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  #5861  
Old 01.04.2020, 15:31
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Re: Coronavirus

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Sweden has 14 deaths per 1M, Denmark has 13, Switzerland has 41

It seems they are doing just fine
Let's see the same numbers as of today:

Denmark: 18 (+38 %)
Sweden: 24 (+71 %)
Switzerland: 53 (+ 29%)

(Swiss numbers for today are probably not final and might increase a little)
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  #5862  
Old 01.04.2020, 15:34
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Re: Coronavirus

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Who? Teachers? Parents? Teacher+parents hybrids? Nurses? Docs? Postmen? Delivery guys? Cashiers? Soldiers?

Cmon, don't rub it in. Some push through 200% shifts.

Sorry for the misunderstanding, the last sentence was meant to mimic the tone of the person I was originally quoting, not my thinking.
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  #5863  
Old 01.04.2020, 15:39
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Re: Coronavirus

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Sorry for the misunderstanding, the last sentence was meant to mimic the tone of the person I was originally quoting, not my thinking.
Non, c'est moi qui s'excuse.. I realized it a bit later. I am working and cooking late lunch and supervising my kid's piano class.



I can't wait for "normal".
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  #5864  
Old 01.04.2020, 16:14
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Re: Coronavirus

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Fifteen times a day, various "experts" from a number of areas make some form of statement, and all of them pretty much contradict each other. An epidemiologist here, a virologist there, a doctor here, an economist there - and they can't even agree within their respective own fields, let alone among each other.
Not sure what you are trying to say here - are you saying that one virologist is saying it's airborne transmission and another says it's not?
Are you saying that one economist is saying these lock-downs are bad for the economy and others are not?

As for an economist not agreeing with an epidemiologist regarding corona, that's not what they actual do, or need to do.

We elect governments to take all this information from the experts in each field and decide a plan of action, which may, or may not be the right one.
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  #5865  
Old 01.04.2020, 16:31
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Re: Coronavirus

With Britain about to enter its second week of lockdown, heres the best protection for those Brit's sitting
in front of the TV and having to endure their partners love of Coronation street.

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  #5866  
Old 01.04.2020, 16:44
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Re: Coronavirus

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no. Switzerland is ahead of planning - started already in january of this year.

It‘s unfortunately other countries that have your scenario of consistently and chaotically running behind, trying to catch-up. It will be bad, but the swiss were made aware of this in a transparent and coherent way as soon as deemed necessary.

Where would you rather be living?


canada
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  #5867  
Old 01.04.2020, 17:03
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Re: Coronavirus

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Who? Teachers? Parents? Teacher+parents hybrids? Nurses? Docs? Postmen? Delivery guys? Cashiers? Soldiers?

Cmon, don't rub it in. Some push through 200% shifts.
You forgot the cleaning personel that are either legally or illegally employed here.
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  #5868  
Old 01.04.2020, 17:09
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Re: Coronavirus

Based on the current knowledge of the virus, it seems the spread is slower in warmer climates. High air temp and humidity reduces the transmission. The whole article here: https://www.ft.com/content/c8ed3692-...a-bf503995cd6f

The most interesting part of the article is the figure below. Right now the ideal transmission conditions for the virus are on this red belt of regions with temps between 5-11C. But, seasons change and this red belt will move North into Canada, Northern Europe and Russia during April/May and a new one will appear in the southern hemisphere during June/July.

So, not possible to compare countries at different latitudes at the same time.


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  #5869  
Old 01.04.2020, 17:12
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Re: Coronavirus

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Based on the current knowledge of the virus, it seems the spread is slower in warmer climates. High air temp and humidity reduces the transmission. The whole article here: https://www.ft.com/content/c8ed3692-...a-bf503995cd6f

The most interesting part of the article is the figure below. Right now the ideal transmission conditions for the virus are on this red belt of regions with temps between 5-11C. But, seasons change and this red belt will move North into Canada, Northern Europe and Russia during April/May and a new one will appear in the southern hemisphere during June/July.

