Wuhan Coronavirus Resource Thread

[kvraghav]

Looks like plasma therapy had positive results in Delhi. The patient was off ventilator on 18th and making good recovery. This might trigger a rush for off label use.

[Aarvee]

Can I get an opinion from the clinicians in this forum?

Detection of SARS-CoV-2 in Different Types of Clinical Specimens
https://jamanetwork.com/journals/jama/f ... le/2762997

Suggests that the viral RNA is detected in only 1% of the bloods tested.

Detection results by RTqPCR:
Bronchoalveolar lavage fluid(93%, n=15), Sputum(72%, n=104), Nasal swab(63%, n=8), Fibrobronchoscope brush biopsy(46%, n=13), Pharyngeal swab(32%, n=398), Feces (29%, n=153) blood(1%, n=307) and Urine (0%, n=72)

We've never made a successful vaccine for a coronavirus before. This is why it's so difficult
https://www.abc.net.au/news/health/2020 ... r/12146616

Ian Frazer, the scientist who developed the HPV vaccine successfully suggests the reason we've never previously been able to develop a Coronavirus vaccine is because its site of replication (alveolar surfaces) are poorly serviced by the humoral immune system.

Now, over a 100 vaccine candidates are being trialed in the world and most of them are subunit vaccines or rDNA vaccines. Would they be efficacious either in the long term or long term?

[pgbhat]

^ Good thread on twitter which talks about on vaccination coverage for corona and flu.

https://twitter.com/PeterKolchinsky/sta ... 7958545410

I’m a virologist & investor... & I’m hearing people say it’s impossible to make covid vaccine b/c we haven’t been able to make one to any coronaviruses. Not true. We have veterinary vaccines for dog & cow strains. Human one’s not been investment worthy, until now. here’s why...

There are 4 coronavirus strains that circulate amongst humans causing nothing more than mild colds in most people. They stimulate a modest immune response- enough to get over an infection and leave you protected for about a year, maybe more. But eventually antibodies wane...

And that’s when you become susceptible to reinfection by same virus. So why haven’t we developed a vaccine against these 4 coronavirus strains? We could take it every year and protect ourselves against colds, right? That’s a nice idea but most colds are caused by other viruses...

Our four standard human coronaviruses only cause 20% of colds. Colds are mostly caused by rhinoviruses, RSV, parainfluenza virus (not same as influenza), and other viruses we haven’t even identified yet. They are all so different that each would require a different vaccine.

So while we could have made a coronavirus vaccine (which really would have had to be four vaccines, one for each strain), the trouble is that it would have only helped protect you against 20% of the viruses that cause colds.

It would be difficult and expensive to run a clinical trial that showed that the coronavirus vaccine worked because even if it reduced your risk of suffering a coronavirus-mediated cold by 75%, that would cut the risk of any cold by only 15% (75% of 20%).

It would be a large trial so that this 15% reduction would be statistically significant. But it’s doable. Bigger problem is the marketing message of 15%. Adults get 2-4 colds a year, so a 15% reduction doesn’t even add up to 1 fewer cold per year. Not very compelling, right?

The commercial product people want is not a coronavirus common cold vaccine. They want a COMMON COLD vaccine that protects them against most of their risk. For that, vaccine would have to protect against most cold viruses (and we don’t even know what causes 30% of colds).

[shaun]

The extent of infection in Bengal can be gauged by the positive cases coming up in the neighbouring states , Odisha which have done double the testing than WB have this to say ..
10 of 13 Covid-19 positive cases in Odisha has Bengal connect; alert sounded

https://www.hindustantimes.com/india-ne ... 3xyWK.html

[g.sarkar]

