COVID-19

[JohnRoberts]

The nursing homes are a fast emerging scandal here now too , Gov,mnt claim its private enterprise so are trying to wash their hands of the situation , somewhere around half of all deaths related to the virus are in the care home setting . PPE wasnt made available to staff early enough and proper guidance wasnt  provided by the health authority . The reality is this whole care home idea needs overhauling , small self contained living spaces with on site medical staff and centralised food prep ,community based might be a plan.

One of the few good things to emerge from this pandemic (after the fact) will be a more rigorous regulation of old age care (and I am not a fan of increased government regulation but private industry really screwed the pooch this time.) I think something close to 50% of the deaths in the US are likewise in or related to such elderly care facilities.

In the future it will be more expensive to be old and secure assisted care. 

Maybe robots could help? I think Japan has experimented with that to some degree.


JR

 

[cyrano]

That's where  you'd expect the most deaths, no? After all, that's where people are sent to die...

Over here we're topping the charts. Now it surfaced that every death in these homes was reported as caused by Corona. Obviously, it isn't.

In one home, 75% of staff and 75% of the residents tested positive. Yet, there aren't more deaths than in other homes.

 

[ruairioflaherty]

One of the few good things to emerge from this pandemic (after the fact) will be a more rigorous regulation of old age care (and I am not a fan of increased government regulation but private industry really screwed the pooch this time.) I think something close to 50% of the deaths in the US are likewise in or related to such elderly care facilities.

In the future it will be more expensive to be old and secure assisted care. 

Maybe robots could help? I think Japan has experimented with that to some degree.


JR

Robots won't help.  The problem is flawed incentives, like so much of U.S. healthcare.

When the price of a month or year in care is fixed, the incentive to drive down costs and hence quality of care is powerful.  Absent "anti-business" regulation and oversight this will not change.

Would a care home CEO mistreat an older patient in person? Of course not....but in the abstract it's just a number on a spreadsheet. 

Make poor quality care worse for the bottom line than good quality care (fines, oversight, regulation), until then nothing changes.


edit: typos

 

[Whoops]

I'm a bit scared with the situation Brazil at the moment.
One of the biggest countries in the world, they have 200 million people and really poor hospital conditions and coverage.

The President refuses to accept the dangers of a quick wide spread, and now fired the Health Minister who was asking people to stay at home.

"Bolsonaro’s health minister, whom the president appears to be freezing out of his deliberations, warned last week that the country’s health-care system “will collapse” by the end of April from a surge of COVID-19 patients."

Even Trump looks normal next to this guy:
"Nicknamed the “Trump of the Tropics,” Bolsonaro has sought to emulate the American president’s right-wing populist-nationalism since launching his bid for the presidency in 2018. But compared with Bolsonaro’s position on the coronavirus pandemic, Donald Trump’s approach looks sober and scientifically grounded."

Some favorite quotes:

"He’s described the illness as a “little flu,” a trifling “cold.”

"He’s argued that while he may be 65, he wouldn’t be at serious risk even if he were to become infected, because of his “history as an athlete."

"Bolsonaro asserted that Brazilians “never catch anything,” even when they dive into “sewage,” and that they may have already developed the “antibodies” to stop the virus’s spread."

https://www.theatlantic.com/politics/archive/2020/03/bolsonaro-coronavirus-denial-brazil-trump/608926/

 

[Whoops]

Would a care home CEO mistreat and older patient in person? Of course not....but in the abstract it's just a number on a spreadsheet. 

Definitely.

Market, Profit, Corporations and Shareholders none care about People Care.

They make profit in a Country
That Country has to regulate them

 

[cyrano]

Well, you know who helped Bolsonaro in the saddle, don't you?

 

[Bo Deadly]

The academic journal Nature (and Science) is where scientists try to publish their articles. Normally this is the peer-reviewed, typeset in latex with lots of tables and symbology stuff that the average person would find incomprehensible. But some of the web articles are highly accessible and no doubt much more accurate than the dumbed down stuff you'll find on the usual mainstream media sites.

