Coronavirus outbreak

[RUPERTKBD]

Looks like nurses in the US have had enough with bidding wars for PPE and the federal government outbidding the states for same:

 

https://www.msn.com/en-ca/news/us/were-beyond-angered-fed-up-nurses-file-lawsuits-plan-protest-at-white-house-over-lack-of-coronavirus-protections/ar-BB12YG0j?li=AAggNb9#interstitial=2

 

Quote

 

For Pamella Brown-Richardson, a nurse practitioner in New York, the fever and cough came in mid-March. Soon after, her fever worsened and she began experiencing shortness of breath and body aches — telltale symptoms of the novel coronavirus. By early April, Brown-Richardson was in the emergency room with double-lobe pneumonia caused by covid-19. 

As Brown-Richardson tells it, there is likely only one place where she could have been exposed to the virus: the primary care clinic in the Bronx, where she says she spent days caring for people suffering from covid-19 symptoms with just a flimsy surgical mask as protection.

Brown-Richardson is one of more than a dozen nurses in New York, the epicenter of the U.S. coronavirus outbreak, who detailed their experiences on the front lines in affidavits corroborating three lawsuits filed Monday against the state health department and two area hospitals. The complaints, which were lodged by New York’s largest nurses union, allege that inadequate protective equipment, among other failures, contributed to “compromising the health and safety of the nurses,” according to a news release from the union.

“These lawsuits were filed to protect our nurses, our patients and our communities from grossly inadequate and negligent protections,” Pat Kane, executive director of the New York State Nurses Association, said in the release. “We cannot allow these dangerous practices to continue.”

More than 9,000 health-care workers in the United States have tested positive for the novel virus, according to recent figures from the Centers for Disease Control and Prevention. But as The Washington Post’s Ariana Eunjung Cha reported, the numbers are “believed to be a gross undercount of infections due to the continuing lack of available tests in many areas” with some regions and facilities choosing not to test health-care workers in favor of saving kits for their sickest patients.

Among nurses, frustration over being forced to choose between doing their jobs and risking exposure to a potentially deadly virus appears to be reaching a tipping point this week. Beyond taking legal action, as in the case of New York’s caregivers, members of National Nurses United, the country’s largest union of registered nurses, have planned a protest outside the White House on Tuesday morning to raise awareness of their plight and demand federal funding for the mass production of personal protective equipment.

“We’re tired of being treated as if we are expendable,” Deborah Burger, president of National Nurses United, which has more than 150,000 members, told The Washington Post. “If we are killed in this pandemic, there won’t be anybody to take care of the rest of the sick people that are going to come.”

She later added, “We’re beyond angered at this.”

At Tuesday’s protest, the names of nurses who have died of covid-19 in the U.S. will be read out loud, according to a news release. While there aren’t official statistics available on the number of nurses who contracted fatal infections, Burger said she estimates that the count exceeds more than a hundred.

Many, if not all, of the cases involving health-care workers could have been prevented had sufficient safeguards been in place, she said.

“Everybody says they love nurses, they want to protect us, but we still don’t have the safety gear that we need,” said Burger, who has been a registered nurse for more than 45 years.

As detailed in the lawsuits filed in New York, nurses there allege the virus’s spread was aided in part by a lack of proper safety supplies. The complaints named the New York State Department of Health and two hospitals, Montefiore Medical Center and Westchester Medical Center, as defendants.

Several nurses alleged that they were told to use one N95 mask per week, and were given paper bags in which to store their masks and no sanitation instructions, according to court documents. Others, like Brown-Richardson, say they were not provided with certain protective equipment despite numerous requests.

“We were instructed that we could only wear a surgical mask, which is not adequate protection against COVID-19, if the patient presented with a cough,” Brown-Richardson wrote in her affidavit. “Otherwise we were prohibited from wearing a surgical mask because management believed that doing so could alarm patients.”