https://www.bbc.com/news/world-us-canada-52359100
Coronavirus lockdown protest: What's behind the US demonstrations?
20 April 2020
Across the country, groups of Americans are taking to the streets in protest of lockdown orders aimed at limiting the spread of Covid-19. Why?
The US now has over 761,000 cases and more than 40,000 deaths, with numbers still rising, though signs have emerged that infection rates are slowing in some states. Some states are beginning to ease restrictions, re-opening parks, beaches and some small businesses in the coming days, but most of the US remains under some form of stay-at-home order. In over a dozen states from coast to coast, protesters have taken to the streets, blocking roads and honking car horns.
Why are they protesting?
Those taking to the streets say that the stringent measures restricting movement and businesses are unnecessarily hurting citizens. Protesters say the stay-at-home measures imposed by state governments to control the spread of Covid-19 are an overreaction. Some have also come bearing firearms as gun rights groups have been among the organisers, citing infringements on civil liberties. Some also say keeping these restrictions in place too long will cause long-term damage to local economies. As of last week, the total number of unemployment claims in the nation reached over 22 million - overturning decades of US job growth. Many cite President Trump's caution that the cure cannot be worse than the disease itself.
.....
Gautam

[Aarvee]

^ Good thread on twitter which talks about on vaccination coverage for corona and flu.

https://twitter.com/PeterKolchinsky/sta ... 7958545410

I’m a virologist & investor... & I’m hearing people say it’s impossible to make covid vaccine b/c we haven’t been able to make one to any coronaviruses. Not true. We have veterinary vaccines for dog & cow strains. Human one’s not been investment worthy, until now. here’s why...

........

Saar, I have a PhD in virology too. what he says is true to a large extant i.e. not having a vaccine against common cold causing viruses. But the science about the virus's tissue etiology, its replication sites and the kind of immune reaction needed is still valid. Route of administration of the vaccine candidate so it raises the immune reaction at the right location etc is important. Also, with this virus it looks like the immune reaction is causing as much harm if not more as the virus it self. So the vaccine has to make sure it doesnt cause additional problems.

Look at this monoclonal antibody therapy trial that crushed the biotech boom.

https://www.ncbi.nlm.nih.gov/pubmed/16908486

A LOT of vaccine candidates fail at trial stage. Either the antibodies raised do not neutralise the virus effectively or some dont even elicit sufficient immune response. I would be happy if one of the vaccine candidates being tested actually work and give long term protection.

Without revealing too much, my PhD was in a BSL4 facility (although my work was only in BSL3). A lot of collaborations with the Wuhan lab , not my project but others.

[DrRatnadip]

I think every death in confirmed hotspots should be notifiable.. There are unconfirmed reports of significantly more than usual burials in such areas.. If we miss those cases , even longest and most stringent lockdown will not work..

[chola]

A LOT of vaccine candidates fail at trial stage. Either the antibodies raised do not neutralise the virus effectively or some dont even elicit sufficient immune response. I would be happy if one of the vaccine candidates being tested actually work and give long term protection.

Without revealing too much, my PhD was in a BSL4 facility (although my work was only in BSL3). A lot of collaborations with the Wuhan lab , not my project but others.

Saar, you guys have collaborations with a chini bioweapons lab?!

[Aarvee]

Saar, you guys have collaborations with a chini bioweapons lab?!

Govt-Govt relationships saar. To "help out", similar to what the french have done. Exchange of scientists etc.

edit: No saar for me please.

[Karan M]

I think every death in confirmed hotspots should be notifiable.. There are unconfirmed reports of significantly more than usual burials in such areas.. If we miss those cases , even longest and most stringent lockdown will not work..

There needs to be a statewide lockdown on WB already. Odisha is already seeing a substantial spike in cases via WB. Center needs to step in even more urgently before we have another huge spike in cases like TJ from WB.

[prasannasimha]

^ Good thread on twitter which talks about on vaccination coverage for corona and flu.

https://twitter.com/PeterKolchinsky/sta ... 7958545410........

Saar, I have a PhD in virology too. what he says is true to a large extant i.e. not having a vaccine against common cold causing viruses. But the science about the virus's tissue etiology, its replication sites and the kind of immune reaction needed is still valid. Route of administration of the vaccine candidate so it raises the immune reaction at the right location etc is important. Also, with this virus it looks like the immune reaction is causing as much harm if not more as the virus it self. So the vaccine has to make sure it doesnt cause additional problems.

Look at this monoclonal antibody therapy trial that crushed the biotech boom.

https://www.ncbi.nlm.nih.gov/pubmed/16908486

A LOT of vaccine candidates fail at trial stage. Either the antibodies raised do not neutralise the virus effectively or some dont even elicit sufficient immune response. I would be happy if one of the vaccine candidates being tested actually work and give long term protection.

