Author Topic: The science of COVID-19  (Read 49281 times)

Offline biobook

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Re: The science of COVID-19
« Reply #340 on: June 30, 2020, 01:36:01 PM »

@biobook as I said
I would be very interested in the latest from Griffin.
Wow! Incredible! Thanks so much for nudging me to listen.  I can't believe I've wasted all these hours on DDF when I could have been wasting them on TWIV!

Offline S209

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Re: The science of COVID-19
« Reply #341 on: June 30, 2020, 01:46:26 PM »
Wow! Incredible! Thanks so much for nudging me to listen.  I can't believe I've wasted all these hours on DDF when I could have been wasting them on TWIV!
Sarcasm? Enlighten us peasants
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Offline ExGingi

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Re: The science of COVID-19
« Reply #342 on: June 30, 2020, 02:18:10 PM »
OK I gave you 5 likes. Happy now?

Back in the day we would feed likes to our kids. Nowadays we just feed them cereal with Blue Milk.
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Re: The science of COVID-19
« Reply #343 on: June 30, 2020, 02:37:01 PM »
Back in the day we would feed likes to our kids. Nowadays we just feed them Rice Chex with Blue Milk.
FTFY
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Offline biobook

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Re: The science of COVID-19
« Reply #344 on: June 30, 2020, 02:51:34 PM »
Is anyone here following TWiV (This Week in Virology https://www.microbe.tv/twiv/) podcast? I saw it mentioned on Twitter as having some good info, but there are several chapters and they are all quite long, so I was wondering if anyone has good info synthesized from the podcast.
It's a 2-hour podcast, which includes interviews with scientists and health professionals.  A frequent visitor is Dr Daniel Griffin who meets both criteria, as a PhD and MD.  In podcast #632 from June 28, he gave an update on how the clinical picture has changed. Here are the notes I took, can't guarantee accuracy. In general he's optimistic, your chance of surviving covid are much better now than if you had gotten it in March. What has changed since then:
  • Testing.  Lots of tests now, but not as much as needed for opening up safely, which would require testing and contact tracing.  Ironically, with the surge in the south, there are now problems again with accessing enough swabs. You can't really get a test whenever you want, even in some hospitals there's a 24-hour turnaround.
  • Better understand the clinical course, and how different complications seem to appear at different times - wk 2- respiratory issues, wk 3- clotting issues, wk 4- post-viral bacterial infections
  • Treatment.  Know value of pulse oximeters, to keep tabs on patients. Better idea of which lab tests to do, to catch problems before they appear. Chest xrays help decide which small subset of patients (about 10%) need antibiotics. High flow oxygen, bipap, cpap are better than ventilators. Putting the patient in prone position is better for patient but worse for health care workers who risk more infection that way, so some are putting up glass slider doors to protect the staff. Remdesivir seems to have a limited role.
  • Exciting news.
    Dexamethasone, for after the first week, when need oxygen. Now shortages, because adopted by many doctors. Gave examples of other steroids that could be substituted.
    Another steroid, tocilizumab, increased survival of patients on ventilator, and African American and Hispanic patients improved even more than Caucasians, raising the question of whether different therapies might be better for different genetic backgrounds.
    Anticoagulation. Clotting issues affects about half of his hospitalized patients. Mentioned some drugs. One Mt Sinai study found 62% mortality of patients on vent, decreased to 29% when given full dose of anticoagulants.  Doing research now to see what dose needed, what to give after discharge, also to look at patients who were never sick enough to go to hospital but develop strokes later.
  • Women of reproductive age are more likely to require hospitalization and intensive care if they're pregnant, but it's not associated with a higher death rate.
A listener asked if he's seen long-term symptoms, as had been described in The Atlantic article that Ergel posted earlier today
https://www.theatlantic.com/health/archive/2020/06/covid-19-coronavirus-longterm-symptoms-months/612679/
He answered that there are some with fatigue, even after 8-10 weeks, but haven't followed them long enough yet to know if it will eventually go away.  Doesn't have a percent yet to know how often, but says it's definitely quite often. Mount Sinai now has a chronic covid clinic.