The lawsuits also claimed that nurses and other health-care workers presenting covid-19 symptoms have been denied testing, raising the risk that they might unknowingly transmit the disease to their loved ones or anyone else with whom they may come in contact.

 

 

[Gawdzukes]

1 hour ago, stawns said:

The government isn't a business, isn't a corporation........it's there to protect and serve people.  We've forgotten that in the last 50 years.

 protect and serve ... control and usurp .... same thing 

[wloutet]

Watching Justin Trudeau this morning (April 21), it really hit me how different his newscasts are to Donald T-rump. No once did I hear him say anything about his party or the other parties. If you were an outsider, you would not even know which party he represented. The questioning was good, and he answered with well thought out responses. There was no blaming, no false numbers, just information that we should know told in a very soothing voice.

[Duodenum]

21 minutes ago, wloutet said:

Watching Justin Trudeau this morning (April 21), it really hit me how different his newscasts are to Donald T-rump. No once did I hear him say anything about his party or the other parties. If you were an outsider, you would not even know which party he represented. The questioning was good, and he answered with well thought out responses. There was no blaming, no false numbers, just information that we should know told in a very soothing voice.

Why waste your time being a leader and giving well thought out responses when you can just be a big baby, lie over and over, and take no responsibility? 

[HerrDrFunk]

25 minutes ago, wloutet said:

Watching Justin Trudeau this morning (April 21), it really hit me how different his newscasts are to Donald T-rump. No once did I hear him say anything about his party or the other parties. If you were an outsider, you would not even know which party he represented. The questioning was good, and he answered with well thought out responses. There was no blaming, no false numbers, just information that we should know told in a very soothing voice.

That's the difference between a leader and a 300 pound toddler. 

[JM_]

37 minutes ago, wloutet said:

Watching Justin Trudeau this morning (April 21), it really hit me how different his newscasts are to Donald T-rump. No once did I hear him say anything about his party or the other parties. If you were an outsider, you would not even know which party he represented. The questioning was good, and he answered with well thought out responses. There was no blaming, no false numbers, just information that we should know told in a very soothing voice.

thats a good point, and isn't lost on most people. The lack of party politics on display is really refreshing. 

 

Other than Sheer being stupid about public gatherings, and Jason Kenney having one off day, its been a good showing by all of them. 

[Kushman]

1 hour ago, Jester13 said:

Not to mention Sweden has around 10 million people only and is a highly socially-minded homogeneous society. Taking their model and putting it onto other countries isn't exactly the best idea. 

Funny no one on the left seems to mention these points when discussing health care systems. 

[-Vintage Canuck-]

 

[Sharpshooter]

53 minutes ago, Gawdzukes said:

 protect and serve ... control and usurp .... same thing 

Usurp who?

 

Sometimes controlling certain things in a pandemic or national emergency situation is about protecting people. Why do you have an issue with that?

[HerrDrFunk]

7 minutes ago, Kushman said:

Funny no one on the left seems to mention these points when discussing health care systems. 

Yeah, I guess they'll just have to use all the other countries, like Canada, with socialized medicine as examples instead. 

[Dr. Crossbar]

wrong thread

Edited April 21, 2020 by Dr. Crossbar
.

[Jester13]

25 minutes ago, Kushman said:

Funny no one on the left seems to mention these points when discussing health care systems. 

What in particular? 

[I.Am.Ironman]

So I subscribe to a medical literature platform that summarizes current research in my areas of interest. They just notified me of their COVID review so I will copy and paste some here (full read is in spoilers):

 

Take home message

 

More than 120 different interventions, including single and combination treatments, are being or will be investigated in clinical trials for the treatment of COVID-19. The most common classes of medication include antimalarials (e.g., hydroxychloroquine/chloroquine), antivirals (e.g., lopinavir + ritonavir, remdesivir), and some biologics (e.g., monoclonal antibodies, stem cells, convalescent plasma). To date, no treatment has proven to be efficacious via high-quality evidence from randomized clinical trials (RCTs).