Without revealing too much, my PhD was in a BSL4 facility (although my work was only in BSL3). A lot of collaborations with the Wuhan lab , not my project but others.

The same happened with the Dengue Virus Vaccine trial - patients had a higher incidence of Cytotoxic storm after vaccination

[hanumadu]

I think every death in confirmed hotspots should be notifiable.. There are unconfirmed reports of significantly more than usual burials in such areas.. If we miss those cases , even longest and most stringent lockdown will not work..

There needs to be a statewide lockdown on WB already. Odisha is already seeing a substantial spike in cases via WB. Center needs to step in even more urgently before we have another huge spike in cases like TJ from WB.

I really hope Hindus in WB are taking care of each other, maintaining social distance and distance from the peaceful community. There won't be any help from the government.

[pgbhat]

Saar, I have a PhD in virology too.

Saar, great field. Great to have your inputs on this.

Look at this monoclonal antibody therapy trial that crushed the biotech boom.

https://www.ncbi.nlm.nih.gov/pubmed/16908486

A LOT of vaccine candidates fail at trial stage. Either the antibodies raised do not neutralise the virus effectively or some dont even elicit sufficient immune response. I would be happy if one of the vaccine candidates being tested actually work and give long term protection.

Thanks for this link... truly scary. Looks like straight out of a star trek episode, where antibodies intended for uber-healthy people start killing regular people by accelerating aging process.

[Aarvee]

Saar, great field. Great to have your inputs on this.

It sure is saar, problem is, funding is always an issue. Some morbid humour- Pandemics like this are good for researchers, funding is assured for a few years. Other wise, there simply arent enough jobs and what ever are available, have low pay and job security.

For example,
https://www.nbcnews.com/health/health-c ... d-n1150091

I too moved onto Cancer genomics as there is more money and opportunities.

[chandrasekaran]

20.04.2020

*Press Release*

TamilNadu Govt Doctors Association (TNGDA) condoles the death of Dr Simon at Chennai due to Covid19 yesterday. He got infected when he unsuspectedly treated at patient.

TNGDA condemns the the action of unruly mob preventing the burial of Dr Simon yesterday. The TNGDA demands and regrets that this being the third such incident of problems with the burial of doctors, Govt should have provided adequate security. Tngda demands stern action against these persons under stringent acts.

The fact is the dead body packed is least infective and the ignorant mob agitating against decent burial needs very stern action. The treatment of even a mild Covid patient is several fold riskier for the HCPs. But still we do the same with dedication and responsibility.

Already the Govt sector is over burdened with Covid and NonCovid emergencies as most private sector institutions have downed their shutters. At this juncture such disheartening incidences will de-motivate the doctors and other HCPs. The TNGDA demands proper action against the perpetrators and protection in all unfortunate future incidents. Why only to Doctors? Is this the reward for our selfless commitment for the fight against the deadly SARS-COV2 virus?

TNGDA cautions the public about the situation if HCPs and other players in this anti-covid war starts thinking about their own safety by this heartless behaviour of certain group.

Govt doctors are risking their own lives with the available poor quality/inadequate protective gears in treating the patients.

Recently many doctors have become positive inspite of wearing protective gears. TNGDA demands supply of proper specified protective gears immediately to all HCPs doing Covid duties. All HCPs should be provided suitable isolated individual accommodation and supply of food and adequate quarantine to reduce the risk of spread during incubation/ asymptomatic period and to reduce the viral load.

Dr K Senthil
State President
TNGDA

More details have emerged on this extremely unfortunate episode. I am adding this message here mainly to set the record straight as the above press release doesn't give any details on who the protestors were.

This link gives the details. https://www.facebook.com/story.php?stor ... 4721232325
Summary is that the Dr was a Roman Catholic, but was taken to a burial ground that was exclusively for CSI members, at Kilpauk. The CSI members protested and denied a burial there. Finally the Doctor's body was taken to Ayanavaram and buried at a burial ground where Hindu's (yes, many Hindu's in TN and KA) bury their dead.