Here are my TLDR reviews of two such articles about coronavirus / COVID-19 / SARS-CoV-2:

Will antibody tests for the coronavirus really change everything?
https://www.nature.com/articles/d41586-020-01115-z

Current antibody test kits are not particularly accurate. They detect antibodies, not live virus so it can take a week or two for even a good kit the test to show decent "sensitivity". There are many test kits being developed and sold right now but it's not clear if any are actually accurate enough to be useful. There needs to be trials with hundreds of known infected / not-infected to determine if an antibody kit is accurate. Early studies indicate antibody kit sensitivity can be as low as 40-60%. Normally they have to be 99% to be considered useful. A bad test is actually worse than no test at all. Emergency approvals have been granted for use of the kits but they're not supposed to be used as the sole basis for confirmation of an infection. Antibody test kits can return false positives because of coronaviruses other than SARS-Cov-2. It may be possible for some individuals to have "binding" antibodies but not develop the "neutralizing" antibodies that give someone longer-term immunity. Meaning even though they test positive for antibodies, they could get it again and be carriers. So far there have not been any documented instances where someone has been re-infected with SARS-Cov-2 (although there have been instances where someone tests positive after recovering, such instances are generally thought to be false-positives such as because of remnants of dead virus particles).

[Personal aside: After some time, protective immunity for respiratory illnesses wears off because the site of infection is in the lungs which are actually on the outside of your body and so those cells have poor contact with the antibodies in your blood inside the body. However, perhaps the body will still have some vague memory of the infection and "take the edge off" of a subsequent infection. One of the main things that makes coronavirus so rough for some people is because they have not had it before. If you imagine an alternate reality where someone had had it say 10 years ago, that previous exposure might give the body just enough protection to "take the edge off" of the virus and people could fair much better. This is wild speculation on my part though.]

Antibody tests suggest that coronavirus infections vastly exceed official counts
https://www.nature.com/articles/d41586-020-01095-0

Although antibody tests are known to be somewhat unreliable (see above), there are numerous ongoing "sero-prevalence surveys" that test largish groups of people to gauge the actual level of infection in an area. Currently, people are only tested if they show signs of infection. Because most people do not develop the requisite signs of infection, the actual level of infection in an area is going to be quite a bit higher than the number of official cases confirmed by conventional PCR tests.

In early April, 3,300 people in Santa Clara, CA where tested for antibodies and they found that around 1 in 66 had antibodies for SARS-Cov-2. They guestimated that between 48,000 and 82,000 people had the virus out of 2 million in the county when official numbers at the time were only 1,000. So thats 50x. Meaning if you have 1,000 cases officially in your area, it could easily be more like 50,000.

[Personal aside: Consider that the primary reliability issue with the antibody test kits is that their sensitivity is low. Meaning a failed test is more likely to be a false-negative than a false-positive (largely because it can take 2 weeks for the antibodies to develop enough for the test kit to see it). So that 50x could be a lot higher still.]

When you use this information to compute the infection fatality rate (IFR) you get between 0.1% and 0.9%.

[Personal aside: Revised mortality is still not great given the scope of people that are vulnerable but it is good news considering we've never had SARS-CoV-2 before. Once we have had it, that number can only go lower. It might become seasonal but it won't spread freely like it is now because many people will have some immunity to it.]

Results from other sero-prevalence surveys around the world are going to be released soon.

 

[JohnRoberts]

I have long used UVc light to kill microbes but UVc (around 250nm wavelength) is harmful to humans kind of like sunlight (don't stare at the sun).  Reportedly during the Spanish flu pandemic over a century ago, they didn't have modern medical tools, one clinic had good results moving the patients outdoors and exposing them to sunlight.  Some try to correlate the sun exposure to vit D. It may be simpler with UV light killing microbes, or both vit d and natural disinfection.