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Re: The science of COVID-19
« Reply #345 on: June 30, 2020, 04:47:26 PM »
It's a 2-hour podcast, which includes interviews with scientists and health professionals.  A frequent visitor is Dr Daniel Griffin who meets both criteria, as a PhD and MD.  In podcast #632 from June 28, he gave an update on how the clinical picture has changed. Here are the notes I took, can't guarantee accuracy. In general he's optimistic, your chance of surviving covid are much better now than if you had gotten it in March. What has changed since then:
  • Testing.  Lots of tests now, but not as much as needed for opening up safely, which would require testing and contact tracing.  Ironically, with the surge in the south, there are now problems again with accessing enough swabs. You can't really get a test whenever you want, even in some hospitals there's a 24-hour turnaround.
  • Better understand the clinical course, and how different complications seem to appear at different times - wk 2- respiratory issues, wk 3- clotting issues, wk 4- post-viral bacterial infections
  • Treatment.  Know value of pulse oximeters, to keep tabs on patients. Better idea of which lab tests to do, to catch problems before they appear. Chest xrays help decide which small subset of patients (about 10%) need antibiotics. High flow oxygen, bipap, cpap are better than ventilators. Putting the patient in prone position is better for patient but worse for health care workers who risk more infection that way, so some are putting up glass slider doors to protect the staff. Remdesivir seems to have a limited role.
  • Exciting news.
    Dexamethasone, for after the first week, when need oxygen. Now shortages, because adopted by many doctors. Gave examples of other steroids that could be substituted.
    Another steroid, tocilizumab, increased survival of patients on ventilator, and African American and Hispanic patients improved even more than Caucasians, raising the question of whether different therapies might be better for different genetic backgrounds.
    Anticoagulation. Clotting issues affects about half of his hospitalized patients. Mentioned some drugs. One Mt Sinai study found 62% mortality of patients on vent, decreased to 29% when given full dose of anticoagulants.  Doing research now to see what dose needed, what to give after discharge, also to look at patients who were never sick enough to go to hospital but develop strokes later.
  • Women of reproductive age are more likely to require hospitalization and intensive care if they're pregnant, but it's not associated with a higher death rate.
A listener asked if he's seen long-term symptoms, as had been described in The Atlantic article that Ergel posted earlier today
https://www.theatlantic.com/health/archive/2020/06/covid-19-coronavirus-longterm-symptoms-months/612679/
He answered that there are some with fatigue, even after 8-10 weeks, but haven't followed them long enough yet to know if it will eventually go away.  Doesn't have a percent yet to know how often, but says it's definitely quite often. Mount Sinai now has a chronic covid clinic.

THANK YOU!!!

Much more useful than much of the noise on DDF. We would appreciate if you continue monitoring this and report back with meaningful updates from Daniel Griffin.
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Re: The science of COVID-19
« Reply #346 on: June 30, 2020, 08:21:07 PM »
Again, thank you @biobook. I find it interesting that many, if not all, of these things have been discussed on here.

@ExGingi I may be way off base, but I think most of the "noise" on DDF comes from people trying to dispute dangerous claims that Covid is cancelled and that safety precautions aren't necessary. If everyone stuck to the science, and not what their eyes can see or the 'heard' immunity they picked up in the mikvah, you'd find DDF much more useful.

ETA: I know that was kind of condescending. I'm a little sorry, but I'm more annoyed than sorry.
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Re: The science of COVID-19
« Reply #347 on: June 30, 2020, 08:58:17 PM »
@ExGingi I may be way off base, but I think most of the "noise" on DDF comes from people trying to dispute dangerous claims that Covid is cancelled and that safety precautions aren't necessary. If everyone stuck to the science, and not what their eyes can see or the 'heard' immunity they picked up in the mikvah, you'd find DDF much more useful.

ETA: I know that was kind of condescending. I'm a little sorry, but I'm more annoyed than sorry.

1. You are way off base.
2. Condescending attitudes are counterproductive.
3. Don't be sorry.
4. I'd tell you what I tell my kids when they tell me me that someone annoys them.
I've been waiting over 5 years with bated breath for someone to say that!
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Offline jose34

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Re: The science of COVID-19
« Reply #348 on: July 01, 2020, 09:43:39 AM »
1. You are way off base.
2. Condescending attitudes are counterproductive.
3. Don't be sorry.
4. I'd tell you what I tell my kids when they tell me me that someone annoys them.

Why is he way off base, I happen to agree with him.
Many studies are coming out that even if people don't die COVID-19 affects people, who get a serious case in some kind of way, long term (or whatever long term can mean at this point, 3 months, 2 months...    :))).