My intention is not to point fingers at any one on this very unfortunate incident. However I am quite sure that this too will be brought up by presstitutes some time later to make Indians and Hindu's guilty.

Request to mod's - If you find this post inappropriate, please delete.

[Lekhraj]

I see a ray of hope here.

https://www.rediff.com/business/report/ ... 200421.htm

In-vitro studies have demonstrated that Interferon alfa-2b has antiviral effect against the novel coronavirus.

[pgbhat]

It sure is saar, problem is, funding is always an issue. Some morbid humour- Pandemics like this are good for researchers, funding is assured for a few years. Other wise, there simply arent enough jobs and what ever are available, have low pay and job security.

These areas are the ones which require significant government commitment to funding. US for all its expertise still has majority of research funded by Private Sector in areas the companies consider that it is "profitable" to invest. Pandemics are probably considered as a "third world" problem and "rare" to pay attention even by government organizations. May be if they had a SARS vaccine by now, it would have probably offered some kind of limited protection against COVID-19 as well. I think for India, it would mean at least in the short/medium term increase the number of health care workers and work towards improving primary health care and fix problems in sanitation and cleanliness. Long term invest in public health and improve facilities in government hospitals such that they should be the first choice for any citizen looking for any kind of consultation on a health related issue.

[nam]

Ian Frazer, the scientist who developed the HPV vaccine successfully suggests the reason we've never previously been able to develop a Coronavirus vaccine is because its site of replication (alveolar surfaces) are poorly serviced by the humoral immune system.

This probably answers the question, which I had in my mind for many days.

If people have to infect others, while being asymptomatic, they should be producing more virus. The question that bothered me, is why is the immunize system not kicking in, as soon as the replication starts?

Looks like the immune system does not detect the replication until it reaches a region, covered well by it. This take 5-7(or 14 days).

It is quite peculiar, that defense against a regular flu kicks in within a day or two, despite using the same path (nose & mouth) to get infected! Why doesn't immunity acts as soon as the replication starts in the nasal cavity or in the throat?

It is as if, the immunity is suppressed, until the virus reaches a certain load or a specific region.

[Gerard]

MIT Professor: Subways Seeded the Massive Coronavirus Epidemic in NYC

The near shutoff of subway ridership in Manhattan – down by over 90 percent at the end of March – correlates strongly with the substantial increase in the doubling time of new cases in this borough. Maps of subway station turnstile entries, superimposed upon zip code-level maps of reported coronavirus incidence, are strongly consistent with subway-facilitated disease propagation. Local train lines appear to have a higher propensity to transmit infection than express lines. Reciprocal seeding of infection appears to be the best explanation for the emergence of a single hotspot in Midtown West in Manhattan.

[Trikaal]

I really hope Hindus in WB are taking care of each other, maintaining social distance and distance from the peaceful community. There won't be any help from the government.

A friend from Kolkata narrated a horrifying incident about a week ago. Their 70 yr old neighbor(who had gone through chemotherapy) had all the symptoms of Covid. Yet they were denied a test. Officals told them "inke liye itna kyu bhaag rhe ho? Thoda toh samay hai, shaanti se raho. Inprr 1 test toh waste nhii krenge hum". This went on for 11 days. Then, suddenly, police took the whole family away to God knows where. They were even patted down to ensure they don't bring their phones. Later, we found out that they were all quarantined. Only people with symptoms were tested. The family moved to a hotel to quarantine themselves cuz the govt facilities were very bad with only 1 meal a day. The govt also wasn't getting the appartment building sanitized so the family paid a private contractor.

[syam]

It is quite peculiar, that defense against a regular flu kicks in within a day or two, despite using the same path (nose & mouth) to get infected! Why doesn't immunity acts as soon as the replication starts in the nasal cavity or in the throat?

HIV is also similar case, right? patient doesn't show anything for months to years. may be some virus are like that?

another theory making rounds is, this strange virus is believed to be key part of some unfinished HIV vaccine. I know next to nothing about virus or medicine/vaccine. please consider these two theories with sack of salt.

[Aarvee]

If people have to infect others, while being asymptomatic, they should be producing more virus. The question that bothered me, is why is the immunize system not kicking in, as soon as the replication starts?