I have recently heard/read  about a shorter wavelength far UV (222nm) that is apparently still harmful to microbes but not to humans. This means protective UV lamps could be used more widely to decontaminate living spaces and even human foot traffic entering workspaces.

It appears that 222nm lamps are in short supply for some reason.  :

JR 

PS: Looks like somebody read my mind and built one into a toilet seat 

 

[Whoops]

Well, you know who helped Bolsonaro in the saddle, don't you?

Of course, the same person who is responsible for denying for a long time the upcoming problem and the same person who is responsible for 2000  people dying from Covid everyday at present in the US, Donald Trump

 

[Whoops]

The present time asks for a profound reflection and for future organizational improvements.

 

[crazydoc]

In early April, 3,300 people in Santa Clara, CA where tested for antibodies and they found that around 1 in 66 had antibodies for SARS-Cov-2. They guestimated that between 48,000 and 82,000 people had the virus out of 2 million in the county when official numbers at the time were only 1,000. So thats 50x. Meaning if you have 1,000 cases officially in your area, it could easily be more like 50,000.

Of potential concern to me is the specificity of the test used. Apparently there is significant cross reactivity with the SARS-Cov-2 spike protein and that of other coronaviruses, so unless the test used was highly specific for SARS-Cov-2, many of these people may have had coronavirus colds in the past, which would overestimate the number of Covid-19 cases..

There is a lot hanging on the uniqueness of the spike protein. In terms of the specificity of serological tests in which it is used, the more unique it is, the lower the odds of cross-reactivity with other coronaviruses—false positives resulting from immunity to other coronaviruses. The most similar of these is severe acute respiratory syndrome coronavirus (SARS-CoV), which led to the SARS outbreak of 2002. But another four coronaviruses cause the common cold, and ensuring there is no cross-reactivity to these is essential. “If you line up the amino acids of the spike proteins of SARS and the COVID-19 virus, there's a 75% identity”, says Lewis. Hibberd reckons the overall figure for common cold-causing coronaviruses is probably about 50–60%, but the potential for cross-reactivity really depends on whether the new tests select sections of the spike protein that are particularly distinct across coronaviruses. Even though SARS cases were recorded in only a handful of countries, many antibody test developers—Euroimmun, Koopmans, and Wang among them—are working to demonstrate the absence of cross-reactivity of the new tests with SARS-CoV or other coronaviruses.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30788-1/fulltext

No mention of the specificity of the test used, though they say the sensitivity is underestimated.

The range of results also reflects uncertainty in both test sensitivity (how good it is at correctly identifying COVID-19 antibodies) and test specificity (how likely it is to produce a false positive). Researchers relied on tests manufactured by the Minnesota-based company Premier Biotech, rather than the newly developed serological test by Stanford, which has been used to test health care workers.

Bendavid told this news organization earlier this week that the tests were chosen because they are very easy to use (they produce a line reading similar to a pregnancy test) and produce results within 15 minutes. They are, however, less precise than laboratory-based tests and give you an underestimate of how many people have coronavirus – a shortcoming that was factored in the study.

https://paloaltoonline.com/news/2020/04/17/stanford-study-more-than-48000-santa-clara-county-residents-have-likely-been-infected-by-coronavirus

I don't think any real conclusions can be drawn until the test has been tested. 

 

[Bo Deadly]

Yes, the accuracy of the antibody kits can be unreliable. That's what the first article I posted to was all about. But, the second article about the Santa Clara sero-prevalence study states that they performed two separate assessments (albeit one unpublished and both very small sample sizes) of the effectiveness of the Premier Biotech "finger-prick" kit and found that, while it did fail to capture some positives, it actually didn't produce a single false negative. So that would suggest that the results are actually conservative.

