them on a sinking ship to put elderly and sick people on them.

The virus is inevitably going to do its thing and make its rounds and exact its toll. Slowing its rounds and minimizing its toll came with a down payment of tens of millions If not over 100 million dollars per life saved or, in most cases, slightly delayed. We have been bombarded with news presenting a sensationalized, fear mongering, panic inducing, fame seeking, and sometimes extreme agenda pursuing goal. Try to settle down and take a more measured look.

It is not Captain Trips, the Plague, or 1918 all over again, no doubt about it. It seems to suck a little bit more than the average flu though.

The following two quotes you make kind of dovetails with something you said earlier in this thread, basically to the effect of "....it seems to be engineered to be more of a pain in the ass".

When looking at the raw data, it does seem to do this at two to three times the rate of influenza.

It’s propensity for some of these know things may be higher..."


I think this has ChiCom fingerprints all over it, even if it was accidentally released.

[ramairthree]

It is not Captain Trips, the Plague, or 1918 all over again, no doubt about it. It seems to suck a little bit more than the average flu though.

The following two quotes you make kind of dovetails with something you said earlier in this thread, basically to the effect of "....it seems to be engineered to be more of a pain in the ass".

When looking at the raw data, it does seem to do this at two to three times the rate of influenza.

It’s propensity for some of these know things may be higher..."


I think this has ChiCom fingerprints all over it, even if it was accidentally released.

I don’t want to sound too tinfoil. This could all be natural antigenic drift and shit.

But...
If I wanted to make a virus that scared the shit out of people, freaked people out, but at they end if the day if I got caught be able to say “Come on man, the same number or less of 3 million people that were going to die any way this year” after everyone was at each other’s throats and spent a ton of money and threw things into horrible short term disarray and longer term issues coming... it would be hard to come up with anything better.

Also, if I wanted to cut losses on elderly nursing home cumbersome and expensive to care for populations, medical train wrecks, and portions of society using a disproportionate amount of social, medical, etc, resources, - this would be very effective in the type of country that’s just going to sit back and watch.

I never could wrap my mind over all the initial panic and sensationalism. I posted on here or elsewhere asking what was up and what was I missing. The initial information and patterns were not at all in line with a big one,

It was never going to be a Spanish Flu event.

In the era of antibiotics, IV therapy that has developed since this, plus a hospital system of over 6,000 facilities capable of over 35,000,000 admissions a year, we were looking at 60k to 600k deaths. Virtually all from elderly and patients with significant medical problems statistically and actuarially that would have died at about the same time or a few months later. In 1918 there were about 600 “hospitals” in America, over which 85% were rudimentary and not capable of even the most basic accreditation concepts of the era.

In 1918 - 1919 there were about 100 million people in America, and about 600,000 died. If they had at least the hospital system, IV therapy capabilities, and antibiotics available since about 1950 or so, the majority of those would have likely lived.

Around 1958, in this more modern medical era, including an only semi effective vaccine, the Asian flu killed about 80,000 of a US population of about 175,000,000.

Ten years later, Hong Kong Flu killed about 100,000 Americans when the population was about 200,000,000. And no regular people I talk to that were old enough to drive or be married, work etc. then seem to have any significant recollection of it.

And again, we are counting deaths like - 50 year old with failed bone marrow transplant on hospice with no white blood cells, hemoglobin of 3, hematocrit of 9, and 7 platelets as corona deaths....
the Hong Kong Flu numbers and impact were more legit.

What changed to make that an unnoticed blip on athe American consciousness with zero societal impact or change to what we have with Corona?

[AKDoug]

Ten years later, Hong Kong Flu killed about 100,000 Americans when the population was about 200,000,000. And no regular people I talk to that were old enough to drive or be married, work etc. then seem to have any significant recollection of it.

I was born in 1969. My parents had been married for 5 years at that point. In 1968 and 1969 they moved a total of 5 times as my dad chased employment up and down the west coast. I was born in California while my dad worked with my grandfather as a painter. We went back to Washington 6 weeks later. Neither of my parents, who are both in excellent mental and physical health, can recall a single thing about that flu year.

[Averageman]

Good Info here, it's less than an hour old.

[ramairthree]

These guys used later data than I did, similar limitations with estimating all infected based on asymptomatic, not symptomatic enough to seek care, etc. so they used symptomatic fatality data to come up with 500k deaths if we had not shut down, and the 100-200k Fauci / White House numbers given at the end of March with the drastic measures to be fairly consistent.

https://www.healthaffairs.org/doi/pd...aff.2020.00455

Did the drastic measures we have taken save, say, 350,000 people? But we know many were already terminal and near death from baseline medical issues. And we know that in NYC and a few other states counting COVID like symptoms as presumed COVID is actually not COVID about have the time from other data. Did we do the right thing? e.g. we just dumped 2 to 4.7 trillion dollars into this up front, was about 10,000,000 in the short term per potential life saved/death short term delayed the way to go? With long term prospects making that essentially a 20% down payment and 80% of the long term costs yet to be reckoned with.


This is a basic look at the thought process of medicines, testing, treatment in uncharted waters. Too many people seem to have a television show/movie plot concept of this, which leads to pretty unrealistic expectations.

https://www.statnews.com/2020/05/11/...desivir-study/

This goes into the basics of what I said about post infection immunity about a month ago. i.e. it’s complicated, not guaranteed, and we won’t know for sure for a while.

https://jamanetwork.com/journals/jam...rticle/2766097

I am in regular contact with a few dozen emergency medicine physicians and handful of intensivists and handful of Hospitalists. I don’t have a single answer for why, but corona is brutal on the obese. I don’t mean the former natural PT stud SF combat diver that is now middle aged with a bear belly or the guy that blew out his knee and also had shoulder surgery and has put on 30 pounds around his waist in the past five years. These guys may have been BMI 25-30 and “overweight” to start but were actually pretty rugged and in good health and working out. Now they are BMI 30-35 and “obese”. These guys aren’t really the ones at risk. They are more out of shape and not working out as much and likely still eating like they’re still an young action guy. But these BMI of 35-40 that were never in shape and not a lot of lean body mass are at increased risk. And the morbidly obese 40 and up types are getting intubated at levels way off the charts. Anecdotally, about half the intubated patients are obese. And chalk up most of the younger patients. In at least one study, 90% of the morbidly obese patients were intubated.

For starters, they have way more diabetes, CAD, Heart failure, renal issues, peripheral vascular disease, pulmonary emboli, strokes, etc. Independent from that,
The sheer amount of fat makes its more work to breath. They have a higher oxygen demand. They have a more likely to get out of hand immune system. They have a higher baseline of inflammatory issues. Getting sick on top of that baseline....
Again, not specific or unique to corona.