Looks like the immune system does not detect the replication until it reaches a region, covered well by it. This take 5-7(or 14 days).

It is quite peculiar, that defense against a regular flu kicks in within a day or two, despite using the same path (nose & mouth) to get infected! Why doesn't immunity acts as soon as the replication starts in the nasal cavity or in the throat?

It is as if, the immunity is suppressed, until the virus reaches a certain load or a specific region.

Clinicians can correct me if I am wrong here-

I think this depends on the tissue etiology of the virus, i.e. what cells are infected by the virus, it looks like Flu can infect both upper and lower respiratory tract infections. Systemic infections, i.e. a body wide/blood? infections can be typically handled well by humoral/antibody based immunity. But when the infection happens at the surface membranes, like say a skin infection, the cell based immunity needs to handle it.

Most viruses like polio, Hepatitis, rabies etc have to travel to their specific tissue sites for propagation like neural system and liver from their site of ingestion but CoV dont look like they travel far, i.e. mostly lower respiratory infection so it is like a local infection.

These old papers from around the time of original SARS are quite illuminating in this context.

Animal coronavirus vaccines: lessons for SARS.
https://www.ncbi.nlm.nih.gov/pubmed/15742624/

Abstract
Severe acute respiratory syndrome (SARS) emerged in China and spread globally as a human pandemic. It is caused by a new coronavirus (CoV) of suspect animal origin. The emergence of SARS stunned medical scientists, but veterinary virologists had previously recognized CoVs as causing fatal respiratory or enteric disease in animals with interspecies transmission and wildlife reservoirs. Because of its public health impact, major efforts are focused on development of SARS vaccines. Occurrence of CoV disease at mucosal surfaces necessitates the stimulation of local immunity, having an impact on the vaccine type, delivery and adjuvant needed to achieve mucosal immunity. Such immunity is often short-lived, requires frequent boosting and may not prevent re-infection, all factors complicating CoV vaccine design. SARS vaccine efforts should be enhanced by understanding the correlates of protection and reasons for the success or failure of animal CoV vaccines. This review will focus on studies of immunity and protection in swine to the enteric CoV, transmissible gastroenteritis (TGEV) versus the respiratory variant, porcine respiratory CoV (PRCV), comparing live, inactivated and subunit vaccines, various vaccine vectors, routes and adjuvants. In addition avian infectious bronchitis CoV (IBV) vaccines targeted for protection of the upper respiratory tract of chickens are discussed. Unfortunately, despite long-term efforts, effective vaccines to prevent enteric CoV infections remain elusive, and generally live, but not killed vaccines, have induced the most consistent protection against animal CoVs. Confirmation of the pathogenesis of SARS in humans or animals models that mimic SARS may further aid in vaccine design and evaluation.

Coronavirus Pathogenesis and the Emerging Pathogen Severe Acute Respiratory Syndrome Coronavirus
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1306801/

[Aarvee]

HIV is also similar case, right? patient doesn't show anything for months to years. may be some virus are like that?

With HIV infections, the body's innate and humoral immune system do manage to restrict the infection early on but because the genome of the virus is inserted into host cells, the production of new viral particles do not stop and overwhelms the body eventually. A few weeks after original exposure, the patient experiences a flu like illness, which is basically the immune system activating against the virus. After this point the viral load actually goes down because the immune system controls it. But after some time (2-4 years?) the production of the viral particles from the host cells over whelms the system and the viral load goes up.

[Aarvee]

I think this is an interesting/innovative approach

https://timesofindia.indiatimes.com/ind ... 185113.cms

[Sachin]

19 new COVID-19 cases in Kerala on Tuesday.
Some thing seems to be a bit fishy here. Of the 19 new cases reported GoKL says 12 of them were non-resident Keralites who landed from a foreign country. 3 patients had jumped the border check points and came from Tamil Nadu. The last few flights which landed in India, landed some where around 22nd March. So by what means did the 12 odd people land up in Kerala in the recent past? The CM on his press brief said the border check points need to be more vigilant, but did not explain the mysterious case of 12 keralites landing in Kannur and Kasaragode districts.

