Wuhan Coronavirus Resource Thread

IndraD · Post by **IndraD** » 18 Sep 2020 01:48

Wearing glasses may offer some protection from Covid-19, but more study needed
http://timesofindia.indiatimes.com/arti ... aign=cppst

IndraD · Post by **IndraD** » 18 Sep 2020 01:56

India will keep 50% of every vaccine order coming from abroad https://www.bbc.co.uk/news/av/world-asia-india-54113777 (inside SII Pune, Video)

chola · Post by **chola** » 18 Sep 2020 13:50

IndraD wrote:India will keep 50% of every vaccine order coming from abroad https://www.bbc.co.uk/news/av/world-asia-india-54113777 (inside SII Pune, Video)

Hopefully.

https://www.wionews.com/business-econom ... udy-328070

Rich nations with 13% population signed deals for getting over half of Covid-19 vaccines: Study

WION Web Team New Delhi, Delhi, India Sep 17, 2020, 09.24 AM(IST)

Wealthy nations that have just 13 per cent of the global population have already bought half of the potential drugs that are leading the Covid-19 vaccines race, a report by Oxfam claimed.

The study analysed agreements signed by five leading vaccine candidates and pharmaceuticals based on data shared by the analytics organisation Airfinity.

...

It said, developed countries and regions, including the US, the UK, European Union, Australia, Hong Kong and Macau, Japan, Switzerland and Israel have notched deals for 2.7 billion (51 per cent) doses out of the total 5.3 billion doses so far.

The remaining 2.6 billion doses have been signed by developing countries, which include India, Bangladesh, China, Brazil, Indonesia and Mexico.

vijayk · Post by **vijayk** » 18 Sep 2020 21:09

https://zeenews.india.com/world/thousan ... 10532.html
Thousands in China test positive for a bacterial infection that can leave men infertile

The Health Commission of Lanzhou, the capital city of Gansu province, announced that 3,245 people had contracted the disease brucellosis. The disease is often caused by contact with livestock carrying the bacteria brucella, CNN reported

IndraD · Post by **IndraD** » 18 Sep 2020 21:49

https://elemental.medium.com/the-most-l ... 430384e5a5
review article recommendations on preventing coronavirus transmission:

one new finding on this virus is that this is fragile like HIV and doesn't survive long outside human body hence fomites and surface transmission is not a great deal. You do not need to bleach your apple

Ambar · Post by **Ambar** » 18 Sep 2020 23:29

As situation in TN and AP slowly improves, Karnataka,Delhi and Punjab are now reporting alarming increase in daily counts and deaths. I don't know if Karnataka's covid death numbers today is due to catching up with the backlog or if its really getting worse but the toll of 179 is an all time high for the state since the crisis began. People have simply stopped caring, i see crowds everywhere with no masks and to make matters worse despite government's orders against holding large gatherings, weddings are back with hundreds of idiots gathering to celebrate. Its a hopeless case, with no cure or vaccine in sight the only hope now is the seasonal reduction in flu cases, India's peak flu season is between Mar-Sept, so hopefully the numbers will begin to drop soon.

darshan · Post by **darshan** » 19 Sep 2020 00:40

Lack of common sense and we know all from videos being forwarded has taken over.

Eating healthy and staying healthy to beat the chinese virus has also gone out the window.

Many had no issue wearing masks and covering up because of pollution, dirty air, etc. And I am hearing from same people complains about masks. Go figure.

chola · Post by **chola** » 19 Sep 2020 01:01

^^^ It is fatigue. There is no way for a population to keep this up for months on end. Especially not for people used to great freedom like Indians, Americans and Brazilians. The ones who done best are the automatons like chinis, Koreans and other East Asians and Germans.

IndraD · Post by **IndraD** » 19 Sep 2020 03:00

IndraD wrote:https://elemental.medium.com/the-most-l ... 430384e5a5
review article recommendations on preventing coronavirus transmission:

a new finding on this virus is, it is as fragile as HIV doesn't survive for long outside human body. Hence fomites are not big deal nor is surface transmission. You do not need to vigorously bleach your apples.

to reiterate 6 months past the pandemic what do we know:

- mask mask mask
-social distancing where possible (reduce crowding of theatres, hand over rooms?)
-Hand wash
-Ventilation (new addition) > adequate ventilation very important
-air purifiers?

Jay · Post by **Jay** » 19 Sep 2020 14:57

A comment I came across on Reddit regarding what was learned by physicians(outside India) in the past 6 months. For posters in the medical sector, how valid is this below quote?

ICU doc who treats COVID-19 and research on COVID, and published on COVID both original research and editorials in reputable medical journals.

We are much better than previously.

Regarding COVID-19 specific therapies:

The UK RECOVERY trial demonstrated a mortality benefit in intubated patients who received dexamethasone. There are some flaws with the study, and the exciting finding may not be methodologically robust, but generally, people are using it.

The NIH ORCHID trial demonstrated no mortality benefit in ICU patients with hydroxychloroquine.