So, not possible to compare countries at different latitudes at the same time.
I take back my previous comment, you obviously ARE Trump in a previous life

Last edited by 3Wishes; 01.04.2020 at 17:35. Reason: fixed quote so it appears correctly
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  #5870  
Old 01.04.2020, 17:17
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Re: Coronavirus

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You forgot the cleaning personel that are either legally or illegally employed here.
Totally, the list is pretty long.
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  #5871  
Old 01.04.2020, 17:22
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Re: Coronavirus

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I take back my previous comment, you obviously ARE Trump in a previous life
I hope Trump was a better person in a previous life
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  #5872  
Old 01.04.2020, 18:05
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Re: Coronavirus

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I hope Trump was a better person in a previous life
I wish he would go back to
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  #5873  
Old 01.04.2020, 19:00
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Re: Coronavirus

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You said it was even less important than the seasonal flu, now it's already difficult time? Pick one
No matter what corona turns out to be - worse than the seasonal flue, the same as or even less - this is definitely a very difficult time now.
No need to pick.
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  #5874  
Old 01.04.2020, 19:22
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Re: Coronavirus

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Let's see the same numbers as of today:

Denmark: 18 (+38 %)
Sweden: 24 (+71 %)
Switzerland: 53 (+ 29%)

(Swiss numbers for today are probably not final and might increase a little)
If we do not know the criteria that Sweden uses to define deaths by coronavirus then the numbers are meaningless.

Currently, Sweden claims only 490 infected cases per million so either their "herd immunity" approach is failing very "bigly" or someone is lying.

Last edited by marton; 01.04.2020 at 20:10.
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Old 01.04.2020, 20:19
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Re: Coronavirus

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If we do not know the criteria that Sweden uses to define deaths by coronavirus then the numbers are meaningless.

Currently, Sweden claims only 490 infected cases per million so either their "herd immunity" approach is failing very "bigly" or someone is lying.
Well since they have a death rate of above 5% they either die very quickly or have restrictions on who gets tested and simply miss a lot of folks for the statistics.
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Old 01.04.2020, 20:20
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Re: Coronavirus

Looks like the number of new cases in Italy is declining, so it is looking hopeful assuming their testing regime was not changed.
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  #5877  
Old 01.04.2020, 20:25
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Re: Coronavirus

Spanish victim numbers are in and they are the same as in Italy.

General Franco's soldiers are dying. It's a tragedy

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The data revealed the mortality rate according to age.

In those over 80 years old, the mortality rate is the highest at 17.9 percent, a figure that drops to 5.2 percent in those aged between 70 and 79. Among coronavirus cases in the 60 to 69 percent age group, the mortality rate is recorded at 2.1 percent.

This puts the mortality rate in those under 59 at less than 1 percent.

Only five people under the age of 30 have reportedly died in Spain from the coronavirus.
https://www.thelocal.es/20200324/men...cases-in-spain
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Old 01.04.2020, 20:26
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Re: Coronavirus

Just thought, many have neither the time nor inclination to listen to a long podcast with Michael Osterholm, a leading epidemiologist/infectious disease expert in the US, and so below are the salient notes from the podcast:


SHOW NOTES

Recapping the brief history of COVID-19 and what potentially lies ahead [2:15]

Brief history of COVID-19

Appeared in December 2019 in China
It’s different that SARS and MERS because…
Those don’t become becoming highly infectious until the fifth or sixth day of illness whereas COVID-19 can be transmitted before symptoms occur much more like influenza
And there’s about 5 days from getting the virus to showing symptoms
These characteristics lead Michael to predict this would be a pandemic in early February
Will it be seasonal or spread year round?

Unclear, but the other coronaviruses (SARS and MERS) are NOT seasonal
MERS for example transmitted just fine in 100 degree heat in Abu Dhabi
How long will COVID-19 be around?

Michael says it’s unlikely to “go away” until 60-70% of the population gets infected
In the US, we’re unlikely to be able to forcibly lock people down like they did in China (nor should we)
“It won’t stop transmitting in any meaningful way till we get 50 or 60 or 70% of the population infected.”
Pessimistic

Michael is pessimistic about the fact that we really just don’t have an “easy way out”
We can’t stay in lock down for while we wait for a vaccine and destroy the economy
But we also can’t just do nothing which would bring down the healthcare system
“How do we find a way to have those people who are at lowest risk of having serious disease. ..be in our workforce, be more public, and handle the issues? So if we can do that, that’s good news.”
A second wave?

Until there’s a vaccine, it’s hard to see how this virus doesn’t hit a majority of the US population (60-70%) because once we come out of sheltering it might spread again (like people speculate is happening in China)
Quick math:
300 million people
60% infection = 180 mil people get COVID-19
20% of those need hospitalization = 36 mil in hospital
1.5% of infect end up dying = 2.7 mil deaths
“It will go until it finds enough immune people that shut it down.”