 

[crazydoc]

Yes, the accuracy of the antibody kits can be unreliable. That's what the first article I posted to was all about. But, the second article about the Santa Clara sero-prevalence study states that they performed two separate assessments (albeit one unpublished and both very small sample sizes) of the effectiveness of the Premier Biotech "finger-prick" kit and found that, while it did fail to capture some positives, it actually didn't produce a single false negative. So that would suggest that the results are actually conservative.

But no mention of false positives, which is what I was getting at regarding the cross-reactivity with other coronaviruses. If there were a large number of them from other coronavirus URI's (colds), that would suggest the results are overblown. That's why these antibody tests that are proliferating need to be quantitatively checked for sensitivity and specificity to be able to estimate the possible errors in the results. Apparently the FDA is unable to do this in a timely manner, and again, a bad test is probably worse than no test at all.

And to my knowledge none of the tests are able to differentiate between neutralizing antibodies or other noneffective antibodies to the virus, so even though someone has a positive antibody test, we don't know if it confers some degree of immunity.  But the Stanford study is encouraging if it turns out there are a large number of people that were infected with SARS-Cov-2 and didn't get sick.

On the whole, Wang finds it too early to say what the role of antibodies is for SARS-CoV-2. “We have no idea if production of antibodies during a primary infection, for example, has any role in clearing virus during that infection, or for that matter, we don’t have any good data on whether antibodies produced during an infection are protective against a second infection,” she says. And even if they were protective, they may not be protective for everyone. “Antibody responses can vary tremendously from person to person.”

https://www.the-scientist.com/news-opinion/what-do-antibody-tests-for-sars-cov-2-tell-us-about-immunity--67425

 

[kambo]

while it did fail to capture some positives, it actually didn't produce a single false negative. So that would suggest that the results are actually conservative.

my understanding on these tests, either u get + or - not both!
if u r failing to to capture positive;  which results in negative right!
which is false negative  ???
so, do you mean, it didnt produce single false positive ?
did any of the tests produce false positive ?
: ???

 

[Bo Deadly]

But no mention of false positives, which is what I was getting at regarding the cross-reactivity with other coronaviruses.

That's not how I read it. The article reads:

"The researchers involved in the Santa Clara study say that they assessed the sensitivity and specificity of the antibody tests they used — a relatively cheap finger-prick kit developed by Premier Biotech, a biotechnology company based in Minneapolis, Minnesota — in an initial 37 positive samples and 30 negative controls. The tests identified 68% of the positive samples and 100% of the negatives. An unpublished follow-up assessment in 30 positive and 88 negative controls found that the test correctly identified 28 positives and all 88 negatives, says Bendavid."

So it got 68% of the positives and 100% of the negatives and in the other it got 28 of 30 positives and 88 of 88 negatives. Meaning it did not identify a negative as a positive which is to say no false positives.

And to my knowledge none of the tests are able to differentiate between neutralizing antibodies or other noneffective antibodies to the virus, so even though someone has a positive antibody test, we don't know if it confers some degree of immunity.

Technically true. But if this virus is like every other virus known to man you do get immunity. Obviously most people develop some immunity or they would never recover! The're just leaving room for the possibility of some outliers.

 

[Bo Deadly]

my understanding on these tests, either u get + or - not both!

You misunderstand. The "assessement" used control groups. So they used people they knew had it and knew did not. So there are four possible outcomes: true negative, true positive, false negative and false positive. You want to get all true negative and true positive. They got a small number of false negative and no false positive.

 

[crazydoc]

That's not how I read it. The article reads:

"The researchers involved in the Santa Clara study say that they assessed the sensitivity and specificity of the antibody tests they used — a relatively cheap finger-prick kit developed by Premier Biotech, a biotechnology company based in Minneapolis, Minnesota — in an initial 37 positive samples and 30 negative controls. The tests identified 68% of the positive samples and 100% of the negatives. An unpublished follow-up assessment in 30 positive and 88 negative controls found that the test correctly identified 28 positives and all 88 negatives, says Bendavid."