The ACTT-1 trial suggested a shorter recovery time in hospitalized patients with COVID who received remdesivir. This is the least solid data of the three studies I mentioned.

At present, there is no compelling data to suggest convalescent plasma, or any other drug, will benefit patients with COVID. Despite this, many physicians, including my colleagues, still administer it and other unproven therapies. Additionally, there isn't compelling data about use of these therapies as a preventative, or administration in mild disease, although the RECOVERY trial suggested that mild disease night do worse with dexamethasone.

There is a desire among physicians who are desperate to try any plausible therapy. But these are unproven and may actually be harmful. We don't know. A few years ago, there was a big splash about a possible therapy of vitamin c, thiamine, and steroids for sepsis. The original study was intriguing, but methodologically flawed. Many docs gave the cocktail anyway, thinking it couldn't hurt, and might help. A few years later, several better studies have been done, and a large one is still underway. There is no evidence of benefit, and some evidence to suggest harm. So the docs you see giving convalescent plasma, hydroxychloroquine, and beta agonists are really practicing magical thinking, not science.

The reason the UK was able to conduct so many studies with larger numbers despite having fewer COVID patients than the US is because there was effective scientific leadership to encourage patients to join trials. We struggled to enroll patients in trials in the US because no patient wanted to be randomized-- they wanted to be sure that they would get the magical hydroxychloroquine, and many docs capitulated to these requests, instead of standing firm and saying, "We don't know if it works, which is why we're studying it."

But the most important benefit to how we treat COVID is better supportive care. Some of this has to do with less resource strain than was present in March, especially in Italy, Spain, New York. Hospitals relied on just-in-time inventory supply chain models and refused to acknowledge problems despite China giving everyone a 2 month head start. Most countries have a reasonable testing/contact tracing program. Even the US, which has done a piss poor job, is doing better than March/April.

With the supportive care, the whole world lost its damn mind with treating COVID. People were pushing crazy ideas like COVID was high altitude pulmonary edema. This theory was espoused by a sea-level emergency doc who was familiar with neither ARDS nor HAPE. People thought that these patients had better lung compliance than traditional ARDS and thought to perhaps give larger tidal volumes on the ventilator. They thought that these patients had higher rates of clots (might be true, but the reported rate is comparable to rates seen in similarly critically ill patients with septic shock or ARDS), and started administering therapeutic doses of anticoagulation despite no evidence of clots. Plenty of non-intensivists would report with amazement discoveries obvious to most seasoned pulmonologists or intensivists, like standard ventilator management worked after trying unproven modes like APRV or known harmful ones like oscillatory ventilation, or that less sedation and less paralytics had quicker recovery times. I helped write up some of the Lombardy Italy experience, and the docs there were throwing everything at patients, based on tweets they read. Give Ace inhibitors. Don't give them. Give hydroxychloroquine, kaletra, remdesivir, tocilizumab, plasma, etc, paralyze all these patients for weeks at a time, and then wonder why all the survivors were so profoundly weak. Things have calmed down to the point where these unproven meds aren't given as routinely as before.

Additionally, we have a better idea about transmission, and are more willing to let people use high flow nasal cannula instead of early intubation. In the US, there was a misconception that many patients needed early intubation. Now, most places will treat COVID like any other severe ARDS and intubate accordingly.

The biggest improvement in the past four months is that docs have calmed down and realized that the right course of action is to provide the same supportive care that we typically do for ARDS instead of relying on witchcraft.

chola · Post by **chola** » 19 Sep 2020 15:02

Ambar wrote:As situation in TN and AP slowly improves, Karnataka,Delhi and Punjab are now reporting alarming increase in daily counts and deaths. I don't know if Karnataka's covid death numbers today is due to catching up with the backlog or if its really getting worse but the toll of 179 is an all time high for the state since the crisis began. People have simply stopped caring, i see crowds everywhere with no masks and to make matters worse despite government's orders against holding large gatherings, weddings are back with hundreds of idiots gathering to celebrate. Its a hopeless case, with no cure or vaccine in sight the only hope now is the seasonal reduction in flu cases, India's peak flu season is between Mar-Sept, so hopefully the numbers will begin to drop soon.

Chennai has done so much better since August when most of the large hotspot cities got their daily infect rates under 1k daily. Mumbai is at over 2000 again and Delhi at 4000. Chennai is still under 1K per day. Those three cities all tracked lower together after bad spikes in June-July. Now Chennai is the only one out of the three who is not spiking again. What is done differently here as opposed to the other two? The unlock seems the same. Chennai opened up the metro for 4.0 even earlier than Delhi.

Is there was a formula that can be replicated? Delhi had halved its infections a few weeks ago and it looked like they've hit on a process but now it is raging worse than before.