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Re: The science of COVID-19
« Reply #349 on: July 01, 2020, 10:19:13 AM »
I'd tell you what I tell my kids when they tell me me that someone annoys them.

You tell them to ignore the people spreading dangerous fake news on public forums? I don't know you, but from what I've gathered, you raise your kids with a little more social responsibility than that.
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Offline biobook

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Re: The science of COVID-19
« Reply #351 on: July 07, 2020, 11:23:36 PM »
TWiV (This Week in Virology) #635, recorded July 5

These are my notes of Dr. Griffin's talk, so I can't guarantee they're accurate.  If you have questions, go listen to the podcast.

Today was the first time since this started that he entered his hospital and had no covid positive cases.  (or did he mean no new ones?) 
 
Testing. Still problems getting adequate tests, which are needed for contact tracing.  Antibody testing: About 20% of infected people don’t produce measurable antibodies, especially those who had milder cases.  And if you look 2 months out, antibody levels go down.  So limited value to antibody tests.

Covid parties. The idea of intentionally contracting covid is absurd, because of our ignorance about how long immunity lasts, whether one can get reinfected, and possible long-term effects. 

Possible reinfection. With some other viruses, a second bout is worse than the first.  Earlier in the epidemic, cases that were initially thought to be reinfections were probably just two phases of a single infection. But we’re still not sure if it was reinfection, or how quickly reinfection would occur. 

With some other viruses, a second reinfection is often more severe.  Dr. Griffin himself caught dengue in China in the 1980s, easily recovered, then got it again in Zimbabwe.  He was so sick the second time that his parents were told “We’ll let you know if he’s still here in the morning.”  Well, obviously he recovered, but we don’t know what will happen with covid, so it’s foolhardy to assume that reinfection would be mild when it could potentially lead to tragic consequences.

A listener asked about his 54-year old patient who had recovered from mild COVID in early April, and had two negative PCR tests (but no antibody test).  Two months later, his son got covid.  The following week, the father again had a positive covid test, with increasingly severe symptoms, and O2 sat of 83.  Was this a reinfection?  Dr. Griffin answered that it's concerning, but thought it’s possible that it’s the same infection, and the tests in April were too insensitive to measure the virus.  Or it might be a different strain of the virus.  Or it might be a re-infection with the same virus.  If it’s re-infection, this would imply that immunity is very short-lasting, perhaps even too short for effective herd immunity or effective vaccines.  However, he thought it’s too early to get too depressed about this.  We need to see if more such cases develop.

He noted that there had been a recent account of a mutated virus that is more transmissible, but he wanted to point out that it’s not more pathogenic.  It’s easier to catch, but not more likely to kill you. 

Lingering effects. Many reports of people still sick, months later.  Several support groups, one has 4000 people.  Need to study how often this occurs, and to educate those doctors who are unaware of it and assume it’s not real, that patients are malingering.

Football players are concerned about restarting to play because of the close contact with possibly asymptomatic teammates. What if they get covid and get late-onset muscle weakness, fatigue? To threaten your future life and a career you dreamed of?   We just don’t know the long-term impact of this disease. 

Patients may describe a chest heaviness, skin feels like had sunburn, persistent fatigue, brain fog, weakness, little exercise tolerance, depression, anxiousness.  Most people say they feel worst in the morning, get better throughout the day, then at 1-2 in the afternoon they feel like they’re dying.  Some doctors suggest that these are more common in young women, and say “the older men die, the younger women suffer”.  But he sees men and women, and all ages with these lingering symptoms. 
 
Recent study of patients 30 days after they were discharged from hospital showed that about half still had suboptimal lung function: respiratory muscles were weak, gas didn’t diffuse as readily into the lungs, and abnormalities were seen via lung imaging.   Published in Respiratory Research but there’s a summary here: https://www.cidrap.umn.edu/news-perspective/2020/06/study-finds-lung-impairment-recovering-covid-19-patients 

Treatment
Some patients say that Mucomyst, prescribed to break up their mucus, made them feel better overall.  Maybe it also acts as an anti-oxidant or anti-inflammatory. He’s not recommending this, just mentioning it.

NSAIDS were opposed early on, based on a single French study, but there have been 70 studies now that show no evidence of problems, so there may be no justification for avoiding ibuprofen, aleve, or aspirin.
 