 

With cases of COVID-19 climbing sharply and spreading from one continent to another, the global death toll has surpassed 100,000 people. Thus, effective therapies for COVID-19 are desperately needed. Since we cannot afford to spend years developing and testing new compounds from scratch, many researchers are now repurposing drugs that are already on the market for other diseases and have acceptable safety profiles. 

 

Hundreds of clinical trials have been initiated by researchers worldwide hoping that, with high-quality evidence, we can quickly discover efficacious interventions for the management of patients with COVID-19 and save thousands of lives. In this OE Original, we summarize what treatments are currently being investigated in clinical trials and highlight the most popular candidates.

Summary

 

While nearly 200 trials are being conducted regarding a variety of potential treatments, the current evidence lacks any support for a particular treatment. Despite this, there have been several national agencies that have recommended the use of some interventions, usually in more severe cases where experimental treatment or compassionate use is warranted.

 

Spoiler

Emerging Treatments in Fight Against COVID-19

 

Take home message

 

More than 120 different interventions, including single and combination treatments, are being or will be investigated in clinical trials for the treatment of COVID-19. The most common classes of medication include antimalarials (e.g., hydroxychloroquine/chloroquine), antivirals (e.g., lopinavir + ritonavir, remdesivir), and some biologics (e.g., monoclonal antibodies, stem cells, convalescent plasma). To date, no treatment has proven to be efficacious via high-quality evidence from randomized clinical trials (RCTs).

 

With cases of COVID-19 climbing sharply and spreading from one continent to another, the global death toll has surpassed 100,000 people. Thus, effective therapies for COVID-19 are desperately needed. Since we cannot afford to spend years developing and testing new compounds from scratch, many researchers are now repurposing drugs that are already on the market for other diseases and have acceptable safety profiles. 

 

Hundreds of clinical trials have been initiated by researchers worldwide hoping that, with high-quality evidence, we can quickly discover efficacious interventions for the management of patients with COVID-19 and save thousands of lives. In this OE Original, we summarize what treatments are currently being investigated in clinical trials and highlight the most popular candidates.

 

Treatment Candidates Against COVID-19

 

We searched the clinicaltrials.gov website and identified 193 interventional studies whose primary aim is treating COVID-19 (search conducted on April 10, 2020), most of which are RCTs.

 

More than 120 different treatments, including single and combination treatments, are under investigation (Figure 1). The size of the areas in the sunburst chart correspond to the number of trials in which the treatment is being tested. Popular treatments included: 

 

• Hydroxychloroquine or chloroquine alone or plus azithromycin (42 studies)
• Lopinavir plus ritonavir (12 studies)
• Stem cells (12 studies)
• Remdesivir (9 studies)
• Tocilizumab (10 studies)
• Convalescent plasma (8 studies)

 

 

We also classified the treatment candidates by the severity of COVID-19 (mild, moderate, severe) being studied (Figures 2a-2d). Note that the sum of the number of trials in each category is greater than the overall trial number because some trials are investigating more than one level of severity. We can see that most trials (193) are not studying a treatment for a particular severity level or did not specify the severity of COVID-19. The remaining investigations focused on severe or critically ill patients (38), mild patients (13), and then moderate patients (12). Moreover, when classified by disease severity, the popularity of treatments under investigation basically remains the same. An exception is that stem cell therapies are more prevalent when considering research on patients with severe or critical COVID-19.

 

 

 

 

 

A Glance at Some of the Most Popular Candidate Treatments Against COVID-19

 

• Hydroxychloroquine/Chloroquine alone or plus azithromycin (42 studies)

 

Chloroquine and hydroxychloroquine are generally used for treating malaria and certain inflammatory conditions such as rheumatoid arthritis, while azithromycin is an antibiotic for the treatment of bacterial infections such as respiratory infection. They have shown some antiviral activity against novel coronavirus in vitro (Wang et al., 2020; Yao et al., 2020). However, there is still a lack of RCT evidence. A non-peer-reviewed study published on MedRxiv showed that hydroxychloroquine could significantly shorten the time to clinical recovery and advance the resolution of pneumonia (Chen et al., 2020). An open-label non-RCT published in a peer-reviewed journal also suggested that hydroxychloroquine plus azithromycin significantly reduces viral load (Gautret et al., 2020).

