Wuhan Coronavirus Resource Thread

Arun.prabhu · Post by **Arun.prabhu** » 03 Sep 2020 09:58

I was vilified and called a chinese shrill here four months back for claiming the disease isn’t as deadly as feared. I did not want to post again here, but the opportunity to gloat is too good to pass up.

https://timesofindia.indiatimes.com/cit ... 881551.cms

Chennai apparently had between 800,000 and 1.4 million recoveries by mid July depending on whether we count the population of Chennai or greater Chennai alone. The whole of Tamil Nadu had 2167 official deaths on July 15. Less than 1 in 400 infected died and potentially less than 1 in 700 Infected died, conservatively. Assuming thedisease wasn’t well established in rest of Tamil Nadu. Chennai isn’t the only data point. Delhi had similar results.17% had the disease and recovered by July.

What does this mean? It means the lot of you who called me a chinese shrill, implied I’m a moron were right geniuses. Mindless sheep. Say bah, dear fellows and lower your head when the kind gentleman with the big machete comes for you because sheep heaven awaits.

I now eagerly await another pointless ban. ( pointless because this is a Parthian shot to gloat. Toodle doo, sheep!

sudarshan · Post by **sudarshan** » 03 Sep 2020 19:52

Saar, you can make the same points without the attitude, people will listen. If you can present hard data to make your point, that will be a service. If you keep displaying an offended attitude and getting banned, what purpose does that serve?

I've also been saying from the beginning that this disease isn't as deadly as was initially feared. That endless lockdowns are pointless, what is needed is better treatment options. So have a few other forumites. Since then, many media reports have also emerged, saying the same thing, and were even posted here. No matter how low the death rate is, people are still dying, in a particularly horrifying way. And many more people go through hell and have lingering issues for months. Even with a 0.1% death rate (same as flu, and that's still not trivial), the rate of people who survive (but with lingering issues) would be 5 to 10 times that, and for each such person, the number of family members affected emotionally and financially would be 5 times that, so overall, 3% to 5% of the population could still be (very) negatively impacted, and that is not a trivial amount.

Gloating that "you were right about the low death rate" is pretty classless here. Others have made the same point, without the attitude, so what you're saying isn't even that novel or revolutionary. Please try to make the same points with a little more sensitivity to the very real suffering, and with some proposals as to what can be done to mitigate that, and that will serve some purpose. Else it's just an ego trip about "I was right and you are all sheep."

Yes, this disease isn't that deadly, most people do just fine, it seems to depend on the infection load. If that initial infection load is overwhelming, then God save the guy, because it seems nothing else will. If people are going to internalize that "the disease isn't that deadly" and indulge in reckless behavior, then that shifts the HIT far to the right, increases the infection loads (and the death rate), strains hospitals, and does a whole lot of other undesirable things. Best to be careful, although full lockdowns seem to be overkill (no pun intended).

darshan · Post by **darshan** » 03 Sep 2020 21:28

I suppose the key here was to get high lethality strains to die out with hosts and before hosts spreading to someone else. In old days, lockdowns would not have been required with population employing common sense. I suspect that the present generation would have all acted like we went to school, watch YouTube, watch tiktok, etc. and thus know better. In hindsight, age old common sense approaches would have sufficed but would they have been followed? It's still very easy to find get togethers in areas that are not that open or under sun with no mask and/or keep the distance. And, of course there are some mobility and comfort caveats in this new age like central HVAC, closed air circulation, etc. I bet poor and rural would have all been okay with affected being urban population that could not change their lifestyles.

Ambar · Post by **Ambar** » 03 Sep 2020 21:32

I'll quote Dr Shiv's latest tweet "I write this to express my irritation at those who say that al iz vel because COVID has a low death rate. My doctor classmates and peers, who lived through the onset of AIDS, Swine flu and Bird Flu are dying in numbers. I have lost 2 doctor friends from college in the last week." .

Until May, i too was in the camp of "this isn't as serious as its being made out" , now i am a firm believer that is unlike anything we've seen since 1918. Yes, majority who contract this virus will recover but for those who are elderly or have co-morbidity its almost a death sentence. The ICU recovery rate in many hospitals is <50%. Please don't underestimate the seriousness or threat of this pandemic, it is real and it is vile.

chola · Post by **chola** » 03 Sep 2020 21:36

I was one of those in the beginning who thought that it was like the flu and maybe herd immunity should be allowed to happen. Maybe we need to keep the economy going and power through this.

But I have changed my stance 180 degrees since. You cannot have a functioning economy when this thing is not under control. Even at 1 or 2 percent this scourge can wreck havoc by overwhelming a healthcare system because of the way it impacts victims.

This chini virus is insidious. The asymptomatic could carry a higher load than even someone dying from ravaged lungs.
It can spread quickly because it rides on people seemingly healthy and then kills when it finds the right victims.

So how can an economy return when you don't even know who is carrying the disease? Even with the flu, the sick person has a fever and runny nose and more often than not laid up in bed. Here you can have a healthy college kid who might have deliberately taken high risk chances at parties and bars and he could be the Grim Reaper with a massive virus load but healthy as a horse.