So is it a case that COVID-19 virus can stay dormant in a person's body for more than 14 days and then reveal itself at a later date of its choosing? Or is it that GoKL now has been taken by surprise, and there could be lots of people who hid their travel history as well as themselves all this while?

[nam]

Ethnic groups are dying & in ICU at a higher percentage compared to White population, in US & UK.

33% of ICU patients are ethnic, for a population of 13-14% in UK!

No yet, fully detailed study as to why, however along with cultural & dietary differences, potentially lack of Vitamin D production, which helps the immune system.

A good video by the doc.



Fundamentally we Indians are not made to live in colder place, with no sun

[chola]

Ethnic groups are dying & in ICU at a higher percentage compared to White population, in US & UK.

33% of ICU patients are ethnic, for a population of 13-14% in UK!

No yet, fully detailed study as to why, however along with cultural & dietary differences, potentially lack of Vitamin D production, which helps the immune system.

A good video by the doc.



Fundamentally we Indians are not made to live in colder place, with no sun

Hmmm, I am living perfectly well in the cold environs of the Amreekan northeast. And I am full-blooded Tamil.

The high rate of ICU patients are mainly blacks and Hispanics I imagine. I don't know about the Pakis and Bangladeshis but desis in my circle seem to have a lower rate of infection than whites and I have no heard of anyone in an ICU (yet.) We seem to be far more careful and conscientious about keeping ourselves and our families safe than goras. (We use a lot of delivery for grocery instead of going out on our own, for example.) Economic class might have to do with it also. Again, those desi cab drivers (mainly pakis/other peacefuls) and convenient store clerks might be having it worse.

[Bart S]

Ethnic groups are dying & in ICU at a higher percentage compared to White population, in US & UK.

33% of ICU patients are ethnic, for a population of 13-14% in UK!

No yet, fully detailed study as to why, however along with cultural & dietary differences, potentially lack of Vitamin D production, which helps the immune system.

A good video by the doc.



Fundamentally we Indians are not made to live in colder place, with no sun

Hmmm, I am living perfectly well in the cold environs of the Amreekan northeast. And I am full-blooded Tamil.

The high rate of ICU patients are mainly blacks and Hispanics I imagine. I don't know about the Pakis and Bangladeshis but desis in my circle seem to have a lower rate of infection than whites and I have no heard of anyone in an ICU (yet.) We seem to be far more careful and conscientious about keeping ourselves and our families safe than goras. (We use a lot of delivery for grocery instead of going out on our own, for example.) Economic class might have to do with it also. Again, those desi cab drivers (mainly pakis/other peacefuls) and convenient store clerks might be having it worse.

I think the basic point is that there is a link between Vitamin D and immunity, especially for respiratory infections. There are actually plenty of Vitamin D deficient people living in India, and it is quite easy to fix that through supplements, though sun exposure is probably even better.

[disha]

Why are they protesting?
Those taking to the streets say that the stringent measures restricting movement and businesses are unnecessarily hurting citizens. Protesters say the stay-at-home measures imposed by state governments to control the spread of Covid-19 are an overreaction

I am with the people asking for opening up the economy in stages.

First of all, there should not be one size fits all. The population density in NY/NJ is nowhere comparable to say Wyoming or Idaho or Oregon or Nevada or Arizona or New Mexico or Pennsylvania. Even with the strictest of social distancing in NY/NJ, one may not achieve a social distancing that would accrue to people already in less dense states like Montana! Or even Indiana!

Further, the primary health care resources available in some states may be actually better than what is available in dense cities!

Given that, everybody will get this infection is it right to shut down the economy? Or restart the economy in phases? Or enable certain restrictions while opening the economy. For example, mandatory masks and gloves with strict contact tracing. It is known to reduce the transmission down to 1-2%.

The cure is actually turning worse than the disease. And let me raise the point here, the corporates are actually liking the cure. Big corporates are seeing their small and nimble competitors are dying. That is what they want.

Big corporates do want a lot of people unemployed. That way they can suppress wage growth. In a nutshell, there is health care mafia, media mafia and wall street mafia and food & drug mafia in US. It is in their interest that the current economic situation prevails a little longer.