So it got 68% of the positives and 100% of the negatives and in the other it got 28 of 30 positives and 88 of 88 negatives. Meaning it did not identify a negative as a positive which is to say no false positives.

You're right - I went to the published study  https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1.full.pdf and read their methods, so if the kit's manufacturer's data are correct, and if the 30 hip-replacement Stanford patients who were used for pre-covid negative controls were a good representation of the population studied, then it looks like there is good specificity.

But if this virus is like every other virus known to man you do get immunity.

Like HIV?

Also:
Speaking in Geneva, the World Health Organization's (WHO) Dr Maria van Kerkhove cast doubt on the benefit of rapid serology tests due to a lack of evidence around coronavirus immunity.

She said: "There are a lot of countries that are suggesting using rapid diagnostic serological tests to be able to capture what they think will be a measure of immunity.

"Right now, we have no evidence that the use of a serological test can show that an individual has immunity or is protected from reinfection."

She added: "These antibody tests will be able to measure that level of seroprevalence - that level of antibodies but that does not mean that somebody with antibodies means that they are immune."

https://www.bbc.co.uk/news/uk-52335210

There still seem to be lots of questions regarding immunity to SARS-Cov-2, and they will eventually be sorted out, and likely there will be significant immunity to it, at least in its present mutation.

 

[Bo Deadly]

Like HIV?

True. So there is one virus that we don't have immunity to. You got me there.

But HIV is unique because it specifically targets immune system. I'm not aware of any viruses other than HIV that target the immune system. There might be but I've never heard of one.

 

[Whoops]

Can look at it many different ways.....??

Definitely, that's really important and your points are important also, thanks

You can also see it that in terms of a Public and Free Health systems the US is at the same level has Mauritania, Mali, Nigeria, Chad, Sudan, Somalia, Angola and Mozambique.

So yes different ways to reflect about the Future.

 

[Whoops]

MASKS

Some weeks ago we discussed here the use of masks and if they offered any level of protection.
At the time WHO was discouraging the use of masks outside medical professionals and saying the masks didn't offer any protection for common population.

Well that was just a big lie, the only reason for WHO to discourage the use of mask was to protect the existing stock of masks for Hospitals, and definitely there was a shortage and it would have been much bigger if everyone bought masks.

Now some countries, like mine, are preparing to remove progressively the lockdown measures so that economy starts rolling again.
One of the first measures is the Recommendation,  and maybe soon mandatory, of the use of masks by everyone.
Government cites the examples of China and Macao (like other Asian countries), were the use of mask is enforced by law, as an example of the importance of the use of masks for protecting others and to protect yourself.

Well China and Macao  were already an example of the use of masks 1 month and 2 months ago...



Wearing a mask properly, and this is important for it's efficiency,  has to be learned.
People have also to know what masks to use and not to use, for example simple surgical masks are the least effective.
Making respirator masks at home or by cloths or textiles companies is possible.

It was clear to me since the beginning, and I wrote here before, that off course the use of masks by everyone would offer more protection than people not wearing it.
If everyone on a supermarket uses masks, you are protected by 2 masks, the mask you use but more importantly the mask other use, it's a double level of protection that will reduce by some small percentage your risk of getting infected. "Small" but impotant nonetheless.

So I would like to leave here somo information on masks that I think will be important for the next months, maybe year, were we will have to live with the virus around us:

Good video on the importance of using a mask and how to sew one:

https://www.youtube.com/watch?time_continue=119&v=q8GwjVihGj4&feature=emb_logo

How to Wear a Cloth Face Covering

1) fit snugly but comfortably against the side of the face
2) be secured with ties or ear loops
3) After fitting the mask don't touch it any longer. Just touch it to remove it at home by the ear loops
4) allow for breathing without restriction

include multiple layers of fabric, be able to be laundered and machine dried without damage or change to shape