Look at the American movie industry, the top film made a piddling $4m opening at over 2000 screens. An economy can't turn around with this kind of fear. The disease has to be slowed down and then controlled for things to really recover.

darshan · Post by **darshan** » 03 Sep 2020 21:36

To add to my previous post, from the national security perspective, nations also had to take a pause and do assessment about biowarfare preparations after coming to realizations about supply chains being in china and china having enough technology to misuse such viruses. Was this a trailer? Is there something else after this? Corona Jihad? Etc.

vera_k · Post by **vera_k** » 03 Sep 2020 21:51

chola wrote:So how can an economy return when you don't even know who is carrying the disease?

And what if this is the new normal? In that there is a new virus or strain every few years. That would require a wholesale reimagining of economies and put paid to a whole bunch of prior planning.

vijayk · Post by **vijayk** » 03 Sep 2020 22:14

Guys. I have a classmate at King George Hospital in Vizag.

I asked him how vaccine trials are going ...

KGH Covid vaccine is not going on smoothly.,bcos of some professional hierarchy... Let us see what they will do!!

Me: Politics? Now?

Him: Not only politics ... , scams also . Corruption is ingrained in the DNA for these rogues.

Ambar · Post by **Ambar** » 04 Sep 2020 00:36

vera_k wrote:
chola wrote:So how can an economy return when you don't even know who is carrying the disease?
And what if this is the new normal? In that there is a new virus or strain every few years. That would require a wholesale reimagining of economies and put paid to a whole bunch of prior planning.

No one know if this is the end or just the beginning. In just the first 2 decades of this century we've seen so many strains of influenza from avian flu to swine flu to mers to covid19, each time it seems to get stronger , deadlier and more contagious than before. We may well be forced to reimagining the world we live in.

chola · Post by **chola** » 04 Sep 2020 01:41

^^^ The world is getting more connected where in old days these thing spread and die out in local populations especially in the third world.

But with Cheen reaching First World in infrastructure and trade and still eating exotic critters like some hunter-gather savages, these things will spread quickly and efficiently. And even if we cut off travel and trade with the chinis, they will still get us. The current pandemic in Bharat comes from Europe and the Gulf. India cut off Cheen early and effectively.

We have to control things with tracking and tracing somehow like the Koreans, Taiwan, Japan and Vietnam. Vietnam is 100M people with a 1000 cases and just 30 odd deaths. And they are rather poor and sit next to the lizard with a lot of trade and interaction with it. These are all densely populated nations like India.

It can be done. We just need to study and implement.

darshan · Post by **darshan** » 04 Sep 2020 05:24

No herd immunity yet, antibody doesn’t sustain for long after Covid-19 patients recover: AMC survey
https://www.deshgujarat.com/2020/09/02/ ... mc-survey/
AMC Riverfront office: Amdavad Municipal Corporation (AMC) today said it conducted second survey related to Covid-19 infection, covering 10,000 persons. While the earlier survey showed 17.61 per cent positivity, the latest survey shows 23.24 per cent positivity. It means there’s 5.5 per cent increase in positivity over one and half month period. This indicates that there’s no herd immunity as of now prevalent in the city because herd immunity would require 70 to 80 percent positivity.

The AMC also did another survey to check antibody among them who had earlier infected with Covid-19 and recovered. In 40 per cent of those surveyed, antibody had disappeared. It shows that after infected with Covid-19 and recovered from the same, anti body doesn’t sustain for long. Around 40 per cent persons had no anti body left which suggest that they may have Covid infection again. However more study is required on this.

mappunni · Post by **mappunni** » 04 Sep 2020 11:31

A Supercomputer Analyzed Covid-19 — and an Interesting New Theory Has Emerged
A closer look at the Bradykinin hypothesis

https://elemental.medium.com/a-supercom ... cb8eba9d63

The study findings

A mechanistic model and therapeutic interventions for COVID-19 involving a RAS-mediated bradykinin storm

https://elifesciences.org/articles/59177

Potential therapeutic interventions, their targets, and predicted effect.
Drug Target Predicted Effect
Danazol, Stanozolol SERPING1 Reduce Bradykinin production
Icatibant BKB2R Reduce Bradykinin signaling
Ecallantide KLKB1 Reduce Bradykinin production
Berinert,Cinryze,Haegarda SERPING1 Reduce Bradykinin production
Vitamin D REN Reduce Renin production
Hymecromone HAS1,HAS2, HAS3 Reduce hyaluronan
Timbetasin TMSB4X Increase fibrinolysis

Manish_P · Post by **Manish_P** » 04 Sep 2020 13:36

So there you have it...

Sion hospital doctor is Mumbai's first recorded case of Covid reinfection

Ten days after doctors in Hong Kong conclusively proved people can be reinfected with the novel Coronavirus a Doctor at Mumbai's Sion Hospital tested positive for the virus a second time after a gap of two months. This is the first recorded cases of reinfection in the city, though the affected doctor has now recovered from the second bout of infection.

A Maharashtra Association of Resident Doctors (MARD) representative said a female doctor from Sion Hospital's anaesthesia department had got reinfection. "The reinfection came to light about two weeks ago. She tested positive once again and was admitted to Seven Hills Hospital in Andheri," the MARD member said.