 

Recommendations for using hydroxychloroquine/chloroquine are controversial across agencies. For example, the National Health Commission of the People's Republic of China (2020) recommends the use of hydroxychloroquine/chloroquine without providing any RCT evidence. The interim guidance from the American Thoracic Society suggests hydroxychloroquine/chloroquine only for patients who are hospitalized and whose clinical condition is severe enough to warrant investigational therapy (Wilson et al., 2020). The British Columbia Centre for Disease Control of Canada (2020) recommends against the use of hydroxychloroquine/chloroquine outside of clinical trials. The United States Food and Drug Administration (FDA) has issued an emergency use authorization (EUA) for the emergency use of oral chloroquine and hydroxychloroquine for the treatment of COVID-19 among hospitalized patients (The United States Food and Drug Administration (FDA), 2020a).

 

• Lopinavir + Ritonavir (12 studies)

 

Lopinavir + ritonavir is a combination of antiviral agents used in the treatment of human immunodeficiency virus (HIV). Lopinavir can effectively inhibit the protease activity of past coronavirus in vitro, such as MERS-CoV (Chan et al., 2015). However, to our knowledge, there are no in vitro studies on novel coronavirus reported so far. Ritonavir can increase the half-life of lopinavir. Evidence from RCTs is limited. An RCT on 200 patients by Cao et al. (2020) found no benefits with lopinavir + ritonavir in hospitalized adult patients with severe COVID-19, compared to standard care. 

 

The World Health Organization (WHO) has not indicated its position on the use of lopinavir + ritonavir for the treatment of COVID-19. The British Columbia Centre for Disease Control of Canada (2020) recommends against the routine use of lopinavir + ritonavir outside of clinical trials. However, another interim guidance suggests clinicians consider the use of lopinavir + ritonavir when hospitalized patients with < 12 days of symptomatic illness do not require mechanical ventilation (Alberta Health Services, 2020).

 

• Remdesivir (9 studies)

 

Remdesivir is not an FDA-approved treatment agent and, thus, not commercially available. Remdesivir inhibits RNA-dependent RNA polymerase and has demonstrated antiviral activity in vitro and in animal models against the MERS-CoV and SARS-Cov (Sheahan et al., 2020).

 

A study published on April 10, 2020, in the New England Journal of Medicine, showed that 36 out of 53 COVID-19 patients (68%) who received at least one dose of remdesivir showed improvement in their conditions. Although the results are very promising, the study has serious drawbacks. For instance, it lacks a control arm which makes it impossible to determine how much, if any of the improvement was due to remdesivir (Grein et al., 2020).

 

To date, the WHO has not taken a position on the use of remdesivir to treat COVID-19. It does include remdesivir as one arm in its ongoing global collaborative SOLIDARITY trial. 

 

• Tocilizumab (10 studies)

 

Tocilizumab is an anti-interleukin 6 monoclonal antibody used for treatment of rheumatoid arthritis. Currently, we only have some case reports showing improvement in patients with severe COVID-19 after receiving tocilizumab (De Luna et al., 2020; Michot et al., 2020).

 

The WHO and US Center for Disease Control (CDC) have not revealed their position on the use of tocilizumab in COVID-19. The interim guidance from the American Thoracic Society (2020) makes no recommendation for or against using tocilizumab for hospitalized COVID-19 patients with pneumonia. However, the British Columbia Centre for Disease Control of Canada (2020) and the Alberta Health Services (2020) explicitly recommend against the routine use of tocilizumab.