IndraD · Post by **IndraD** » 19 Sep 2020 15:09

Jay wrote:A comment I came across on Reddit regarding what was learned by physicians(outside India) in the past 6 months. For posters in the medical sector, how valid is this below quote

very fact that this read up is available only on reddit should have alarm bell ringing! Virus is vasculotropic as much it is SARS, hence anticoagulation is saving lives, patients presenting with clots from head to toe is a truth than fiction. UK trials may not be fullproof (RECOVERY) but no other country has been delivering rapid studies like them.
Yes the experience with covid has increased and so has the management over all.

darshan · Post by **darshan** » 19 Sep 2020 18:45

When one reads through this, it feels like that common sense is escaping. Keep the distance and be in open is enough. Soap kills virus. Be in open sun. Virus is spreading because of not maintaining distance and mask. Issuing SOPs to destroy small vendors won't help. While guidelines are all good and dandy, the whole point being missed is that govt is failing to get distance and mask rules going whether that is through enforcement or education. Still no education on take your mask and look at the sun through it and see how effective it's. If not, then keep your mouth pointed away and down when talking to someone.

Covid-19 pandemic: AMC announces SOPs for tea stalls
https://www.deshgujarat.com/2020/09/19/ ... ea-stalls/

There's no easy way to handle high tempo movements of crowd. This may turn out to be a disaster at a crowd level.
In pictures: Girls practicing for Garba wearing traditional masks
https://www.deshgujarat.com/2020/09/18/ ... nal-masks/

chola · Post by **chola** » 19 Sep 2020 21:25

In the US, we were trending down after the really bad days in July when there were over 75K cases one day. The first week of September, there was a day where cases fell to only 25K. But with school starting for many that week, you can see the spike coming now about two weeks later.

Sept 15: 36K
Sept 16: 40K
Sept 17: 46K
Sept 18: 51K

This thing is like clockwork. After any major re-opening, in two weeks we will see spikes.

In India too, the bigger cities like Delhi, Mumbai and Chennai were able to halve their infection rates. Then the trend went up after Unlock 4.0. In the US, the trend upwards again came from opening of schools and colleges.

In both India and the US, we need to see if we can quickly peak during fall and winter (when schools/businesses/transportation are back in full gear) and then start lowering the rate again.

DavidD · Post by **DavidD** » 20 Sep 2020 04:20

Jay wrote:A comment I came across on Reddit regarding what was learned by physicians(outside India) in the past 6 months. For posters in the medical sector, how valid is this below quote?

ICU doc who treats COVID-19 and research on COVID, and published on COVID both original research and editorials in reputable medical journals.

We are much better than previously.

Regarding COVID-19 specific therapies:

The UK RECOVERY trial demonstrated a mortality benefit in intubated patients who received dexamethasone. There are some flaws with the study, and the exciting finding may not be methodologically robust, but generally, people are using it.

The NIH ORCHID trial demonstrated no mortality benefit in ICU patients with hydroxychloroquine.

The ACTT-1 trial suggested a shorter recovery time in hospitalized patients with COVID who received remdesivir. This is the least solid data of the three studies I mentioned.

At present, there is no compelling data to suggest convalescent plasma, or any other drug, will benefit patients with COVID. Despite this, many physicians, including my colleagues, still administer it and other unproven therapies. Additionally, there isn't compelling data about use of these therapies as a preventative, or administration in mild disease, although the RECOVERY trial suggested that mild disease night do worse with dexamethasone.

There is a desire among physicians who are desperate to try any plausible therapy. But these are unproven and may actually be harmful. We don't know. A few years ago, there was a big splash about a possible therapy of vitamin c, thiamine, and steroids for sepsis. The original study was intriguing, but methodologically flawed. Many docs gave the cocktail anyway, thinking it couldn't hurt, and might help. A few years later, several better studies have been done, and a large one is still underway. There is no evidence of benefit, and some evidence to suggest harm. So the docs you see giving convalescent plasma, hydroxychloroquine, and beta agonists are really practicing magical thinking, not science.

The reason the UK was able to conduct so many studies with larger numbers despite having fewer COVID patients than the US is because there was effective scientific leadership to encourage patients to join trials. We struggled to enroll patients in trials in the US because no patient wanted to be randomized-- they wanted to be sure that they would get the magical hydroxychloroquine, and many docs capitulated to these requests, instead of standing firm and saying, "We don't know if it works, which is why we're studying it."

But the most important benefit to how we treat COVID is better supportive care. Some of this has to do with less resource strain than was present in March, especially in Italy, Spain, New York. Hospitals relied on just-in-time inventory supply chain models and refused to acknowledge problems despite China giving everyone a 2 month head start. Most countries have a reasonable testing/contact tracing program. Even the US, which has done a piss poor job, is doing better than March/April.