PS: Really have to respect and admire the courage and dedication of the Doctor's and health care personnel on the front-lines

darshan · Post by **darshan** » 04 Sep 2020 18:06

Delhi: Doctor and 2 of his aides arrested for forging Coronavirus test reports, have duped 75 people so far
https://www.opindia.com/2020/09/delhi-d ... le-police/
The Delhi police have apprehended a doctor and his aides from Malviya Nagar area of South Delhi for allegedly forging Coronavirus test reports. According to reports, the gang has duped at least 75 people so far. After the arrest, DCP South said: “It was a nexus. Dr Kush Parashar confessed that he, his associate and helper collected samples, destroyed them without testing and issued forged reports of 4-5 reputed labs to the people.”

vijayk · Post by **vijayk** » 04 Sep 2020 21:53

https://www.cnbc.com/2020/09/04/russian ... -says.html
Russia’s potential coronavirus vaccine shows ‘no serious adverse’ effects and creates antibody response: The Lancet study

Early results from trials of Russia’s potential coronavirus vaccine show no major negative side effects, a study published in the peer-reviewed medical journal The Lancet revealed Friday.

Doctors involved in the trials conducted “two open, non-randomised phase 1/2 studies at two hospitals in Russia,” on 76 healthy volunteers aged 18 to 60, the Lancet article said. It added that the vaccine formulations tested were “safe and well tolerated.”

“The two 42-day trials – including 38 healthy adults each – did not find any serious adverse effects among participants, and confirmed that the vaccine candidates elicit an antibody response,” the study’s authors wrote.

It added: “Large, long-term trials including a placebo comparison, and further monitoring are needed to establish the long-term safety and effectiveness of the vaccine for preventing COVID-19 infection.”

The Lancet is one of the world’s oldest medical journals, with editorial offices in New York, London and Beijing.

sudarshan · Post by **sudarshan** » 05 Sep 2020 04:57

Daily deaths have been flat in India for two to three weeks now. Cases are still going up, at almost 90K per day now. Testing is also going up (I checked the numbers). Got to check the positivity fraction, currently around 8%, but the trend is what is important. Those are the raw facts, not doing any conclusions for now, will wait a week or two more.

Manish_P · Post by **Manish_P** » 05 Sep 2020 14:29

Coronavirus: Tests 'could be picking up dead virus'

The main test used to diagnose coronavirus is so sensitive it could be picking up fragments of dead virus from old infections, scientists say.

Most people are infectious only for about a week, but could test positive weeks afterwards.

Researchers say this could be leading to an over-estimate of the current scale of the pandemic.

But some experts say it is uncertain how a reliable test can be produced that doesn't risk missing cases.

Prof Carl Heneghan, one of the study's authors, said instead of giving a "yes/no" result based on whether any virus is detected, tests should have a cut-off point so that very small amounts of virus do not trigger a positive result.

He believes the detection of traces of old virus could partly explain why the number of cases is rising while hospital admissions remain stable.

greatde · Post by **greatde** » 05 Sep 2020 18:02

There should be a food revolution in India. So much pre-existing conditions including obesity, diabetes etc. That has possibly made the Covid crisis worse, and it's both extremes where there is malnutrition and then chronic illness. Many heavy butter, ghee, fried stuffs people eat everyday

vijayk · Post by **vijayk** » 05 Sep 2020 18:14

A good first hand experience with covid19 chronicled by Kiran Mazumdar of Biocon:

Covid19 Diary

My first symptoms were a mild feverish feeling late evening on 16th August. I had felt similar symptoms in early June and I tested negative so I just took a Crocin n thought it would take care of it. The next morning though, I continued to feel feverish n I measured it - 99 F. That’s when I decided to test myself and my entire household as I have my 89 year old mother, a cancer survivor and my 71 year old husband, a cancer patient to worry about. I immediately self quarantined in a separate room and waited anxiously for the test results. At 5 pm I was told that I tested positive but that everyone else at home including my staff tested negative. Mercifully, the virus spared my mom and my husband. I asked for the CT (Cycle Threshold) value to assess my viral load and when I saw it was 23, I felt the load was safe enough to be home quarantined under tele-supervision. Dr Murli Mohan from Narayana Health, Bengaluru and Dr Shashank Joshi from Lilavati hospital, Mumbai, were my key medical supervisors. I was put on a course of Favipiravir, azithromycin and paracetamol. Apart from this, I continued with my daily dose of Vit C, Vit D, Zinc, baby aspirin and chyavanprash! Not to mention my twice a week 200mg dose of HCQ! Day 2 & 3 were uneventful. I was measuring my oxygen saturation levels 6 times a day which were all between 96-98% even after a brisk 6 minute walk. My temperature was normal but late evening on Day 3, I felt fluish n it extended to Day4 & 5. No measurable temperature but frequent bouts of sweating which suggested that my body was fighting the virus. I was also tracking my Cytokine levels. My cRP was normal at <0.5 throughout the infected period which indicated no inflammation. My D-Dimer and Ferritin levels were also within normal range. I also tracked my cytokine levels especially IL-6 which were undetectable. By Day 6, I started feeling better. My rtPCR test on Day 10 was still positive but with a CT value of 33 suggesting a very low and non infectious viral load generally attributed to dead virus shedding. I also tested my blood for antibodies n T-cells on Day 9. IgM was noticeably present but not IgG. My innate immune response based on Dendritic and NK cells was strong. A robust T cell activation was observed in my sample with a higher frequency of antigen specific T cells, effector T cells,Memory T cells and cytokine release on stimulation. I basically had developed T Cell immunity which could potentially protect me for a long duration. On Day 12 My rtPCR test was positive with a CT value of 36 heralding the final leg of my Covid19 saga!