 

• Mesenchymal Stem Cells (MSCs, 12 studies)

 

MSCs have been widely used in cell-based therapy. Not only do they possess differentiation abilities but they are also effective immunomodulators. The immunomodulatory effects of MSCs are triggered by the activation of toll-like receptors in MSCs, which are stimulated by double-stranded RNA from a virus (Li et al., 2012). A recent non-RCT showed that the pulmonary function and symptoms of 7 patients with COVID-19 were significantly improved after MSC transplantation, compared with 3 patients in the placebo control group. However, the results were inconclusive. 

 

Recently, the US Food and Drug Administration (FDA) approved several clinical trials aiming to use MSC treatments in COVID-19 patients. To our knowledge, there are no recommendations existing on whether MSCs should be used to target COVID-19.

 

• Convalescent Plasma (8 studies)

 

Convalescent plasma therapy, a type of immunotherapy, has been applied to the treatment of many infectious diseases. A meta-analysis, which was published in 2015 and included 32 studies investigating SARS and severe influenza, showed a significant reduction in mortality following convalescent plasma therapy compared with the placebo or no therapy group (odds ratio (OR), 0.25; 95% confidence interval (CI), 0.14 to 0.45) (Mair-Jenkins et al., 2015).

 

Currently, we don’t have any evidence from RCTs available to support the use of convalescent plasma in patients with COVID-19. There are, however, some results generated from non-randomized interventional studies. For example, a study showed that a single 200 ml transfusion of convalescent plasma significantly improved the clinical symptoms of 10 adult patients with COVID-19 compared to their status before transfusion (Duan et al., 2020).

 

The US FDA has approved the use of convalescent plasma to treat patients who have severe or immediately life-threatening COVID-19, provided that doctors get approval before its use (The United States Food and Drug Administration (FDA), 2020b). 

 

Besides those mentioned above, there are some candidate treatments which are less popular in terms of the number of registered trials, but news cycles have been paying attention to them more recently. For example, baricitinib (also called Olumiant, a JAK1 and JAK2 inhibitor for the treatment of rheumatoid arthritis in adults) had only 3 trials registered on Clinicaltrials.gov by April 10th, 2020; however, the New York Times has been reporting on this treatment in recent articles. Currently, we could not find any formal recommendation from major agencies about the use of baricitinib against COVID-19.

 

 

Attitudes and Expectations in the Medical Community

 

The attitudes towards the hundreds of clinical trials that have been initiated and expectations of the various candidate treatments against COVID-19 are controversial. A newly published report in the Lancet addressed this issue (Mullard, 2020).

In this report, some experts revealed their concerns about the fact that people have rushed into clinical trials and all these trials lack comprehensive trial coordination mechanisms:

            “The scale of these trials is too small, and the variation in terms of how they are being run is too large. These trials aren't really designed to answer the questions that need to be answered.”  

-- John-Arne Røttingen, chief executive of the Research Council of Norway and proponent of a more collaborative approach --

Some other experts partially agree with the above statement, but also see the other side of the argument:

            “On the one hand, we want to be coordinated. On the other hand, we don't want to spend too much time getting coordinated because the pace of this thing is so rapid. Everyone's doing their best.”

-- Merdad Parsey, chief medical officer at Gilead --

As for the expectations of the numerous candidate treatments, experts are also mixed.

            “Will we have a magic bullet? Most likely not.”

-- Marie-Paule Kieny, director of research at The Institut national de la santé et de la recherche médicale --

“I don't want to set expectations too high. I'm not saying these will be a cure for COVID-19. But even if we can reduce the proportion of patients that need ventilators by, say, 20%, that could have a huge impact on our national health-care systems.”

-- John-Arne Røttingen --

 

Summary

 

While nearly 200 trials are being conducted regarding a variety of potential treatments, the current evidence lacks any support for a particular treatment. Despite this, there have been several national agencies that have recommended the use of some interventions, usually in more severe cases where experimental treatment or compassionate use is warranted.