Some positive news about immunity and reinfection [10:45]
This study showed that macaque monkeys could not get reinfected after they recovered from the virus

This suggests that it’s possible that once you get COVID-19, you will be immune from getting or spreading it after you recover

“This study really gave us more hope that there really is durable immunity, at least in the short term . . . I know that if you have short term immunity, oftentimes that bodes well for a long term immunity picture.”


Case fatality rate—the challenge in finding the true rate, difference by country, and the impact of age, underlying conditions, and obesity [13:00]
Lancet paper with update case fatality information from China

The revised CFR now looks to be 0.66%
This was down from 1.38% before they added a bunch more people to the denominator that were previously in the unconfirmed bucket
Michael’s response:

we’re also missing the number people in the numerator
In other words, there are people dying at home that never get diagnosed
And this adds people to the numerator
“The numerator is actually more sensitive in terms of impacting the rate than is the denominator. And so one of the challenges that we’ve had is ‘what is that overall numerator?’ and ‘How many cases were missed?’”
See Michael’s take on what the real CFR is below …
Underlying conditions and comorbidities

In China, many males over 65 were dying, but women weren’t
The difference? Smoking is prevalent in 70% of men and only 2% of women
–Other risk factors:

Hypertension
Renal disease
Obesity may be the highest risk factor for younger people who die
“We’re seeing an increased number of severe illnesses and deaths in people between the ages of 25 and 50…and the risk factor appears to be obesity.”
What is Mike’s estimate of the actual CFR?

Some people hope the CFR is as low as 0.1-0.5%
Mike says that’s a pipe dream
Mike thinks it’s likely to be in the 1.0-2.5% range
–Why so high?

US has a large population over 65
And we have a lot of obesity in young people


What has to be true for less than 100,000 Americans to die from COVID-19? [24:30]
We’re currently at about 2,000 deaths in the US

What has to happen for the death total to stay under 100,000?

Two things, says Miks:

1—We have to basically suppress transmission as much as we can

“which I don’t think is doable [long term]…as a country we can’t sustain that.”
This would destroy the economy
Mike’s op ed in the NY Times, he wrote about how this is not a choice between saving lives and costing the economy…it’s a combination of both
2—We have to make sure the supply of critical care supplies and drugs are available

China makes most of our generic drugs in for hospitals and ICUs
Mike is concerned that we will have shortage of those things leading to unnecessary death


How do we best protect healthcare workers? [29:45]
The main thing is we need all healthcare workers supplied with an n95 mask
There is some confusion that a surgical mask is sufficient (not the case)
An n95 mask stops aerosols
But we don’t have nearly enough to match the demand despite 3m trying to ramp up production
“We don’t send our soldiers into war without some kind of protective equipment or without bullets in their guns. . .We send healthcare workers into this viral battle and we’re going to be sending them in without bullets or without protective equipment. And that to me is really sad.”
Ways to get more out of the n95 masks:

1—One…We should start forming wards, large wards where basically we have 18 or 20 patients.

You never leave the contaminated zone so you never throw away your mask
2—Secondly, can we reuse the n95 somehow?

Mike and his team is working on a technique to make that possible
One more solution: What can we do to get infected healthcare workers back?

“I’d like to test as many healthcare workers as I could for antibody and making, having the discussion we just had on the ability to know that somebody’s likely protected”
Once they are immune they won’t require a mask


Concerns about testing capability—reagent shortfall and a supply chain problem [39:30]
The US has tested about 800,000 people so far
For the PCR tests (which look at whether you are currently infected), the test kits are mostly being provided by Roche
“Supply chain, supply chain, supply chain.”

Mike is very concerned about the supply chain of the test kits and just as importantly, the reagents which are needed to get the results of the test
China was a big manufacturerAnd now they are obviously dealing with their own issues with the virus
Plus the whole world needs the tests, not just the US
Abbott tests

Some good news it Abbot is developing a new COVID-19 test
But Mike still remains concerned that we will have a shortfall of reagent water
So we might have plenty of tests but no way to get the results


Vaccines and antivirals—The outlook, timing, and challenges [47:45]
In Peter’s discussion with biotech companies (off the record), nobody seems confident a vaccine will be ready any sooner than 12 months from now

-Mike explains a bit about why it’s so challenging to develop:

The effectiveness of a vaccine would be the easier part to solve
What will hold us up is the safety component
Another issue ⇒ the supply chain

We might have the vaccine ready but not have the capability to meet the demand
Antivirals