My experience has been mild and uneventful. No loss of smell or taste n no drop in oxygen saturation. I recommend to everyone with mild fluish symptoms to test and decide on hospitalisation or home quarantine based on viral load: CT values <20 with fever ought not to home isolate. Monitoring oxygen saturation several times a day is psychologically good for your virus fighting morale. I also recommend that you try and exercise or go for a short walk every day to keep fit. I did not experience any loss of appetite and I suggest a diet of fruit, vegetables, lentils and cereal. Soups and salads were a daily feature for my meals. My constant companions were NETFLIX n Amazon Prime; avoid TV and social media as negative news are bad for fighting Covid19! My simple learnings:

1. Don’t panic on testing positive.
2. Make sure you assess your viral load based on CT value.
3. Mild symptoms with moderate viral load qualifies for home isolation.
4. Monitor your oxygen saturation several times a day to ensure it doesn’t drop below 95%
5. Make sure you are supervised by a doctor through a Telehealth program.
6. Do yoga and walk as much as you can.
7. Your body will fight the virus in a week.
8. Doctors should not just treat clinical Symptoms but rather the cause of the symptoms. Eg If SpO2 reduces, just increasing oxygen flow is not the answer. Treating inflammation caused by cytokines is the answer.
9. Lack of early intervention in mitigating the inflammation n cytokine storm can cause post Covid 19 fatigue and respiratory ailments.
10. Finally, please test and present yourself as soon as you feel mild symptoms. Do not be in denial n wait for more severe symptoms. You have reduced your chances of a mild disease by doing so.

Leveraging science to manage the virus is the only reliable way forward.

In June I was half hoping that I contracted COVID-19 to overcome the paranoia and the suspense that has taken over our lives. I was also expecting the infection to be mild n short lived. My Covid19 experience has matched these expectations and I hope that it allays the fear of the virus.

chola · Post by **chola** » 05 Sep 2020 18:19

greatde wrote:There should be a food revolution in India. So much pre-existing conditions including obesity, diabetes etc. That has possibly made the Covid crisis worse, and it's both extremes where there is malnutrition and then chronic illness. Many heavy butter, ghee, fried stuffs people eat everyday

To be perfectly honest, Indian food is very healthy compated most other cultures'.

The death rate is low because the population overall is young and healthy. The problem is the spread and that has to do with economics, social behavior and hygiene not the diet.

The truth is you can stop this thing in its track with just masks and social distancing if everyone does it. But making 100 out of 100 desis follow this is like herding cats. And then there are those who simply can't social distance because of economic condition -- many migrants must room together in cities because of cost and their jobs almost always require physical interactions.

greatde · Post by **greatde** » 05 Sep 2020 18:33

chola wrote:
greatde wrote:There should be a food revolution in India. So much pre-existing conditions including obesity, diabetes etc. That has possibly made the Covid crisis worse, and it's both extremes where there is malnutrition and then chronic illness. Many heavy butter, ghee, fried stuffs people eat everyday
To be perfectly honest, Indian food is very healthy compated most other cultures'.

The death rate is low because the population overall is young and healthy. The problem is the spread and that has to do with economics, social behavior and hygiene not the diet.

The truth is you can stop this thing in its track with just masks and social distancing if everyone does it. But making 100 out of 100 desis follow this is like herding cats. And then there are those who simply can't social distance because of economic condition -- many migrants must room together in cities because of cost and their jobs almost always require physical interactions.

Homefood is relatively healthy. Yet, it is the lifestyle which has to be optimized . Many eat a lot of outside food regularly, and those vendors use bad oil, butter and unhealthy ingredients. There is a great number of people with chronic illness and so, it is definitely a big issue. Additional, we don't fully know the long term impact of Covid, like there are studies showing those infected yet recovered do suffer heart damage etc. And then, there is the malnutrition also affecting a larger number of population.

Ambar · Post by **Ambar** » 05 Sep 2020 19:14

greatde wrote:There should be a food revolution in India. So much pre-existing conditions including obesity, diabetes etc. That has possibly made the Covid crisis worse, and it's both extremes where there is malnutrition and then chronic illness. Many heavy butter, ghee, fried stuffs people eat everyday

If you look at the old pictures/videos from 1970s to 1990s India and today's India, i think the average urban Indian is almost 1 1/2 to 2 times the size we were back then. Much of it has to do with with increasing income and calorie rich food which comes with it. Unfortunately this has also brought with it chronic illness such as diabetes, high BP etc. What's making matters worse is our dust, pollution and ill-planned cities which have led to poor lung health even among young people. We really need to go back to the vedic food traditions where diary was rarely used and the diet was entirely plant based.

Sadly, 99% of us in India don't have access to the kind of healthcare that Kiran Mazumdar does, so her experience and that of a regular person like me will be entirely different. We are making the suffering many of a times worse by inflicting self-wounds. Why are hospitals/nursing homes asking fully pregnant women to get covid -ve certificate before admitting them ? So many horror stories of women giving birth on the road or bleeding out without care. After overtaking Mexico last week, we have rapidly reached 4 million cases today and will overtake Brazil for the 2nd highest number of cases in the world within a day or two. I think in less than 2 months time we will likely overtake US as well to be no.1 in overall cases.