With the supportive care, the whole world lost its damn mind with treating COVID. People were pushing crazy ideas like COVID was high altitude pulmonary edema. This theory was espoused by a sea-level emergency doc who was familiar with neither ARDS nor HAPE. People thought that these patients had better lung compliance than traditional ARDS and thought to perhaps give larger tidal volumes on the ventilator. They thought that these patients had higher rates of clots (might be true, but the reported rate is comparable to rates seen in similarly critically ill patients with septic shock or ARDS), and started administering therapeutic doses of anticoagulation despite no evidence of clots. Plenty of non-intensivists would report with amazement discoveries obvious to most seasoned pulmonologists or intensivists, like standard ventilator management worked after trying unproven modes like APRV or known harmful ones like oscillatory ventilation, or that less sedation and less paralytics had quicker recovery times. I helped write up some of the Lombardy Italy experience, and the docs there were throwing everything at patients, based on tweets they read. Give Ace inhibitors. Don't give them. Give hydroxychloroquine, kaletra, remdesivir, tocilizumab, plasma, etc, paralyze all these patients for weeks at a time, and then wonder why all the survivors were so profoundly weak. Things have calmed down to the point where these unproven meds aren't given as routinely as before.

Additionally, we have a better idea about transmission, and are more willing to let people use high flow nasal cannula instead of early intubation. In the US, there was a misconception that many patients needed early intubation. Now, most places will treat COVID like any other severe ARDS and intubate accordingly.

The biggest improvement in the past four months is that docs have calmed down and realized that the right course of action is to provide the same supportive care that we typically do for ARDS instead of relying on witchcraft.

It's a very, very good summary of the thought process of most intensivists in the US right now. The thought processes he described are exactly what my hospital as well as other colleagues in my previous hospitals have gone through. Just for reference I work in the SF bay area currently, and I used to work in NYC.

Early on, people were throwing the kitchen sink, understandable but unscientific. There was some real conflict between very experienced physicians on this, but now a consensus is mostly built.

Things we do: Dexamethasone, Remdesivir, proning, similar intubation timings and ventilator settings as ARDS, use procalcitonin level to guide antibiotic therapy.

Things we no longer do: HCQ, Kaletra, Tocilizumab, therapeutic anticoagulation with or without a D-dimer level, among many, many other treatment strategies (e.g. vitamins, etc.)

Things we sometimes do: convalescent plasma (some early results from the Mayo trial which we participated in is coming out that it can reduce mortality, larger trials are being run now), higher dose but not therapeutic dosing of anticoagulation (no evidence for this beyond typical weight based adjustments. We're moving away from it but I still see some people do this. Not so much in my hospital but I know it still happens).

DavidD · Post by **DavidD** » 20 Sep 2020 04:26

IndraD wrote:
Jay wrote:A comment I came across on Reddit regarding what was learned by physicians(outside India) in the past 6 months. For posters in the medical sector, how valid is this below quote
very fact that this read up is available only on reddit should have alarm bell ringing! Virus is vasculotropic as much it is SARS, hence anticoagulation is saving lives, patients presenting with clots from head to toe is a truth than fiction. UK trials may not be fullproof (RECOVERY) but no other country has been delivering rapid studies like them.
Yes the experience with covid has increased and so has the management over all.

I'd think that this read up is available only on Reddit because it's basically common knowledge and accepted best practice in the US right now. As it stands, there is currently no evidence that anticoagulation is saving lives, and no evidence that COVID causes more blood clots than similarly ill patients. Critically ill patients have higher risk of getting clots, but they also have a higher risk of bleeding, so therapeutic anticoagulation is not harmless and should be done only in the setting of a clinical study.

Jay · Post by **Jay** » 20 Sep 2020 06:27

DavidD wrote:
Things we do: Dexamethasone, Remdesivir, proning, similar intubation timings and ventilator settings as ARDS, use procalcitonin level to guide antibiotic therapy.

Things we no longer do: HCQ, Kaletra, Tocilizumab, therapeutic anticoagulation with or without a D-dimer level, among many, many other treatment strategies (e.g. vitamins, etc.)

Things we sometimes do: convalescent plasma (some early results from the Mayo trial which we participated in is coming out that it can reduce mortality, larger trials are being run now), higher dose but not therapeutic dosing of anticoagulation (no evidence for this beyond typical weight based adjustments. We're moving away from it but I still see some people do this. Not so much in my hospital but I know it still happens).

Mortality rates in US have come down rapidly since the peak in April/May, and I believe that some of the treatments you mentioned above is one reason. By any chance do we have any information about what medical practitioners are doing/recommending in India? I have read a few scientific articles in the last month or so which described treatment options in various countries(US/UK/Spain/Italy) and what stands out is that there is no proven method/medication that is universal, yet. I see that treatments options are converging towards a standard protocol, but that might not happen in the next 6 months, which is slow for this pandemic, but fast by any traditional standards. I'm a little angsty about how all this will be rolled out in India.

Ambar · Post by **Ambar** » 20 Sep 2020 06:56

DavidD, thanks for the very informative post. Is there any reason why your hospital stopped administering Tocilizumab ? In India it is being touted as a "miracle drug" leading do shortages, price gouging, black marketing, and dangerously fake Tocilizumab being sold on the market. I am also curious about the "higher dose but not therapeutic dosing of anticoagulation" , does this apply to even those with coronary heart disease with stent ? The reason i ask is because of high number of patients who seem to die of a sudden heart attack while their lungs are showing clear signs of healing. Also, development of blood clots in critical covid patients is said to be contributing towards worse than expected ICU outcomes. So i am curious wouldn't a higher dosage of anticoagulation help ? Also, any thoughts on why are so many critical patients dying of sudden heart attack during the recovery stage ?