Hence all the protests to open up the economy will be met with slanted articles basically putting them under 'deplorables' category.

[saip]

Why is Pakistan sending Chloroquin tablets when the need is for Hydroxchloroquin? The SAPM is supposed to be a Physician herself. Does she not know the difference?

Link

[hanumadu]

NY cases are coming down rapidly. In 6 days, the new cases have gone down from 12000 to 5000. It can't be just social distancing for such a rapid decline. Herd immunity must be at play here.

https://www.nytimes.com/interactive/202 ... cases.html

NYC is the best place to test a lot of theories and understand the virus like herd immunity, reinfection, antibodies, fatality etc.

[SriKumar]

The 12,000 new case number on Apr 15 is a bit of an outlier and I was puzzled when I first saw it. I was expecting it to be around 7K that day (following previous day trends) at the worst. Previous to that, the high was about 10,000 around Apr 10, and it grradually started to come down; but in space of 2 days it went from 6K (Apr 13) it went to 11k (Apr 15). This seems like an outlier and I would put it down to how and when the cases were counted in a span of those 2 days. Outside of this spike, the overall trend for new cases was more or less gradual. It is now been sustained at 6K and dropping for the past 3-4 days. Looks like the end is in sight.

https://www.google.com/search?source=hp ... ent=psy-ab

[hanumadu]

What would be the impact of the faulty chinese kits on the number of cases in India? Are there more cases than we know or are they less? When will made in India test kits come online and do we still have to depend on chinese kits and for how long?

I think the lock down extension to a great extent is because of lack of test kits, PPE, ventilators and hospitals and we are using this time to set up these things.

[sivab]

https://apnews.com/a5077c7227b8eb8b0dc23423c0bbe2b2

More deaths, no benefit from malaria drug in VA virus study

Researchers analyzed medical records of 368 male veterans hospitalized with confirmed coronavirus infection at Veterans Health Administration medical centers who died or were discharged by April 11.

About 28% who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone. About 22% of those getting the drug plus azithromycin died too, but the difference between that group and usual care was not considered large enough to rule out other factors that could have affected survival.

Hydroxychloroquine made no difference in the need for a breathing machine, either.

Researchers did not track side effects, but noted a hint that hydroxychloroquine might have damaged other organs. The drug has long been known to have potentially serious side effects, including altering the heartbeat in a way that could lead to sudden death.

Earlier this month, scientists in Brazil stopped part of a study testing chloroquine, an older drug similar to hydroxychloroquine, after heart rhythm problems developed in one-quarter of people given the higher of two doses being tested.

On Tuesday, NIH issued new treatment guidelines from a panel of experts, saying there was not enough evidence to recommend for or against chloroquine or hydroxychloroquine for COVID-19. But it also advised against using hydroxychloroquine with azithromycin because of the potential side effects.

https://www.medrxiv.org/content/10.1101 ... 1.full.pdf

Outcomes of hydroxychloroquine usage in United States veterans hospitalized
with Covid-19

Joseph Magagnoli, M.S.1,2,*, Siddharth Narendran, M.D.4,5,*, Felipe Pereira M.D.4,5,*, Tammy
Cummings, Ph.D.1, James W. Hardin, Ph.D.3, S. Scott Sutton, Pharm.D.1,2, Jayakrishna Ambati,
M.D.4,5,6,7


A total of 368 patients were evaluated (HC, n=97; HC+AZ, n=113; no HC, n=158). Rates of
death in the HC, HC+AZ, and no HC groups were 27.8%, 22.1%, 11.4%, respectively. Rates of
ventilation in the HC, HC+AZ, and no HC groups were 13.3%, 6.9%, 14.1%, respectively.
Compared to the no HC group, the risk of death from any cause was higher in the HC group
(adjusted hazard ratio, 2.61; 95% CI, 1.10 to 6.17; P=0.03) but not in the HC+AZ group
(adjusted hazard ratio, 1.14; 95% CI, 0.56 to 2.32; P=0.72). The risk of ventilation was similar in
the HC group (adjusted hazard ratio, 1.43; 95% CI, 0.53 to 3.79; P=0.48) and in the HC+AZ
group (adjusted hazard ratio, 0.43; 95% CI, 0.16 to 1.12; P=0.09), compared to the no HC group.