Not using HCQ, famotidine, azithromycin. There’s now a price of $3120 for a 5 day treatment with remdesivir, which might affect its use.  Steroids and anticoagulation is being discussed more, need guidance on what to recommend for those at home.

Patients who were hospitalized have been studied most intensively, and we need more information on those who recovered at home.  Recent MMWR says outpatients tend to be younger, fewer underlying conditions, more likely lower socioeconomic status, and 2-3 weeks after symptoms, one-third say I’m still sick.

First trial of convalescent serum didn’t show benefits, and in fact, those treated late in the disease developed more clotting complications. It seems possible that antibodies play more of a role in the early response to the virus, and T cells are important later, in which case convalescent serum would be expected to benefit those in earlier stages of the disease.  We need more studies of this. 


School reopening.  The American Academy of Pediatrics strongly recommends that kids should be physically present in school this fall.  Dr Griffin agrees, says “Open schools, not bars”, especially since not every kid has a great home environment.  But need to open in the right way and accurate, frequent testing is critical for that, and we don’t have ability for frequent testing.  If you can’t afford to test students frequently, then you can’t afford to open schools.  Kids need to be kept in small groups, plastic separations. He doesn’t think many states will run it properly.  Some have said students don’t need to wear masks when they sit down… and he sees that as a problem.  Even if not 100% effective, masks act as a reminder to be careful.  States and federal government should financially help local school districts. 

True, that young people much less likely to get covid, but MSI has been found in 200 kids in NYS, and he thinks its underreported.  Also, recent studies showed viral load in children is similar to adult, so they may be as likely to transmit infection.  On the other hand, one study showed very little viral shedding from kids.  And epidemiological data doesn’t show schools playing a role in spread of covid, as occurs with most respiratory diseases, though this could be because schools that stayed open in March were already taking precautions.  Just don’t know yet.

Airplanes.  HEPA filters clean the air, although if someone sick is sitting right next to you, the filters don’t protect you.  So airplanes are not low risk, but are safer than being in a bar or at a party.  The greater risk is not from the flight, but the fight you get into over why your neighbor isn’t wearing a mask!  So try to move, if that happens.

Masks:  Don’t have good data on comparing different kinds, or knowing value of plastic shields.  Homemade cloth masks are fine for catching droplets, and are important to prevent spread from an infected person.  Nobody can wear it 24/7, but think about time and dose: The more you wear it, and the better you cover your nose and mouth, the better you will be protected and protect others.  The more you fiddle around with it, the greater risk of spread, so put it on and leave it there. If you have long hair, tie it back, so it doesn’t hit the mask.  If you wear hearing aids, tuck the bands under the hearing aids.  Here are some other tips for wearing a mask with hearing aids:  https://www.hearingloss.org/wp-content/uploads/Wearing_mask_and_hearingaids.jpg

Some can’t wear a mask for good medical reasons, but that’s fine.  Like herd immunity, we don’t need to get to 100%, but if enough people wear one, it will cut transmission.
« Last Edit: July 07, 2020, 11:28:20 PM by biobook »

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Re: The science of COVID-19
« Reply #352 on: July 07, 2020, 11:33:12 PM »
Wow, thanks for the summary!
Save your time, I don't answer PM. Post it in the forum and a dedicated DDF'er will get back to you as soon as possible.

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Re: The science of COVID-19
« Reply #353 on: July 07, 2020, 11:39:16 PM »
TWiV (This Week in Virology) #635, recorded July 5

These are my notes of Dr. Griffin's talk, so I can't guarantee they're accurate.  If you have questions, go listen to the podcast.
Thank you very much for this. Seems like one of the most honest, unbiased yet knowledgeable sources.

No noise. Just good old information with professional interpretation (and a healthy dose of honesty and humility). And combined with @biobook's excellent note taking, summarizing and writing skills! A real gem amongst all the noise.