Jay - ICMR has standard guidelines but how closely they are followed depends on the states, hospitals, doctors etc. The standard treatment for critical patients in many southern states seems to be dexamethasone, remdesivir, Tocilizumab ( if the patient can afford it), warfarin and some antibiotics. How closely this protocol is followed depends on the hospitals, doctors, availability of the drugs etc. India is losing salvageable patients for a variety of reasons most of which have been well documented on this thread. Some states had standardized HCQ but have stopped now, then there are states like UP that have switched from HCQ to Ivermectin, so there are many variations.

arshyam · Post by **arshyam** » 20 Sep 2020 08:49

Been a while since we heard from DrRatnadip and his informative insights, hope all is well.

chola · Post by **chola** » 20 Sep 2020 15:55

Extremely troubling and heartbreaking if true. I see this kind of government rejecting science and conveniently cherrypicking data in the United States which led to the disaster here. My god, the President and politicians were dismissing and contradicting of doctors at the head of American health organizations. If this is happening in India then we can never get a grip on things. In the US, the top flight health care system and its massive resources had blunted the effects somewhat and it is still the worst affected country in the world.

India's health care system cannot afford this kind of interference from the government. If the story is true, we were covering up massive community spread in the cities in May. Research can only "described only the lower prevalence rates in the other districts —ranging from 0.62 per cent to 1.03 per cent — and a national average of 0.73 per cent." The "36 per cent in Dharavi, Mumbai; 48 per cent in Ahmedabad; 30 per cent in Calcutta" were forced to be omitted. The people fighting on the front line were blindsided. This is akin to giving the army at the front deliberately wrong intelligence.

https://www.telegraphindia.com/india/ho ... id/1792482

‘Remove the data or don’t publish’

How Covid numbers were hushed up

The head of India’s health research agency had asked researchers to remove infection prevalence information from the 10 cities’ hotspots they had included in their paper

G.S. Mudur
New Delhi Published 20.09.20, 02:20 AM

Researchers acting under government orders expunged from a scientific paper the prevalence rates of the new coronavirus infection in containment zones or hotspots in 10 cities, estimated through a nationwide survey, authoritative sources have said.

...

This newspaper spoke to seven of the 74 co-authors. Four of them spoke on the condition of anonymity while three spoke on record.

“We were told: remove the hotspots data or don’t publish,” one co-author said. Two other co-authors corroborated this account.

...

The survey to determine what proportions of people the coronavirus had infected used randomly selected blood samples from 400 people in each of 70 districts and 500 people from hotspots in each of 10 cities — Ahmedabad, Bhopal, Calcutta, Delhi, Hyderabad, Indore, Jaipur, Mumbai, Pune and Surat.

...

Under Bhargava’s directive, the researchers omitted from their paper the relatively high prevalence rates found in the hotspots — for instance, 36 per cent in Dharavi, Mumbai; 48 per cent in Ahmedabad; 30 per cent in Calcutta.

Their paper, published this month in the Indian Journal of Medical Research, described only the lower prevalence rates in the other districts —ranging from 0.62 per cent to 1.03 per cent — and a national average of 0.73 per cent in early May.

...

Six among the 74 co-authors of the scientific paper have told this newspaper that they cannot explain why they were asked to expunge the data from hotspots, especially because subsequent surveys revealed comparable prevalence rates in several cities.

“The pursuit of science is to look for the truth — suppressing research is illogical,” said Jayaprakash Muliyil, a co-author and former head of community medicine at the Christian Medical College, Vellore, and a member of the council’s epidemiology and surveillance group for the coronavirus disease. The researchers tried to publish the full findings but found themselves stonewalled.

The co-author, who disclosed they were told to “remove the hotspots data or don’t publish”, said the ultimatum had triggered a debate among them over whether to publish an incomplete paper or drop the publication in protest. “We decided to publish anyway,” the co-author said.

Breach of ethics
Medical ethics experts view the council’s directive to alter the paper’s content as tantamount to cherry picking — deleting data that is inconvenient — and a violation of its own rules on research integrity.
...

“As members of the surveillance group, we cannot say why the data was held back. The council can answer that.”

The omission of the hotspot data marks a fresh instance of government representatives directing researchers to alter a scientific paper. In April this year, health officials had blocked publication of the names of the 36 districts where researchers had detected evidence of community transmission.

Rahul M · Post by **Rahul M** » 20 Sep 2020 17:04

Since it is the telegraph I would hold my horses before believing, since they are a notch above Goebbels in pushing twisted news.

darshan · Post by **darshan** » 20 Sep 2020 17:35

Tata And CSIR-IGIB's CRISPR Based Low Cost Feluda COVID-19 Test Gets DCGI Nod
https://swarajyamag.com/insta/tata-and- ... s-dcgi-nod
In a big boost for the nation's efforts against COVID-19, the Drug Controller General of India (DCGI) yesterday (19 September) gave its nod for the commercial launch of India's first Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) COVID-19 test called 'Feluda', reports Livemint.