I hope i am wrong but i think we are underestimating the political ,economic and security fallout from this crisis in the days and months to come.

sudarshan · Post by **sudarshan** » 05 Sep 2020 22:04

LOL, billionaire's perspective on COVID! What are the masses in India to do? Or even the upper middle class? Get tested at the first sign of trouble, monitor SPO2 (this might be doable), telehealth(!!), diet of fruit, vegetable... good if one can pick and choose one's diet of course, treatment regimen, asking for and getting info(!!) on viral load. If you can do all that, good chance of getting away with mild disease. If not, Ram Bharose onlee.

Cyrano · Post by **Cyrano** » 05 Sep 2020 23:57

Sudarshan ji,
What Kiran M has done in terms of home quarantine and eating better is definitely accessible to many Indians, certainly most middle class folks as well. Fruit, veggies, rice, dal, roti are basic staples in Indian diet. Not sure why you think thats not the case.

Most of the medicines in her protocol can be had as fairly cheap generics except perhaps Favipiravir whose price is about 100Rs / tablet. Even that is not horrendously expensive. What is hard to get is good tele medicine, what is uber expensive is private hospitalisation.

My uncle and aunt both 65+ who live in Vizag got the Covid symptoms, got tested and were found positive. My aunt recovered in a week's time, her symptoms, protocol and recovery were pretty similar to Kiran M's.

My uncle suffered more and after a week at home had to be hospitalised when he complained of stomach pains. We have doctors in the family and therefore connections to get an ICU bed in a private hospital, and my uncle got admitted there. Once you are Covid +ve and in special ward/ICU no one outside knows whats going on. His ulcers had flared up. They put him on to heavy painkillers and oxygen and let him like that for 3 days. When the docs in my family followed up they were very pissed, got him tested again, this time he tested -ve and was discharged. They got him an appointment with a gastroenterologist and then got him back home for 1 more week of home quarantine to be sure.

Hospital bill for 3 days : 1 lakh 30 thousand.

No doc in our families wants to argue with the hospital on the bill. Anyway it was paid when the patient was discharged. I haven't seen the bill myself, but I've been told it has PPE kits, huge no of disposables, each check with finger pulse oximeter is charged at 1500Rs etc etc. Pure and simple burglary.

Doctors & hospital staff might be putting their lives in danger but hospital managements seem to be skinning people alive or dead.

vijayk · Post by **vijayk** » 06 Sep 2020 00:09

https://www.the-scientist.com/news-opin ... -19--67876

Is a Bradykinin Storm Brewing in COVID-19?
Excess of the inflammatory molecule bradykinin may explain the fluid build-up in the lungs of patients with coronavirus infections. Clinical trials of inhibitors are putting this hypothesis to the test.

Jacobson followed this abnormal RAS in the lung fluid samples to the kinin cascade, an inflammatory pathway that is tightly regulated by the RAS. He found that the kinin system—in which a key peptide, bradykinin, causes blood vessels to leak and fluid to accumulate in tissues and organs—was thrown out of balance as well in COVID-19 patients. Infected individuals showed heightened expression of genes for the bradykinin receptors, as well as for enzymes called kallikreins that activate the kinin pathway, compared with controls.

The results, published July 7 in eLife, could perhaps explain the abnormal accumulation of fluid in the lungs that is so common in COVID-19 patients, the authors say.

Unbeknownst to Jacobson, Frank van de Veerdonk, an infectious disease specialist at the Radboud University Medical Center in the Netherlands, was heading down the same molecular pathway in mid-March. He had noticed two features in COVID-19 patients in his clinic—fluid in the lungs and inflammation. Because other labs had pegged angiotensin-converting enzyme-2 (ACE2), a key enzyme in the RAS, as being the SARS-CoV-2 receptor, and because he knew that ACE2 regulates the kinin system, van de Veerdonk began connecting the dots. In April, he and his group hypothesized that a dysregulated bradykinin system was leading to leaky blood vessels in the lungs and perhaps causing excess fluid to build up.

See “Receptors for SARS-CoV-2 Present in Wide Variety of Human Cells”

Josef Penninger, director of the Life Sciences Institute at the University of British Columbia in Vancouver who discovered that ACE2 is the essential in vivo receptor for SARS, tells The Scientist that he is convinced that bradykinin plays a role in COVID-19 pathogenesis. “It does make a lot of sense.”

He adds that Jacobson’s study lends support to the hypothesis, but further confirmation is needed. “Gene expression signatures don’t tell us the whole story. I think it is very important to actually measure the proteins.”

van de Veerdonk recognizes that peptide levels need to be measured and is currently setting up mass spectrometry to measure kinins in the plasma, which have a half-life in plasma of just a few seconds.

van de Veerdonk’s group is also testing the plasma kallikrein inhibitor (which is being supplied by Takeda, a company that also manufactures icatibant) in a multicenter clinical trial in the Netherlands in hospitalized COVID-19 patients receiving supplemental oxygen, to see whether the drug decreases the need for oxygen.