@Dan maybe when you do a COVID-19 DDMS post you should link to these summaries of Dr Griffin by @biobook for those that want an executive summary of what's really going on with cases, treatments, effects and prevention rather than trying to make sense of all the noise on MSM.
« Last Edit: July 07, 2020, 11:43:19 PM by ExGingi »
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Re: The science of COVID-19
« Reply #354 on: July 08, 2020, 12:36:34 AM »
Once again, great stuff @biobook ! TYVM! Again I'm noticing that most of this has been discussed on this forum already. Great to have the info confirmed by the pros.
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Re: The science of COVID-19
« Reply #355 on: July 09, 2020, 09:17:49 AM »
Anecdotaly, last night a friend who is has type 2 diabetes mentioned that when he got COVID-19 he was initially hit hard, with his blood glucose levels going to 400. He was prescribed HCQ and within 24 was doing much better, and says that his arthritis seems to have also gone away. He says he has friends with similar experiences.
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Re: The science of COVID-19
« Reply #356 on: July 09, 2020, 11:12:09 AM »
It's stuff like this (I've seen it elsewhere, just was reading Vin and thought to post )

https://vosizneias.com/2020/07/09/ucl-study-finds-new-evidence-of-brain-complications-caused-by-covid-19/

That has me worried. I mean these can be few and far in between but there is so much about the covid19 after effects we do not know.

Ultimately I worry about people who got it, no effects, have no worries and if reinfection is possible could see damage in round 2.

I worry but also I realized there's not much we can do. I avoid people and wear a mask.

I take my temp often and always on my toes regarding taste and smell (this is super easy, I'm crazy about coffee and wine... If any aroma or taste was off I'd know it instantly)

I also of course realize that newly infected with no symptoms shed the most, that's why I had really tried staying home Shabbat.

Now, the thing is, even with Florida blowing up, I only personally spoke to 1 person who had it and never was in contact with them.

Also while hospitals are filling up, I don't see bh a heavy death rate.

This gives way to what many are thinking, it's invitable, why stay locked up?

They are right that it's not as deadly, I don't think the virus changed, I think treatment is better, less intubation, drugs that work etc

This is also how the walking dead started so I don't know..

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Re: The science of COVID-19
« Reply #357 on: July 09, 2020, 12:52:17 PM »
It's stuff like this (I've seen it elsewhere, just was reading Vin and thought to post )

https://vosizneias.com/2020/07/09/ucl-study-finds-new-evidence-of-brain-complications-caused-by-covid-19/

That has me worried. I mean these can be few and far in between but there is so much about the covid19 after effects we do not know.

Ultimately I worry about people who got it, no effects, have no worries and if reinfection is possible could see damage in round 2.

I worry but also I realized there's not much we can do. I avoid people and wear a mask.

I take my temp often and always on my toes regarding taste and smell (this is super easy, I'm crazy about coffee and wine... If any aroma or taste was off I'd know it instantly)

I also of course realize that newly infected with no symptoms shed the most, that's why I had really tried staying home Shabbat.

Now, the thing is, even with Florida blowing up, I only personally spoke to 1 person who had it and never was in contact with them.

Also while hospitals are filling up, I don't see bh a heavy death rate.

This gives way to what many are thinking, it's invitable, why stay locked up?

They are right that it's not as deadly, I don't think the virus changed, I think treatment is better, less intubation, drugs that work etc


This is also how the walking dead started so I don't know..

Nice to see this coming from you. I would add that we have here a case of ברי ושמא. The lockdowns have DEFINITE, MEASURABLE negative consequences, while in many cases contracting COVID-19 is (may I say this or is it borderline blasphemy?) just another mild flu.
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Re: The science of COVID-19
« Reply #358 on: July 09, 2020, 12:59:15 PM »
Nice to see this coming from you. I would add that we have here a case of ברי ושמא. COVID can and does have DEFINITE, MEASURABLE negative consequences (including death and long term physical damage), while in nearly all cases wearing a mask and being cautious (may I say this or is it borderline blasphemy?) has absolutely no negative ramifications.
FTFY
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Offline ExGingi

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Re: The science of COVID-19
« Reply #359 on: July 09, 2020, 01:02:44 PM »
FTFY


OK. While death is a definite, measurable negative consequence, as @chevron pointed out, that is turning out to be much less of an outcome. Long-term physical damage, we will only know about in the long-term. Mental, emotional, and financial damage as a result of the lockdown - by far more prevalent than serious COVID-19 cases are.

Why don't you take a poll and see how many households that have had COVID-19 symptoms have any DEFINITE, MEASURABLE negative consequences, and how many have such consequences as a result of the lockdown?
« Last Edit: July 09, 2020, 02:48:14 PM by ExGingi »
I've been waiting over 5 years with bated breath for someone to say that!
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