CONCLUSIONS:
In this study, we found no evidence that use of hydroxychloroquine, either with or without
azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19.
An association of increased overall mortality was identified in patients treated with
hydroxychloroquine alone. These findings highlight the importance of awaiting the results of
ongoing prospective, randomized, controlled studies before widespread adoption of these drugs.

[SSridhar]

The stopcoronatn.in (official state govt) site has detailed info. . . . .

Bart S, thank you. Yeah, they are most likely to be 'single source'.

[disha]

It's the second section in the news link which wants me to go to Gujarat & wish to be asymptomatic!

https://ahmedabadmirror.indiatimes.com/ ... 281418.cms

[Mort Walker]

It's the second section in the news link which wants me to go to Gujarat & wish to be asymptomatic!

https://ahmedabadmirror.indiatimes.com/ ... 281418.cms

You do know that Guj is a dry state?

[Gerard]

Coronavirus Kills More Americans in One Month Than the Flu Kills in One Year

The seasonal flu kills 0.1 percent of people infected, but the new coronavirus has already killed 0.1 percent of the entire population of the state of New York. That may seem like a small percentage. But imagine the entire country getting hit as badly as New York state: 0.1 percent of the U.S. population is 330,000 people. And there’s no reason to believe that New York’s current death toll marks the upper limit of the virus’s lethality.

The Absurd Case against the Coronavirus Lockdown

If we are going to have 60,000 deaths with people not leaving their homes for more than a month, the number of deaths obviously would have been higher — much higher — if everyone had gone about business as usual. We didn’t lock down the country to try to prevent 60,000 deaths; we locked down the country to limit deaths to 60,000 (or whatever the ultimate toll is).

[arvin]

19 new COVID-19 cases in Kerala on Tuesday.
Some thing seems to be a bit fishy here. Of the 19 new cases reported GoKL says 12 of them were non-resident Keralites who landed from a foreign country. 3 patients had jumped the border check points and came from Tamil Nadu. The last few flights which landed in India, landed some where around 22nd March. So by what means did the 12 odd people land up in Kerala in the recent past? The CM on his press brief said the border check points need to be more vigilant, but did not explain the mysterious case of 12 keralites landing in Kannur and Kasaragode districts.

So is it a case that COVID-19 virus can stay dormant in a person's body for more than 14 days and then reveal itself at a later date of its choosing? Or is it that GoKL now has been taken by surprise, and there could be lots of people who hid their travel history as well as themselves all this while?

Even if KL mandated 28 days quarantine days are taken, foreign cases simply cant pop up now. All international flights ceased on march 22 and 28 days from that is April
18.
All so called foreign cases after that is something else and I suspect its TB league. KL is fudging numbers for you know whom.
If it is indeed foreign case, the only way they can come is old fashioned way via dhows. So are dhows dumping people from gulf here??

[shaun]

What would be the impact of the faulty chinese kits on the number of cases in India? Are there more cases than we know or are they less? When will made in India test kits come online and do we still have to depend on chinese kits and for how long?

I think the lock down extension to a great extent is because of lack of test kits, PPE, ventilators and hospitals and we are using this time to set up these things.

Chinese Rapid tests kits are for surveillance and yes it affects our over all detection with respect to community transmission. Indian made kits are already online and shipments going on for quite some time to different states . Many states have bought kits in their individual capacities . Ramping up of producing kits going on and will be available in sufficient quantity by early May.

MyLab : Producing RT-PCR Kits ,already available in market.They got GOI funding .
HLL Life care : Producing COVID-19 antibody detection kit, 1 lakh kits ready for supply as on 18th April . It can also directly supply to states if needed. Raw materials sourced from US
Voxtur Bio :Producing COVID-19 antibody detection kit , orders already placed should be available by end of April.Raw materiel indigenously sourced

Apart from that , some Indian manufacturers like CPC Diagnostics , Lab Care etc are also into the fray in rapid testing but materials sourced from china , should be in position to deliver kits from early may. Overall by middle of May we will see sufficient kits available in market.