If all goes well for van de Veerdonk and his team, lanadelumab will be integrated into the REMAP-CAP trial that is evaluating several drugs for community-acquired pneumonia in thousands of patients across several countries and includes COVID-19 patients in one arm.

Kaplan has his reservations, and notes that using the monoclonal antibody against plasma kallikrein in COVID-19 could be interesting, but if it turns out that tissue kallikrein is more important in the disease, it won’t work.

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https://www.the-scientist.com/news-opin ... -who-67910
Steroid Drugs Are an Effective Treatment for Severe COVID-19: WHO
A meta-analysis of seven randomized controlled trials concludes that dexamethasone and other corticosteroids reduce 28-day mortality in seriously ill patients.

Dexamethasone and other corticosteroid drugs are effective treatments for seriously ill COVID-19 patients, according to a meta-analysis of seven randomized controlled trials including a total of more than 1,700 participants. The analysis, conducted by a team at the World Health Organization (WHO) and published yesterday (September 2) in JAMA, concluded that the drugs reduced the risk of dying within 28 days compared with standard care or placebo. The organization has issued new guidelines recommending use of the drugs in the treatment of patients with severe or critical COVID-19.

“Steroids are a cheap and readily available medication, and our analysis has confirmed that they are effective in reducing deaths amongst the people most severely affected by Covid-19,” Jonathan Sterne, a professor of medicine and epidemiology at Bristol University who helped conduct the meta-analysis, tells The Guardian. “The results were consistent across the trials and show benefit regardless of age or sex.”

sudarshan · Post by **sudarshan** » 06 Sep 2020 00:34

Amar_P (CyranoDB - whichever you prefer) - I was talking more of the following:

If somebody has a temperature of 99F (but no other symptoms) and goes asking for a COVID test, is that person going to get it? Can that person also get family members tested on that basis? Kiran M can demand tests for all her household and get them, but AFAIK, India or US, you can't just "show up at the first symptom and get tested, just to be safe" like Kiran M is recommending, especially if that first symptom is a temperature less than 100F (that's the guideline in the US I think). As you say, telemedicine is pretty hard to get in India, especially for the poorer folks. Volunteers could show up with pulse oximeters to get the SPO2, so that is doable. Diet should be mostly fine, as you say, fruits/ veggies aren't too much of a problem. But what info is a person going to get, if (s)he goes asking for the viral load factor? Blank looks? Does one get to decide whether or not to home quarantine (based on the viral load factor, as Kiran M says) if one doesn't have some kind of influence, doesn't have to be a billionaire's influence?

Like you said, in India, once the person gets shut up in a hospital for COVID, info is hard to come by, and it's Ram Bharose for the relatives after that. Parts of the protocol are fine and doable, the rest seem impossible for the lower sections at least. And the protocol is also imposed - in a hospital in India if one goes saying "I take these vitamins daily and also do yoga, and want to continue with that," will that work? Even required medications might be a stretch here, no way for the family to verify if the patient is continuing to receive those. How about walking and yoga - fine if one is at home.

The disease can very much be overcome with little discomfort, if one gets to choose based on good info. Most people also overcome it with little discomfort otherwise, but that's still Ram Bharose (luck of the draw on not getting too much of a viral load), it's fortunate that it works that way in most cases.

What Ms. Mazumdar writes is all very low effort-high impact items, it is commendable that a billionaire came up with such a down-to-earth list. I was just commenting on the fact that such basic common sense seems to be out of reach for most of the population, whereas a billionaire can get it done. If state and local govt.s would focus on this kind of action item list, rather than on knee-jerk lockdowns, we could get this under control. Telemedicine is a stretch, but arranging for door-to-door volunteers to implement some of these action items is definitely doable. We would not get the case load under control of course (is there really a need to reduce case load?), since this is a treatment protocol, not a prevention one, but the deaths tally, hospitalizations, and incidences of severe disease could be much reduced, I'll wager. And that is the important thing.

Ambar · Post by **Ambar** » 06 Sep 2020 02:45

Just to add , Kiran Mazumdar's journal has her getting rtPCR tests almost every couple of days ! Us aam janta will get one at the beginning to find out if its covid, and in most places this involves standing upto 4-5 hrs in crammed corridors of a govt facility with other suspected cases. Also, the interlukin-6 test is not performed in labs in tier-2 cities (so lets forget about smaller towns/villages), speaking from personal experience, we were lucky to find a lab that had the ability to collect the sample and ship it to another lab in a metropolitan city, and we received the result after a day. Here she is talking about multiple anti-body tests so she can self-monitor her IL-6, cytokine levels, T-cell response etc. We are in a situation where most poor and middleclass are dying unable to find a bed in a hospital or unable to afford a place in pvt hospitals, so lets forget about having a sophisticated lab readily available to perform all sorts of tests at the snap of your fingers. Only her advise on diet and monitoring 02 levels is perhaps practical for atleast the middleclass , the rest is just wishful thinking.

vijayk · Post by **vijayk** » 06 Sep 2020 03:56

Why is Pakistan having so many low cases? Why is China back to normal while other European countries have second waves?

CT: Possibly China has made vaccine and using it on Chinese and Pakistani citizens where as countries like Pakistan w/o Phase 3 or approvals.