Developed by the Tata Medical and Diagnostics Limited in a collaboration with CSIR-IGIB (Institute of Genomics and Integrative Biology), the test meets high-quality benchmarks with a sensitivity of 96 per cent and specificity of 98 per cent in the detection of the disease in a person's body.

The test is the world's first diagnostic test to deploy a specially adapted Cas9 protein to successfully detect the virus. Its genome-editing CRISPR technology has been indigenously developed and it works by detecting the genomic sequence of the COVID-19 virus.
....

Jay · Post by **Jay** » 21 Sep 2020 00:03

Dabid ji, thanks for your insight on Covid treatment options. What you said and what was narrated in the reddit post is also what I heard from a couple of medical professionals(nurses) here in Midwest US.

Ambar ji, I have been following this tragic thread and have come across a few tragic stories, yours's included. I hope you and families like you have strength and hope to rebound from this tragedy. A couple of my family members in India contracted Covid, but fortunately are recovering now. Both of them are in tier-2 cities where treatment seems un-cohesive. These two families are decently middle class and educated, so they do have some options if things get worse, but from what I hear if you are lower middle class and down then you are "Sh** out of luck", and that's scaring me a lot. We are fortunate that demographics favor us but everything else is stacked against us. I feel(because of my lack of information) that we as a nation are only looking for a vaccine but are not focusing on treating this virus.

DavidD · Post by **DavidD** » 21 Sep 2020 03:02

Ambar wrote:DavidD, thanks for the very informative post. Is there any reason why your hospital stopped administering Tocilizumab ? In India it is being touted as a "miracle drug" leading do shortages, price gouging, black marketing, and dangerously fake Tocilizumab being sold on the market. I am also curious about the "higher dose but not therapeutic dosing of anticoagulation" , does this apply to even those with coronary heart disease with stent ? The reason i ask is because of high number of patients who seem to die of a sudden heart attack while their lungs are showing clear signs of healing. Also, development of blood clots in critical covid patients is said to be contributing towards worse than expected ICU outcomes. So i am curious wouldn't a higher dosage of anticoagulation help ? Also, any thoughts on why are so many critical patients dying of sudden heart attack during the recovery stage ?

Jay - ICMR has standard guidelines but how closely they are followed depends on the states, hospitals, doctors etc. The standard treatment for critical patients in many southern states seems to be dexamethasone, remdesivir, Tocilizumab ( if the patient can afford it), warfarin and some antibiotics. How closely this protocol is followed depends on the hospitals, doctors, availability of the drugs etc. India is losing salvageable patients for a variety of reasons most of which have been well documented on this thread. Some states had standardized HCQ but have stopped now, then there are states like UP that have switched from HCQ to Ivermectin, so there are many variations.

Data from Tocilizumab has been mixed at best. Some retroprospective studies suggested a benefit, but the only RCT with results that I'm aware of did not.

Blood clots do contribute to worse outcomes, but so does bleeding. Anticoagulation has always been a double-edged sword in helping with clots but promoting bleeding, so the trick is to find scenarios where clotting is a bigger risk than bleeding. This has not been shown to be the case for COVID. Also note that the benefit of anticoagulation in both preventing and treating heart attacks has been studied numerous times, and the benefit is pretty minimal. They're mostly used in acute heart attacks for a short period of time these days, and there are many who even question the utility of that since even the positive studies did not show a long term benefit.

The underlying reason that we were doing these things in the early days is this pervasive but unfounded belief that critically ill COVID patients are different from patients who are critically ill from other respiratory diseases. They may clot more, hence the anticoagulation; their lungs may be more compliant, thus the different vent settings. That has turned out to be largely untrue, so we're starting to treat them similarly. Even for steroids like Dexamethasone, while it's not used for ARDS in the US, it's actually standard recommendation in Europe and the US was likely moving toward using it for all other ARDS patients as well. So really the only practice specific for COVID thus far is Remdesivir.

Jay wrote: Mortality rates in US have come down rapidly since the peak in April/May, and I believe that some of the treatments you mentioned above is one reason. By any chance do we have any information about what medical practitioners are doing/recommending in India? I have read a few scientific articles in the last month or so which described treatment options in various countries(US/UK/Spain/Italy) and what stands out is that there is no proven method/medication that is universal, yet. I see that treatments options are converging towards a standard protocol, but that might not happen in the next 6 months, which is slow for this pandemic, but fast by any traditional standards. I'm a little angsty about how all this will be rolled out in India.

Sorry, I'm not familiar with treatment protocols in India. As more proven therapies come out, I expect practitioners around the world will become less inclined to use non-proven therapy, and thus a standardization should emerge. People are different, though, so there may not be a one-size-fits-all type of solution but they should be roughly similar.