 

References

 

Alberta Health Services. (2020). Recommendations for Antimicrobial Management of Adult Hospitalized Patients with COVID-19. Retrieved from https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-recommendations.pdf 

Date accessed: April 12, 2020

 

The British Columbia Centre for Disease Control. (2020). Unproven Therapies for COVID-19. Retrieved from http://www.bccdc.ca/Health-Professionals-Site/Documents/Guidelines_Unproven_Therapies_COVID-19.pdf Date accessed: April 12, 2020

 

Cao, B., Wang, Y., Wen, D., Liu, W., Wang, J., Fan, G., . . . Wang, C. (2020). A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. doi:10.1056/NEJMoa2001282

 

Chan, J. F., Yao, Y., Yeung, M. L., Deng, W., Bao, L., Jia, L., . . . Yuen, K. Y. (2015). Treatment With Lopinavir/Ritonavir or Interferon-beta1b Improves Outcome of MERS-CoV Infection in a Nonhuman Primate Model of Common Marmoset. J Infect Dis, 212(12), 1904-1913. doi:10.1093/infdis/jiv392

 

Chen, Z., Hu, J., Zhang, Z., Jiang, S., Han, S., Yan, D., . . . Zhang, Z. (2020). Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. medRxiv, 2020.2003.2022.20040758. doi:10.1101/2020.03.22.20040758

 

Duan, K., Liu, B., Li, C., Zhang, H., Yu, T., Qu, J., . . . Yang, X. (2020). Effectiveness of convalescent plasma therapy in severe COVID-19 patients. Proc Natl Acad Sci USA. doi:10.1073/pnas.2004168117

 

De Luna, G., Habibi, A., Deux, J. F., Colard, M., d'Alexandry d'Orengiani, A., Schlemmer, F., . . . Bartolucci, P. (2020). Rapid and Severe Covid-19 Pneumonia with Severe Acute Chest Syndrome in a Sickle Cell Patient Successfully Treated with Tocilizumab. Am J Hematol. doi:10.1002/ajh.25833

 

Mullard, A. (2020). Flooded by the torrent: the COVID-19 drug pipeline. The Lancet, Retrieved from https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)30894-1.pdf Date accessed: April 17, 2020

 

The United States Food and Drug Administration (FDA). (2020a). Emergency Use Authorization (EUA) to authorize use of chloroquine and hydroxychloroquine. Retrieved from https://www.fda.gov/media/136534/download Date accessed: April 12, 2020

 

The United States Food and Drug Administration (FDA). (2020b). Recommendations for Investigational COVID-19 Convalescent Plasma. Retrieved from  https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma Date accessed: April 12, 2020

 

Gautret, P., Lagier, J. C., Parola, P., Hoang, V. T., Meddeb, L., Mailhe, M., . . . Raoult, D. (2020). Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents, 105949. doi:10.1016/j.ijantimicag.2020.105949

 

Grein, J., Ohmagari, N., Shin, D., Diaz, G., Asperges, E., Castagna, A., . . . Flanigan, T. (2020). Compassionate Use of Remdesivir for Patients with Severe Covid-19. N Engl J Med. doi:10.1056/NEJMoa2007016

 

Li, W., Ren, G., Huang, Y., Su, J., Han, Y., Li, J., . . . Shi, Y. (2012). Mesenchymal stem cells: a double-edged sword in regulating immune responses. Cell Death Differ, 19(9), 1505-1513. doi:10.1038/cdd.2012.26

 

Mair-Jenkins, J., Saavedra-Campos, M., Baillie, J. K., Cleary, P., Khaw, F. M., Lim, W. S., . . . Convalescent Plasma Study, G. (2015). The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis, 211(1), 80-90. doi:10.1093/infdis/jiu396

 

Michot, J. M., Albiges, L., Chaput, N., Saada, V., Pommeret, F., Griscelli, F., . . . Stoclin, A. (2020). Tocilizumab, an anti-IL6 receptor antibody, to treat Covid-19-related respiratory failure: a case report. Ann Oncol. doi:10.1016/j.annonc.2020.03.300

 