In countries like US/India, every thing is politicized by people on the left by casting aspersions on institutions scaring any short cuts to reap political benefits

https://www.theguardian.com/us-news/202 ... p-election

Kamala Harris says she wouldn't trust Trump on safety of Covid vaccine before election
Democratic vice-presidential nominee told CNN she worried of potential for political interference by Trump to boost re-election

Look at the bad press by leftists scums including politically left calling Putin names and making jokes on Trump but here is the real news:

https://www.bbc.com/news/world-europe-54036221
Coronavirus: Russian vaccine shows signs of immune response

https://www.cnn.com/2020/09/04/health/r ... index.html
Russia's Covid-19 vaccine generated an immune response, study says

This is the same thing they did on HCQ. Look at Kiran M ... she was taking HCQ + Azithromycin + Zinc + D + C

https://www.livescience.com/china-appro ... rkers.html
China started giving experimental COVID-19 vaccine to medical workers in July

Clinical trials that would show whether the vaccine works have not been completed.

DavidD · Post by **DavidD** » 06 Sep 2020 08:16

Showing an immune response doesn't mean much, as that's something which is studied beginning in the earliest testing phase, starting with animal tests. A vaccine is usually only approved if the immune response translates to significant immunity, which is the primary focus of Phase 3 trials. Phase 1 and 2 are focused on safety, side effect profile, immune response, etc. The Russian vaccine is not criticized because of its dangers or its lack of efficacy--we don't know about those things yet--it's criticized because it's approved before it even started Phase 3 trials. As far as I can recall, no vaccine had been approved anywhere without concluding Phase 3 trials prior to the Russian vaccine.

The Oxford and the Sinovax vaccines released their Phase 2 results quite a few months ago, and both are still at least months away from concluding Phase 3 studies and thus government approval. The Russian vaccine had just concluded Phase 2 trials and Russia has already approved it for use on the general population. At that stage, experimental use in special cases are done quite often, but using it on the general population had no recent precedence to my memory.

Ambar · Post by **Ambar** » 06 Sep 2020 08:30

There are truly some very callous people among us. Maybe China was able to contain the virus because they were so ruthless in imposing restrictions ? Here we are clocking near 100k new cases/day and 1000 deaths per day and this is how our public is taking precautions -

https://twitter.com/ANI/status/1302423954850676736

sum · Post by **sum** » 06 Sep 2020 12:30

Honestly, when something streches over 5 -6 months and no real end in sight, cant expect 1 Billion folks to be cooped up and following "social distancing" in a super dense and unplanned ( where there will be 1 park for whole city) place like ours
Fatigue will set in and its something unavoidable IMHO

My only worry is the poorest section ( and that is a huge section) is really being pushed to the brink with the cutdown in their livelihood due to COVID restrictions. I just hope and pray it doesnt lead to spike in crime rates due to so many desperate folks

Karan M · Post by **Karan M** » 06 Sep 2020 12:53

amar_p wrote:Sudarshan ji,
What Kiran M has done in terms of home quarantine and eating better is definitely accessible to many Indians, certainly most middle class folks as well. Fruit, veggies, rice, dal, roti are basic staples in Indian diet. Not sure why you think thats not the case.

Question is whether she was already on HCQ 2x a week or did it start after diagnosis? If from before itself, it could have contributed to a low viral load but also, by itself it didnt prevent infection but reduced its severity.

Karan M · Post by **Karan M** » 06 Sep 2020 12:55

Ambar wrote:There are truly some very callous people among us. Maybe China was able to contain the virus because they were so ruthless in imposing restrictions ? Here we are clocking near 100k new cases/day and 1000 deaths per day and this is how our public is taking precautions -

https://twitter.com/ANI/status/1302423954850676736

I look at these a-holes and wonder what India did to deserve such morons.

Raja · Post by **Raja** » 06 Sep 2020 13:24

vijayk wrote:
In countries like US/India, every thing is politicized by people on the left by casting aspersions on institutions scaring any short cuts to reap political benefits

It is not about left and right. There are safety protocols established based on decades of medical experience. When someone says, "Wait a second, you cannot claim that a vaccine is safe before it goes through all the tests" - it does not mean that they are being political, it just means that they know what they are talking about. Medical history is full of stupid mistakes which caused even more suffering because we did not know better.

Also, there is no Chinese vaccine being used in Pakistan. Either Pakistani numbers are totally b.s. (due to low testing) or shocker, they managed to do something right somehow. Pakistan is not the only poor country that seems to be doing okay on the surface. Maybe, just maybe, things were not handled correctly in India?

chola · Post by **chola** » 06 Sep 2020 14:10

^^^ The chinis are slated to start ~~experimenting~~ testing in Pakiland soon. Also Bangladesh.

https://www.reuters.com/article/us-heal ... SKBN25W0BA

BEIJING (Reuters) - China National Biotec Group (CNBG) and Sinovac Biotech Ltd said on Saturday they have each found two more countries to run late-stage clinical tests of their coronavirus vaccine candidates, as China steps up its efforts in the global race.

Serbia and Pakistan have agreed to participate in the Phase 3 trials of CNBG’s vaccine candidates while Sinovac has received approval from Turkey and Bangladesh. The two companies are seeking more data from overseas as new cases in China are dwindling.

...