IndraD · Post by **IndraD** » 21 Sep 2020 04:03

any RCT in favour of Remdesivir ? ^

By the time RECOVERY trial came pandemic was on way out. Hence usefulness of dexamethasone could not be established , now with return of pandemic it will hopefully be part of treatment plan.
https://elemental.medium.com/coronaviru ... 4032481ab2
Around April-May there were quite a few articles suggesting SARS 2 is a vasulotropic virus hence the quest for anticoagulation in more than normal dose and it did save lives.

Ambar · Post by **Ambar** » 21 Sep 2020 05:59

Here's another tragic story from Karnataka - https://www.republicworld.com/india-new ... covid.html

The Republic story does not have all the details but many Kannada newspapers do. The story is of a 38 yr old doctor working in a taluk govt hospital who contracted covid. He had no comorbidites and was home quarantining. After few days his breathing worsened and he was admitted to the same taluk hospital where he worked. As his condition worsened, despite the taluk hospital having ventilators, ECMO etc, none of the staff including the doctor in charge had the know-how to use the equipment ! So they put him in an ambulance and tried moving him to a district hospital some 50 odd kms away and the poor doctor died while being moved.

There are countless stories like the above . I doubt if there will be any changes post pandemic but I hope someday our citizens will realize the dangers of reservation in medical schools where the admission is not based on merit for more than half the candidates, and we also really really need to up the standards for those who qualify to study medicine. It is bad enough that everyone from a fakir to a unani practitioner uses Dr against their name and practice allopathy , but it is really worrying when doctors with real degrees get out of college without sound understanding of clinical concepts or necessary skills to save lives.

sudarshan · Post by **sudarshan** » 21 Sep 2020 06:28

May I believe my eyes

? It seems like active cases are dropping in India (also Brazil). USA still going up on that score.

saip · Post by **saip** » 21 Sep 2020 07:04

Looking at 7 day moving average the rise in active case is showing a sharp decline from 9/10 or so. Hope it holds.

vijayk · Post by **vijayk** » 21 Sep 2020 07:06

saip wrote:Looking at 7 day moving average the rise in active case is showing a sharp decline from 9/10 or so. Hope it holds.

I have been watching 7 day MVA and praying

https://covid19.who.int/region/searo/country/in

0.89% last 7 days

yensoy · Post by **yensoy** » 21 Sep 2020 07:56

chola wrote:Chennai has done so much better since August when most of the large hotspot cities got their daily infect rates under 1k daily. Mumbai is at over 2000 again and Delhi at 4000. Chennai is still under 1K per day.

Yes, but barely so. It's suspiciously hovering between 950 something and 990 something! Testing is big in TN, 80k+ tests per day (and I think they are RT-PCR tests, not the simpler one). Reporting is rather tight with mandatory Aadhar card to correlate - so regardless of what is being reported publicly, the govt has a good idea of what's going on.

chola wrote:Now Chennai is the only one out of the three who is not spiking again. What is done differently here as opposed to the other two? The unlock seems the same. Chennai opened up the metro for 4.0 even earlier than Delhi.
Is there was a formula that can be replicated? Delhi had halved its infections a few weeks ago and it looked like they've hit on a process but now it is raging worse than before.

From what I am hearing, a lot of positive cases have been relocated to Delhi (by family members) to get treatment since the surrounding areas are rather poorly equipped from medical standpoint. Unlock has facilitated this move and morally I see nothing wrong with it since Delhi has the resources (the people of India's resources) and capacity (much touted 10000 bed isolation facility and a lot of hospitals) to handle the influx. TN has a much better distribution of medical facilities at the district level, especially in hard hit districts like Madurai, Coimbatore etc.

chola · Post by **chola** » 21 Sep 2020 11:26

yensoy wrote:
chola wrote:Now Chennai is the only one out of the three who is not spiking again. What is done differently here as opposed to the other two? The unlock seems the same. Chennai opened up the metro for 4.0 even earlier than Delhi.
Is there was a formula that can be replicated? Delhi had halved its infections a few weeks ago and it looked like they've hit on a process but now it is raging worse than before.
From what I am hearing, a lot of positive cases have been relocated to Delhi (by family members) to get treatment since the surrounding areas are rather poorly equipped from medical standpoint. Unlock has facilitated this move and morally I see nothing wrong with it since Delhi has the resources (the people of India's resources) and capacity (much touted 10000 bed isolation facility and a lot of hospitals) to handle the influx. TN has a much better distribution of medical facilities at the district level, especially in hard hit districts like Madurai, Coimbatore etc.

This makes a lot of sense. As the virus spreads to rural areas, the place with a top heavy concentration in resources like Delhi would get a heavier concentration of patients as well.

The daily cases seem to gone down a bit. We are seeing days in the 80K range. Hopefully things are stabilizing and then go into reverse.

vijayk · Post by **vijayk** » 21 Sep 2020 20:16

<REMOVED OFFENSIVE MAP OF INDIA>

https://covid19.who.int/region/searo/country/in

-0.1% in last 7 days

chola · Post by **chola** » 21 Sep 2020 23:06

Very hard to pin this thing to the mat. Every time progress is made, the thing would flair up again. This is the same globally it seems.