Even more challenging than a vaccine might be creating an antiviral for treatment
Over the last 60 years, only ~5,000 antiviral drugs that we being approved, only about 90 were approved (and 40 were for HIV)
This tells us that T cell biology is so robust…T cells are so amazing at what they do that they save us from all these viruses that otherwise we’d be dead from already
“In other words, if not for the fact that we had a competent immune system that could fight off most viruses, we’d be doomed because our, our hit rate of developing drugs to stop viruses is actually pathetic compared to our ability to stop bacteria.” -Peter Attia
Mike says, the HIV research can help us
But… “I worry about the fact that we’ve already made judgements to a certain degree about what works and doesn’t work.”
The 2 kinds of drugs being explored to tread COVID-19:
Immunologic modulators (i.e., chloroquine)
“But if we have people dying from a myocarditis type picture, well that’s a whole different situation and we may actually cause problems using chloroquine.”


Long term health of survivors of COVID-19 [56:45]
Unfortunately, we know little about the possible side effects of having gotten and recovered from COVID-19

For example:

We don’t understand how much lingering myocarditis is out there.
We don’t understand how much lingering kidney disease is out there.
We don’t understand how much lingering lung disease remains in terms of fibrosis or maybe even permanent destruction of a subset of the pneumocytes
Does Mike have any insight on this from his work with SARS and MERS?

Again, not much research has been done with this health of survivors
The one good news is that humans do not seem to get reinfected with MERS once they’ve had it even if they are re-exposed to it


The impact of comorbidities—Diabetes, obesity, and immunosuppressed patients [59:30]
Type 2 diabetes and obesity are both risk factors
Type 1 diabetes patients also seems to be at higher risk but it’s unclear why that’s the case
What about immunosuppressed people?

The data is all being revealed on this but as of today it does not appear that immunosuppressed people are at higher risk (e.g., HIV patients don’t seem at higher risk)

The data from China and Italy doesn’t show anything that would indicate that immunosuppression puts you at higher risk

Compared to influenza…

Peter points out that this is another differentiation from influenza which attacks immunosuppressed people
Another thing… there is pretty compelling evidence now out of studies that were done in China that the kids do get infected at the same rate that the adults do, but they just don’t show clinical signs and symptoms and which is just the opposite with the flu where kids have major symptoms and spread it very easily


Understanding R0 and how the disease spreads [1:01:30]
R0 (aka R naught)

Mike alluded that average R0 is between 2 and 2.4
Peter wonders is symptomatic vs asymptomatic would have a different R0 and if we should be thinking about those cases differently
Mike says they are currently having that debate right now so it’s unclear
Looking at MERS and SARS for answers

Mike says R0 isn’t really relevant to MERS and SARS and the reason being the existence of “super spreaders”
In other words, it’s possible that for 10 people who had the virus, 9 of them didn’t give it to anyone, but there would be 1 super spreader who would spread it to multitudes of people
With the “super spreader” … this is a property of the host, not the virus because it’s the same virus
“So to say that the R0 in a situation like that, it’s kinda like saying your head’s in the freezer, your feet are in the oven, but on average, your temperature is just right. You know, it doesn’t make sense.”
So with MERS and SARS, Mike always challenged the relevance of R0
So what about COVID-19?

-With this disease, Mike says we have a “hybrid”

-Example of super spreader event: Choir practice turns fatal. (from the LA Times)

60 people in the choir showed up to practice, 45 have gone on to test positive, and 2 have died, 3 more in the hospital
“Something about that” says Peter
“We have these events like that and I think that we’ve had more of those than we care to realize. But on the other hand, we also have, I think the ‘regular’ transmission.”
-Transmission could occur even with little to no symptoms:

The virus found in a throat swab of people showing the very early signs of COVID-19 found that the virus level was 1000x what they see with SARS
They think it’s possible that the virus could be even higher in the days before the symptoms are showing
So even if a person isn’t coughing or sneezing, the higher volume of virus in the throat means that the virus could be spread just by breathing and pushing out aerosols
-Understanding aerosols:

The next time in your house and sunlight is peering through a window and you see all that dust floating in the air and you think, ‘Oh, my house is dusty., those are aerosols. That’s just from us talking. That’s from us breathing. That’s what goes on in your house.
The second thing is next time you’re in a shopping center and you are in a department store and you’re three aisles away from the perfume section but you can still smell it… that’s an aerosol.
“The breathing and just the talking would put [the virus] out there.”
-”Presymptomatic” instead of asymptomatic

we kind of call this presymptomatic
meaning that they’re going to get sick
but they may be infectious beforehand they are sick
–What about truly asymptomatic people?

Mike says he’s been looking at PCR and culture data for truly asymptomatic people in China data…
“they were pretty loaded, too” says Mike but he’s not sure how much they are driving the outbreak
“How much [asymptomatic people] are driving the outbreak, I don’t know, but I think we can’t ignore that they have to be there. And I do believe we have SARS-like super spreader events just like with the choir event. But there’s a lot of just efficient transmission.”


The challenge of forecasting with so many unknowns [1:08:00]
Forecasting would be great to know in order know where we need to allocate resources
I.e., which 5 cities after NYC will need the most help
But the models are so challenging to put together
The models are inevitably wrong because we don’t know the simplest things that the model is incredibly sensitive to like R0
“We don’t know what the probability distribution looks like of these things.”
What does Mike think we should be doing here?

“I ascribe very much to the fact that all models are wrong. Some just provide helpful information.”
In the 2014/2015 Ebola outbreak, the CDC model said the cases could reach 1 million, but it only ended up being 20,000
The variability in the output of a model is so huge because we don’t know some of the variables
So it’s incredibly challenging
On the other hand, you can theoretically say without knowing everything things like:
If you are able to suppress 85 or 90% of the transmission events, you can have this happen.
Or if you do this, you can have that happen.
But it can’t tell you that’s what it’s going to be. It can just tell you within the framework of what might it look like.
Mike on his predictions so far:

“We were right on with this thing all along to this point, even to picking hotspots.”
“But now we can’t … because it’s beyond the scope of our experience.”
“I can tell you, I can paint the whole United States, we have a hundred percent chance to have a COVID-19 problem. But I can’t tell you exactly much more than that right now.”


What explains the difference in cases and fatalities in different parts of the world? [1:14:30]
Globally, the communication has not be great to this point
China doesn’t seem to reveal all the information
Right now, for example, China isn’t saying it publicly but it appears that are closing movie theaters again and potential dealing with more spreading since they removed their strict lock down procedures
What might explain the variations in cases and fatality rates in different parts of the world?

Each country is fighting for the same supplies that are critical and in shortage so the lower income countries will likely not be able to get the same stuff
However, lower income countries will have less older people with underlying issues (who are the most susceptible to die from this) simply because of the fact that those people have already died in the country since the country doesn’t have the healthcare that we have in the US, for example
This implication is that the lower income country may have less fatality rate because of that
Obesity and age
The countries will more obesity in the younger population may see an uptick
The countries with older populations will see an increase
Comparing Italy and Spain to Germany

Italy and Spain are more similar and Germany seems better
Mike says the difference in results is largely just artificial
He says that most parts of the world will end up in a similar results when we look back 2 or 3 years from now
“I hate to say this, but every week is like a snapshot. It’s not the whole movie. And if we could play the whole movie out for the next two to three years, I think there’ll be a lot more similar kinds of pictures that will over time bear that out. That where the risk factors were for comorbidity, associated severe disease, we’re going to see higher case fatality rates. When you age adjust and when you adjust on risk factors, I don’t think there’s a lot of difference here that we’re going to see around the world.”


Repurposed drugs/antivirals being considered for treatment options—any optimism? [1:16:45]
Peter asks Mike… “Is there any of the sort of repurposed drugs that are currently being thrown around in non RCT manners that you have any optimism around?”

Some examples: Remdesivir, Camostate, Hydroxychloroquine, etc.
There was a study that was published out of France looking at hydroxychloroquine showing promise
But studies like these don’t have the luxury of being randomly controlled so it’s hard to take much from them
Mike admits that this is not his expertise but that he feels optimistic
“I do believe we’re going to have much more information on therapies much sooner than vaccines and that could be really important.”
A parting message from Michael about what lies ahead [1:18:30]
First, this is serious: “This is real and more people are going to know somebody in the next couple of weeks that are going to be seriously ill or die”

Secondly, it’s going to be okay: “we’re going to get through this”
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  #5879  
Old 01.04.2020, 20:27
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Re: Coronavirus

With all these people on here, counting the new cases, the deaths, omg, BFG is five minutes late again and not only that, their numbers are different from .... who the f ever, Sweden claims this, Kairo has reported that ...
..... I sometimes wonder if this is replacing the Eurovision Song Contest 2020?
Sweden: 5 points Ireland: 9 points .....
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Old 01.04.2020, 20:48
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Re: Coronavirus

Alot of people love throwing numbers and statistics around. Does that give some sort of security?
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