National Health Commission of the People's Republic of China. (2020). Interpretation of COVID-19 treatment guidelines (6th version). http://www.gov.cn/zhengce/2020-02/19/content_5480958.htm 

Date accessed: April 12, 2020

 

Sheahan, T. P., Sims, A. C., Leist, S. R., Schafer, A., Won, J., Brown, A. J., . . . Baric, R. S. (2020). Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun, 11(1), 222. doi:10.1038/s41467-019-13940-6

 

Wang, M., Cao, R., Zhang, L., Yang, X., Liu, J., Xu, M., . . . Xiao, G. (2020). Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res, 30(3), 269-271. doi:10.1038/s41422-020-0282-0 

 

Wilson KC, Chotirmall SH, Bai C, Rello J.  COVID-19: Interim Guidance on Management  Pending Empirical Evidence. (2020). https://www.thoracic.org/professionals/clinical-resources/disease-related-resources/covid-19-guidance.pdf Date accessed: April 12, 2020

 

Yao, X., Ye, F., Zhang, M., … Liu, D. (2020). In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clinical Infectious Diseases, ciaa237, https://doi.org/10.1093/cid/ciaa237

 

 

[NewbieCanuckFan]

1 hour ago, wloutet said:

Watching Justin Trudeau this morning (April 21), it really hit me how different his newscasts are to Donald T-rump. No once did I hear him say anything about his party or the other parties. If you were an outsider, you would not even know which party he represented. The questioning was good, and he answered with well thought out responses. There was no blaming, no false numbers, just information we should know told in a very soothing voice.

Look at a right of center politician - Doug Ford.   He *knows* how to work with others.  You might not agree with much of his beliefs but he's a leader.

[Elias Pettersson]

http://publichealth.lacounty.gov/phcommon/public/media/mediapubhpdetail.cfm?prid=2328

 

USC-LA County Study: Early Results of Antibody Testing Suggest Number of COVID-19 Infections Far Exceeds Number of Confirmed Cases in Los Angeles County

Los Angeles (April 20, 2020) - USC and the Los Angeles County Department of Public Health (Public Health) today released preliminary results from a collaborative scientific study that suggests infections from the new coronavirus are far more widespread - and the fatality rate much lower - in L.A. County than previously thought.   The results are from the first round of an ongoing study by USC researchers and Public Health officials. They will be conducting antibody testing over time on a series of representative samples of adults to determine the scope and spread of the pandemic across the county.   Based on results of the first round of testing, the research team estimates that approximately 4.1% of the county's adult population has antibody to the virus. Adjusting this estimate for statistical margin of error implies about 2.8% to 5.6% of the county's adult population has antibody to the virus- which translates to approximately 221,000 to 442,000 adults in the county who have had the infection. That estimate is 28 to 55 times higher than the 7,994 confirmed cases of COVID-19 reported to the county by the time of the study in early April. The number of COVID-related deaths in the county has now surpassed 600.   "We haven't known the true extent of COVID-19 infections in our community because we have only tested people with symptoms, and the availability of tests has been limited," said lead investigator Neeraj Sood, a USC professor of public policy at USC Price School for Public Policy and senior fellow at USC Schaeffer Center for Health Policy and Economics. "The estimates also suggest that we might have to recalibrate disease prediction models and rethink public health strategies."   The results have important implications for public health efforts to control the local epidemic.   "These results indicate that many persons may have been unknowingly infected and at risk of transmitting the virus to others," said Dr. Barbara Ferrer, director of the L.A. County Department of Public Health. "These findings underscore the importance of expanded polymerase chain reaction (PCR) testing to diagnose those with infection so they can be isolated and quarantined, while also maintaining the broad social distancing interventions."   The antibody test is helpful for identifying past infection, but a PCR test is required to diagnose current infection.   "Though the results indicate a lower risk of death among those with infection than was previously thought, the number of COVID-related deaths each day continues to mount, highlighting the need for continued vigorous prevention and control efforts," said Dr. Paul Simon, chief science officer at L.A. County Department of Public Health and co-lead on the study.   The study's results have not yet been peer reviewed by other scientists. The researchers plan to test new groups of participants every few weeks in coming months to gauge the pandemic's trajectory in the region.   About the study With help from medical students from the Keck School of Medicine of USC, USC researchers and Public Health officials conducted drive-through antibody testing April 10th and 11th at six sites. Participants were recruited via a proprietary database that is representative of the county population. The database is maintained by LRW Group, a market research firm.   The researchers used a rapid antibody test for the study. The FDA allows such tests for public health surveillance to gain greater clarity on actual infection rates. The test's accuracy was further assessed at a lab at Stanford University, using blood samples that were positive and negative for COVID-19.   In addition to Sood and Simon, other authors and institutions contributing to the study include Peggy Ebner of the Keck School; Daniel Eichner of the Sports Medicine Research & Testing Laboratory; Jeffrey Reynolds of LRW Group; Eran Bendavid and Jay Bhattacharya of Stanford University School of Medicine.   The study was supported with funding from USC Schwarzenegger Institute, USC Lusk Center, USC President's Office, Jedel Foundation, LRW Group, Soap Box Sample, and several individual donors.