We might need to live with repeated waves. The realistic goal is probably not eradication, at least not in the next few years. The realistic goal is coping successfully with the waves.

https://www.usnews.com/news/health-news ... limb-again

U.S. COVID Death Toll Nears 200,000, While Cases Start to Climb Again

Sept. 21, 2020
By Robin Foster and E.J. Mundell
HealthDay Reporters

MONDAY, Sept. 21, 2020 (Healthday News) -- As the U.S. coronavirus case count neared 200,000 on Monday, public health experts debated whether the spread of the virus will continue to slow or a new surge will come, as cold weather returns to much of the country.

...

In the United States, fewer new coronavirus cases have been detected week by week since late July, but the nation's daily count of new cases has started to climb again in recent days, the Times reported. Meanwhile, at least 73 other countries are seeing second surges in new cases.

Dr. Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health in Baltimore, told the Times it was conceivable that the death toll in the United States could reach 300,000 if Americans start to relax social distancing measures.

As case counts started trending upward again, 1,400 public schools in New York City reopened Monday for nearly 90,000 pre-K students and children with advanced disabilities. The remaining 1 million students will start their school year online, with the option of returning to classrooms in the next few weeks, the Times reported.

...

vijayk · Post by **vijayk** » 22 Sep 2020 05:42

Exclusive: Study Suggests Dengue May Provide Some Immunity Against COVID-19
https://www.usnews.com/news/top-news/ar ... t-covid-19

A new study that analyzed the coronavirus outbreak in Brazil has found a link between the spread of the virus and past outbreaks of dengue fever that suggests exposure to the mosquito-transmitted illness may provide some level of immunity against COVID-19.

The not yet published study led by Miguel Nicolelis, a professor at Duke University, and shared exclusively with Reuters, compared the geographic distribution of coronavirus cases with the spread of dengue in 2019 and 2020.

Places with lower coronavirus infection rates and slower case growth were locations that had suffered intense dengue outbreaks this year or last, Nicolelis found.

"This striking finding raises the intriguing possibility of an immunological cross-reactivity between dengue's Flavivirus serotypes and SARS-CoV-2," the study said, referring to dengue virus antibodies and the novel coronavirus.

"If proven correct, this hypothesis could mean that dengue infection or immunization with an efficacious and safe dengue vaccine could produce some level of immunological protection" against the coronavirus, it added.

Nicolelis told Reuters the results are particularly interesting because previous studies have shown that people with dengue antibodies in their blood can test falsely positive for COVID-19 antibodies even if they have never been infected by the coronavirus.

In states such as Paraná, Santa Catarina, Rio Grande do Sul, Mato Grosso do Sul and Minas Gerais, with a high incidence of dengue last year and early this year, COVID-19 took much longer to reach a level of high community transmission compared to states such as Amapá, Maranhão and Pará that had fewer dengue cases.

The team found a similar relationship between dengue outbreaks and a slower spread of COVID-19 in other parts of Latin America, as well as Asia and islands in the Pacific and Indian Oceans.

Nicolelis said his team came across the dengue discovery by accident, during a study focused on how COVID-19 had spread through Brazil, in which they found that highways played a major role in the distribution of cases across the country.

jaysimha · Post by **jaysimha** » 22 Sep 2020 09:25

Webinar on Contribution of DRDO in Prevention & Management of COVID-19 by Shivaji College, DU
[Sept 26, 4 PM]: Register by Sept 23
https://www.noticebard.com/webinar-cont ... i-college/

Speaker:
The webinar will be hosted by Dr. Himanshu Ojha, Scientist E & Joint Director, INMAS DRDO.
Registration:
There is no registration fee for the webinar. The webinar will be conducted via the Zoom/ Youtube platform.

http://du.ac.in/du/uploads/17092020Webi ... 0final.pdf

Mort Walker · Post by **Mort Walker** » 22 Sep 2020 09:48

vijayk wrote: <MAP REMOVED>
https://covid19.who.int/region/searo/country/in

-0.1% in last 7 days

That WHO map is very disturbing. Has the GoI lodged a complaint?

hnair · Post by **hnair** » 22 Sep 2020 09:59

Thanks Mort Walker for pointing out. vijayk, make sure to not post maps drawn by China in BRF

vijayk · Post by **vijayk** » 22 Sep 2020 18:26

hnair wrote:Thanks Mort Walker for pointing out. vijayk, make sure to not post maps drawn by China in BRF

oops! WHat int he world WHO is doing

saip · Post by **saip** » 22 Sep 2020 20:09

During the past four days recoveries have exceeded new cases and finally the seven day moving average of rise in new cases has dipped below zero. Hope the trend continues.

SRajesh · Post by **SRajesh** » 22 Sep 2020 20:10

What's with Coupta!!

He seems to have taken a 180 degree turn: seems to be sympathetic to the GOI
https://youtu.be/TbZ4Z9Se-mY
I saw a similar attitude in cut-the-crap episode on Agri bills!!!

Any news of 'Bangalore Torpedo' being put up his 'Musharaff'
why is he singing soprano??