CNBG’s Phase 3 trials are expected to involve 50,000 people in about 10 countries, said CNBG vice president Zhang Yuntao. Trials have already begun in United Arab Emirates, Bahrain, Peru, Morocco, Argentina and Jordan.

...

Sinovac’s vaccine candidate CoronaVac, being tested in Brazil and Indonesia, also obtained approvals from Turkey and Bangladesh for Phase 3 trials, Sinovac CEO Yin Weidong told Reuters on Sunday.

Cyrano · Post by **Cyrano** » 06 Sep 2020 14:37

Sudarshan,

"If somebody has a temperature of 99F (but no other symptoms) and goes asking for a COVID test, is that person going to get it? Can that person also get family members tested on that basis? "

Yes, it is possible in Hyd now to get an on demand test. Rs 3000 for a test. If they collect swab from your home, they are charging Rs 500 extra. My nephew (kid) had a throat infection and was tested as precaution. He came out -ve (no Covid). If this is the case in Hyd, I'm guessing it should be possible to get an on demand test in most big cities and towns.

While most people billionaires or not, will not be as knowledgeable as Kiran M to ask for specific tests and track the disease evolution so carefully, I'm actually glad that she did and shared her experience. Will definitely help others if they are obliged to deal with it.

Cyrano · Post by **Cyrano** » 06 Sep 2020 14:49

Karan M wrote:
amar_p wrote:Sudarshan ji,
What Kiran M has done in terms of home quarantine and eating better is definitely accessible to many Indians, certainly most middle class folks as well. Fruit, veggies, rice, dal, roti are basic staples in Indian diet. Not sure why you think thats not the case.
Question is whether she was already on HCQ 2x a week or did it start after diagnosis? If from before itself, it could have contributed to a low viral load but also, by itself it didnt prevent infection but reduced its severity.

Quite possible that she was taking HCQ prophylactically. But you'll have to ask her

Here in France, Prof Didier Raoul is getting (HCQ)rucified for his papers, media interventions and stance. France Health Minister has hung him out to dry. His papers are being accused as insufficient to make claims, his methods are being questioned, overall the French medical and health community seems to have turned against him. In this noise about HCQ as "treatment", its virtues as a prophylactic are being ignored. I havent read up enough on the latest developments to comment on the matter, just reporting whats happening.

DavidD · Post by **DavidD** » 06 Sep 2020 15:46

amar_p wrote:
Karan M wrote:
Question is whether she was already on HCQ 2x a week or did it start after diagnosis? If from before itself, it could have contributed to a low viral load but also, by itself it didnt prevent infection but reduced its severity.
Quite possible that she was taking HCQ prophylactically. But you'll have to ask her

Here in France, Prof Didier Raoul is getting (HCQ)rucified for his papers, media interventions and stance. France Health Minister has hung him out to dry. His papers are being accused as insufficient to make claims, his methods are being questioned, overall the French medical and health community seems to have turned against him. In this noise about HCQ as "treatment", its virtues as a prophylactic are being ignored. I havent read up enough on the latest developments to comment on the matter, just reporting whats happening.

Have you read his papers? The methods are objectively quite poor. Here's the paper:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102549/

Just off the top of my head, some issues with this paper:

1) There was no real control group. Part of his control group were a bunch of patients who did not even participate in the study.
2) There was no randomization. They basically offered HCQ to everyone, and those who refused became a part of the control group.
3) It was a small study, only 36 patients total, 20 in the HCQ arm and 16 in the control arm.
4) An important fact that's glossed over in the study is that 4 patients, or 1/5 in the HCQ group were "lost to follow up" because...drum roll...1 died and 3 ended up in the ICU. None were lost in the control group.
5) Azithromycin was not randomly added, but done so under clinician discretion. Again, a lack of randomization makes this data rather useless.

Now, given the timing and urgency at the publication time of this paper, even a paper of such poor quality is helpful. It suggested that we should look into HCQ and/or Azithromycin more, which the world did, and data has been somewhat mixed. I'm not ready to call it one way or another, I think more studies are needed, but I'd like to make it clear that Dr. Raoul's paper does not have the quality to change most clinicians' practice at the present time.

vijayk · Post by **vijayk** » 06 Sep 2020 16:23

Raja wrote:
vijayk wrote:
In countries like US/India, every thing is politicized by people on the left by casting aspersions on institutions scaring any short cuts to reap political benefits

It is not about left and right. There are safety protocols established based on decades of medical experience. When someone says, "Wait a second, you cannot claim that a vaccine is safe before it goes through all the tests" - it does not mean that they are being political, it just means that they know what they are talking about. Medical history is full of stupid mistakes which caused even more suffering because we did not know better.

Also, there is no Chinese vaccine being used in Pakistan. Either Pakistani numbers are totally b.s. (due to low testing) or shocker, they managed to do something right somehow. Pakistan is not the only poor country that seems to be doing okay on the surface. Maybe, just maybe, things were not handled correctly in India?

I am referring to pre-emptive politics

For example, Kamala started her politics even before phase 3 results are even announced

darshan · Post by **darshan** » 06 Sep 2020 19:19

I'm not sure why people even think of pakistani numbers. Out of desperation? All of middle east have had strictest rules for pakis throughout the saga. Who else would know more about them than their masters?