[RUPERTKBD]

Is there a dumber conspiracy theory out there than 5G causes Coronavirus?

 

https://www.msn.com/en-ca/news/world/conspiracy-theorists-burn-5g-towers-claiming-link-to-virus/ar-BB12YJ18?li=AAggNb9

 

Honestly, I'm against Capital punishment and I dislike guns, but if you're stupid enough to believe this idiotic theory, do yourself and the world a favor and jump in front of a bus, or train....

Edited April 21, 2020 by RUPERTKBD

[Me_]

1 hour ago, wloutet said:

Watching Justin Trudeau this morning (April 21), it really hit me how different his newscasts are to Donald T-rump. No once did I hear him say anything about his party or the other parties. If you were an outsider, you would not even know which party he represented. The questioning was good, and he answered with well thought out responses. There was no blaming, no false numbers, just information that we should know told in a very soothing voice.

Soooooo proud to be Canadian.

 

The misogynist a$$ monkey will never be in the same league as the world leading figures.

[RUPERTKBD]

4 minutes ago, Me_ said:

Soooooo proud to be Canadian.

 

The misogynist a$$ monkey will never be in the same league as the world leading figures.

An actual exchange between the toddler in chief and a reporter this morning:

https://www.msn.com/en-ca/news/newspolitics/trump-rips-cnn-reporter-for-self-congratulation-question-you-dont-have-the-brains-you-were-born-with/ar-BB12XXcE?li=AAggNb9

Quote

 

"But the clips that you played and what you read earlier was praising you and your administration. Why is now the moment to do that? On the day more than 40,000 Americans have now died?" Diamond said.

 

"Those people have been just absolutely excoriated by some of the fake news like you. You're CNN. You're fake news. And let me just tell you, they were excoriated by people like you that don't know any better because you don't have the brains you were born with. You should be praising the people that have done a good job, not doing what you do," Trump said.

 

"Look, you're never going to treat me fairly, many of you, and I understand that," the president added. "I got here with the worst, most unfair press treatment they say in the history of the United States for a president. They did say Abraham Lincoln had very bad treatment."

 

[BPA]

3 hours ago, stawns said:

They're going to get heavy pushback from teachers I think.  I, literally, get sneezed or coughed on at least three times a day.  No joke

I have young children and I can totally understand.   I was never as sick this much in a year until I had kids.

[Me_]

1 minute ago, RUPERTKBD said:

An actual exchange between the toddler in chief and a reporter this morning:

https://www.msn.com/en-ca/news/newspolitics/trump-rips-cnn-reporter-for-self-congratulation-question-you-dont-have-the-brains-you-were-born-with/ar-BB12XXcE?li=AAggNb9

They’re exposing him for the fraud he is. I’m proud of the journalists in that room.

 

Here’s the footage you’re talking about: