New Covid-19 Thread

[shiny!]

French Study on Early Treatment with HCQ+AZ

From Science Direct. A French study showing that when used early before complications occur, the combination of hydroxychloroquine and azithromycin is safe and effective.

Safe, effective and cheap, so the U.S. pans it and bans it.

Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France

https://www.sciencedirect.com/scienc...77893920302179

https://doi.org/10.1016/j.tmaid.2020.101738

Abstract

Background:
In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19.

Methods:
We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated with HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days) for at least three days. Outcomes were death, clinical worsening (transfer to ICU, and >10 day hospitalization) and viral shedding persistence (>10 days).

Results:
A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years – range 14–95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74–95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision).

Conclusion:
Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with very low fatality rate in patients.

[jk]

Re: French Study on Early Treatment with HCQ+AZ

kaletra may also work if given early, but only if given early.

[shiny!]

Gallup, NM Extreme Lockdown, Again

The shutdown of Gallup, NM just made the AP. They keep doing this on payday. Those poor people up there:

Extreme lockdown shows divide in hard-hit Navajo border town


By MORGAN LEE23 minutes ago



1 of 15
New Mexico state police officers screen cars for compliance with an emergency lockdown order that bans nonessential visitors and limits vehicle passengers to two people as they enter Gallup, N.M., Thursday, May 7, 2020. New Mexico Gov. Michelle Lujan Grisham renewed the lockdown order amid concerns about the rapid transmission of COVID-19 in the area. Gallup and surrounding McKinley County are one of the worst rural hot spots for coronavirus infections in the U.S. (AP Photo/Morgan Lee)


GALLUP, N.M. (AP) — Like clockwork, payday arrives and tens of thousands of people from the Navajo reservation and other rural stretches along the New Mexico-Arizona border flood into Gallup, a freewheeling desert oasis of just 22,000 that can quickly quadruple in size with all the visitors.

Not now.

As the modern-day trading post reels under a coronavirus outbreak that has infected more than 1,450 people and killed at least three dozen in the city and surrounding rural county — overrunning a patchwork health care system — Gallup has gone into extreme lockdown. Barricades are manned by state police and the National Guard, keeping out anyone who doesn’t live there or face an emergency.

That has sent thousands of people scrambling for options other than the city’s coin-operated bulk water station and monthly shopping runs to Walmart and Tractor Supply Co. Up to one-third of homes on remote stretches of the Navajo Nation lack full plumbing, and grocery stores are mostly tiny and limited.

The roads into Gallup may open up Friday evening, but the rules allowing only essential shopping will remain, and the reservation has its own lockdown that prevents people from leaving on evenings and weekends. Navajo police patrol for people breaking the rules.
On Thursday, hundreds of cars idled at a roadblock in hopes of entering town, just before the lockdown was extended for three more days under the state Riot Control Act.

The effectiveness of the lockdown, enacted by the governor and endorsed by Gallup’s fledgling mayor, is up for debate. Infections are still mounting in town, with about 240 confirmed cases within one ZIP code, and more than 2,650 across the Navajo Nation that extends into portions of Arizona and Utah. If the Navajo Nation were its own state, it’d have the second highest per capita rate of positive coronavirus cases in the country, behind only New York.

The dividing line traced by roadblocks also is tugging on sensitivities about birthrights and inequities, as Native American visitors worry about the social stigma of being locked out because of the contagion.

The outbreak on the huge Navajo reservation, the nation’s largest with 175,000 people, has made people in Gallup nervous. Many see hints of the racism that has divided people in the town for centuries.

“They targeted the people around here. They’re going to be coming to Gallup to shop, so they put a stop to that,” said Johnnie Henry, adding that two of his relatives from the Navajo Nation were apparently infected with COVID-19 while working at a Gallup hospital. “We kind of look at each other and say, are we the ones bringing it? No, it’s all over.

“There’s a lot of people who want to go back into Gallup, but they’re afraid that they’re going to call us names ... say that we are the carriers,” Henry said.

In Gallup, the streets are empty, with downtown thoroughfares largely free of cars. The lockdown idled pawn shops, halted informal jewelry sales by walking vendors, and thinned out crowds at grocery stores and Walmart.

“The lockdown has been awesome, you don’t have to worry about any crowds,” Andrew Sandoval, a delivery worker for Home Depot, said as he ducked into a grocery store to buy his wife a cup of coffee.

At Gallup’s main hospital, Rehoboth McKinley Christian, the battle against the virus has taken a toll, with 32 infections among employees. The hospital’s sole pulmonologist left Wednesday without a replacement, and patients with serious respiratory conditions are being flown to Albuquerque, Chief Medical Officer Val Wangler said.

For most, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.

The trajectory of the pandemic could hinge on Gallup’s homeless population — many who left the Navajo Nation and struggle with alcoholism.

Infections raced through a detox center in early April. Now, free room and board are offered at four local motels — including the famous El Rancho hotel visited by legendary actor John Wayne and President Ronald Reagan — to about 140 homeless patients who are quarantined. They are tested repeatedly before being cleared with a certification card that can let them back into shelters.

Beyond Gallup, New Mexico’s stay-at-home restrictions expire May 15, and there’s uncertainty about what’s next.

“I’m so confused. What is going to really work if this doesn’t?” state Sen. George Munoz of Gallup said of the community lockdown. He has taken to buying giant pallets of bottled water for indigenous communities with campaign funds. “I don’t know the answer.”

At a motel, Dr. Caleb Lauber opens a conversation with a coronavirus-positive patient in the Navajo language before administering a nasal swab test to see if the infection persists.

“There’s more than one benefit from doing this,” he said. “It allows us the opportunity to ensure that the community is protected.”
But the program is financially unsustainable, Lauber said.

South of Gallup in Zuni Pueblo, a tribal community of 800 residents set amid red rock mesas, Lt. Gov. Carleton Bowekaty supports extending the Gallup lockdown, noting that it keeps more pueblo members safely at home. He said the tribe has stockpiled food and water to help support members who have to quarantine after being exposed to the virus.

He said a COVID-19 outbreak in the pueblo is far from contained, with about 55 confirmed infections and two deaths amid intensive testing, evening curfews and a daytime roadblock aimed at discouraging nonessential travel.

An end to the Gallup lockdown would likely mean stricter restrictions in the pueblo, where Bowekaty says tribal members are struggling with social distancing in ceremonial life, including burials.

Thoughts have turned to preserving oral traditions that might be lost with more coronavirus casualties.

“How do we capture their knowledge if they pass on?” he asked.
___
Associated Press data editor Meghan Hoyer contributed to this report.

[touhy]

Re: New Covid-19 Thread

Amen Woodsman.

[lakedaemonian]

Re: French Study on Early Treatment with HCQ+AZ

From Science Direct. A French study showing that when used early before complications occur, the combination of hydroxychloroquine and azithromycin is safe and effective.

Safe, effective and cheap, so the U.S. pans it and bans it.

Directly from a classmate who is an MD/researcher on the frontline response in Singapore, and a senior admin guy, HCQ/AZ has some quite serious cardiac toxicity side effects.

And that’s for non smoking Asians with better diet/cardiac health than Caucasians.

[lakedaemonian]

Re: French Study on Early Treatment with HCQ+AZ

From Science Direct. A French study showing that when used early before complications occur, the combination of hydroxychloroquine and azithromycin is safe and effective.

Safe, effective and cheap, so the U.S. pans it and bans it.

Directly from a classmate who is an MD/researcher on the frontline response in Singapore, and a senior admin guy, HCQ/AZ has some quite serious cardiac toxicity side effects.

And that’s for non smoking Asians with better diet/cardiac health than Caucasians.

[jk]

Re: French Study on Early Treatment with HCQ+AZ

fwiw hydroxychlorogquine is first line in yale's current algorithm for hospitalized covid-19 patients. they do not recommend it for outpatients.

at harvard's mgh they're starting prophylactic anticoagulants, remdesivir for a defined subset of patients. they're using acitominophen as a preferred anti-pyretic. they say to "consider" hcq. they also discuss choices of antibiotics [1st is doxycycline] but it's not clear to me if this is only with evidence of bacterial pneumonia on top of the viral pneumonia.

as the disease increases in severity, or in the case of special condition [e.g. pregnancy, cytokine release syndrome, immunocompromised post-transplant, etc] both algorithms get more complicated from what i've written above

[shiny!]

Re: French Study on Early Treatment with HCQ+AZ

fwiw hydroxychlorogquine is first line in yale's current algorithm for hospitalized covid-19 patients. they do not recommend it for outpatients.

at harvard's mgh they're starting prophylactic anticoagulants, remdesivir for a defined subset of patients. they're using acitominophen as a preferred anti-pyretic. they say to "consider" hcq. they also discuss choices of antibiotics [1st is doxycycline] but it's not clear to me if this is only with evidence of bacterial pneumonia on top of the viral pneumonia.

as the disease increases in severity, or in the case of special condition [e.g. pregnancy, cytokine release syndrome, immunocompromised post-transplant, etc] both algorithms get more complicated from what i've written above

I was under the impression that Hydroxychloroquine is considered a relatively safe drug. Not without risk of side effects (no drug is) but with a long track record of general safety. It is routinely prescribed for people with malaria and rheumatoid arthritis.

Is it being given at a higher dosage than normal for Covid-19? The French doctors are recommending it for early treatment before severe complications from the virus set in. Are the Singapore doctors using it at the same early point in the disease as the French doctors?

Perhaps when treatment is delayed until people are very sick, they give it at a higher dose which causes problems for the heart? Or perhaps people in Singapore have a tendency towards lower levels of selenium, putting them at higher risk of developing heart complications in the presence of a virus?

There is just so much we don't know yet.

[shiny!]

Re: French Study on Early Treatment with HCQ+AZ

Heartbreaking.

Virus Rampages across Navajo lands, close-knit families

[shiny!]

The Importance of Masks

From Vanity Fair. (I like to copy/paste in plain text to avoid breaking the pages here. There are several links embedded in this article that I didn't bother to hyperlink, but you can see them if you go to the source article.)

All of this makes me want to tear my hair out, that our so-called leaders aren't really, really emphasizing this message! Instead, they continue to mismanage funding and resources. They have destroyed the economy for years to come. They want to authorize billions for contact tracing and other compilicated schemes instead of spending billions on MASKS. With the full support, no, collusion of the MSM, they try to make people feel so frightened and helpless that the people welcome the abridgement of their constitutional rights in the name of "keeping us safe."

If 80% of Americans Wore Masks, COVID-19 Infections Would Plummet, New Study Says

There’s compelling evidence that Japan, Hong Kong, and other East Asian locales are doing it right and we should really, truly mask up—fast.

By David Ewing Duncan
May 8, 2020

It sounds too good to be true. But a compelling new study and computer model provide fresh evidence for a simple solution to help us emerge from this nightmarish lockdown. The formula? Always social distance in public and, most importantly, wear a mask.

If you’re wondering whether to wear or not to wear, consider this. The day before yesterday, 21 people died of COVID-19 in Japan. In the United States, 2,129 died. Comparing overall death rates for the two countries offers an even starker point of comparison with total U.S. deaths now at a staggering 76,032 and Japan’s fatalities at 577. Japan’s population is about 38% of the U.S., but even adjusting for population, the Japanese death rate is a mere 2% of America’s.

This comes despite Japan having no lockdown, still-active subways, and many businesses that have remained open—reportedly including karaoke bars, although Japanese citizens and industries are practicing social distancing where they can. Nor have the Japanese broadly embraced contact tracing, a practice by which health authorities identify someone who has been infected and then attempt to identify everyone that person might have interacted with—and potentially infected. So how does Japan do it?

“One reason is that nearly everyone there is wearing a mask,” said De Kai, an American computer scientist with joint appointments at UC Berkeley’s International Computer Science Institute and at the Hong Kong University of Science and Technology. He is also the chief architect of an in-depth study, set to be released in the coming days, that suggests that every one of us should be wearing a mask—whether surgical or homemade, scarf or bandana—like they do in Japan and other countries, mostly in East Asia. This formula applies to President Donald Trump and Vice President Mike Pence (occasional mask refuseniks) as well as every other official who routinely interacts with people in public settings. Among the findings of their research paper, which the team plans to submit to a major journal: If 80% of a closed population were to don a mask, COVID-19 infection rates would statistically drop to approximately one twelfth the number of infections—compared to a live-virus population in which no one wore masks.

The mask debate, of course, has been raging for weeks in the States and globally. Pro-maskers assert that the widespread use of face coverings can diminish the spread of COVID-19. Some anti-maskers, including various politicians and public health officials, have insisted that there is no proof of the efficacy of face guards. According to some activists, a blanket mask mandate places a limit on individual liberty and even one’s right to free speech. (Pro-mask advocates are fighting back with #masks4all and #wearafuckingmask Twitter campaigns).

Representatives of the World Health Organization have also been sounding rather anti-mask, fretting that many people won’t wear masks properly, thereby risking infection, or that masks will give people a false sense of security and encourage risky behavior, such as partying up close and personal—none of which seems to have played out, as far as we know, in Japan or Hong Kong or other mask-wearing places. Adding to the brouhaha has been the shortage of medical masks for doctors, nurses, bus drivers, and the guy who delivers burritos to your door.

The muddle over masks is what drove Berkeley’s De Kai to drop everything two months ago and help convene an ad hoc team of scientists and academics: a physician from London, a bioinformaticist from Cambridge, an economist from Paris, and a sociologist and population-dynamics expert from Finland.

“I felt like this was pretty urgent,” said De Kai, who was born in St. Louis, and is the son of immigrants from China. “I saw the country where I grew up, where my family lives [now mostly in the Bay Area], about to face this pandemic without knowing much about something as simple as wearing a mask to protect themselves and others.” In part, this comes from a cultural difference between East Asia, where masks have been routinely worn for decades to fend off pollution and germs, and other parts of the world. This includes the U.S., where people are unaccustomed to wearing masks, and, in the past, have sometimes been insensitive, even stigmatizing East Asians, many of whom had chosen to wear them in public prior to the pandemic, and had continued the practice in the aftermath of the SARS and MERS outbreaks. (In part, this habit was meant to show other people that they were concerned about transmitting the disease—something we in the West would do well to emulate.)

De Kai’s solution, along with his team, was to build a computer forecasting model they call the masksim simulator. This allowed them to create scenarios of populations like those in Japan (that generally wear masks) and others (that generally don’t), and to compare what happens to infection rates over time. Masksim takes sophisticated programming used by epidemiologists to track outbreaks and pathogens like COVID-19, Ebola, and SARS, and blended this with other models that are used in artificial intelligence to take into account the role of chance, in this case the randomness and unpredictability, of human behavior—for instance, when a person who is infected decides to go to a beach. De Kai’s team have also added some original programming that takes into account mask-specific criteria, such as how effective certain masks are at blocking the invisible micro-droplets of moisture that spray out of our mouths when we exhale or speak, or our noses when we sneeze, which scientists believe are significant vectors for spreading the coronavirus.

Along with the masksim site, the team is also releasing a study that describes their model in detail as well as their contention that masksim’s forecasts support a growing body of pro-mask evidence. “What’s most important about wearing masks right now,” said Guy-Philippe Goldstein, an economist, cybersecurity expert, and lecturer at the Ecole de Guerre Economique in Paris—and a masksim collaborator, “is that it works, along with social distancing, to flatten the curve of infections as we wait for treatments and vaccines to be developed—while also allowing people to go out and some businesses to reopen.”

While all models have limitations and are only as good as their assumptions, this one is “a very thorough model and well done,” said William Schaffner, an infectious disease specialist at Vanderbilt University, who reviewed the De Kai team’s paper. “It supports a notion that I advocate along with most other infectious disease experts: that masks are very, very important.” Jeremy Howard, founding researcher at fast.ai and a distinguished research scientist at the University of San Francisco, also assessed the paper. “It’s almost overkill how careful they were with this modeling,” said Howard, who also coauthored and spearheaded a study last month (recently submitted to the journal PNAS) that reviewed dozens of papers assessing the effectiveness of masks.

During a screen-share Zoom from his home office in Hong Kong, De Kai, who has not had to shelter in place (“because nearly everyone in here wears masks”), explained to me how the model works. (Check out this video where De Kai demos the site). On De Kai’s Zoom screen, a box pops up filled with dozens of blue dots, each representing a person who is publicly zipping and zapping about, doing their thing, and sometimes interacting with others. These blue dots denote the “uninfected, but susceptible.” As the simulation rolls along, one of the dots becomes orange, representing a person who has been exposed to the coronavirus. This orange dot then touches a nearby blue dot, which also changes to orange while the original orange dot changes to red. This means that dot-person is now infected. As the model runs and simulated “days” pass by, with the dots continuing to bounce around, some of the oranges and reds turn green, meaning they have recovered—or died.

On the screen-share, De Kai first ran a simulation that shows what happens when COVID-19 strikes a population in which no one wears a mask. The orange and red dots proliferate at a frightening speed; “susceptibles” becoming “exposed/infected,” then recovered or dead. “This is what you don’t want,” said De Kai. He changed the setting to simulate what would happen if 100% of the make-believe population wore masks; almost all of the dots would stay blue—with each of them surrounded by a white square, representing someone wearing a mask.

Next De Kai added another tweak, modeling a situation in which 80% of a given population wore a mask. Here, most of the dot-people stay blue, with a few going orange, red, and green. “This is the goal,” De Kai maintained. “For 80 or 90% of the population to be wearing masks.” Anything less, he added, doesn’t work as well. “If you get down to 30 or 40%, you get almost no [beneficial] effect at all.”

“I started to go out just to buy food in mid-March,” recalled economist Guy-Philippe Goldstein. “I was the only one wearing a mask, and people were making fun of me. They aren’t now, although there still aren’t enough people in Paris wearing masks.” This may be one reason why only a few states in the U.S. currently require people to always wear masks when they are out in public, although many states require masks for certain workers, for entering businesses, and on public transportation. Many cities and counties, including Denver and Los Angeles County, require them too. Whether you’re in a blue state or a red one, you don’t want to become one of De Kai’s red dots.

[jk]

Re: The Importance of Masks

a security guard at a dollar general was shot to death 2 days ago when he insisted that some customers put on masks.

[Woodsman]

Re: The Importance of Masks

a security guard at a dollar general was shot to death 2 days ago when he insisted that some customers put on masks.

Well, isn't that something of a non-sequitur? So how precisely do you see the actions of a violent criminal in this incident as relevant to the efficacy of ubiquitous masking, Doctor?

Sharmel L. Teague, 45, of Flint, was arraigned Tuesday, May 5, 2020 in 67th Distirct Court on first-degree murder and felony firearm charges. The charges stem from the May 1, 2020 shooting death of 43-year-old Calvin James Munerlyn, a security guard at the Family Dollar off East Fifth Avenue in Flint who was allegedly killed following a dispute over a customer not wearing a mask into the store. (Jake May | MLive.com)The Flint Journal, MLive.com

[Woodsman]

Re: The Importance of Masks

...They have destroyed the economy for years to come. They want to authorize billions for contact tracing and other compilicated schemes instead of spending billions on MASKS. With the full support, no, collusion of the MSM, they try to make people feel so frightened and helpless that the people welcome the abridgement of their constitutional rights in the name of "keeping us safe."

From a comment in a story posted at the Tuscon Sun Sentinel:

Spoke with a friend of mine who works in DC. He is sick to his stomach every day he goes to work. He said democrat congress members are literally giddy with the results the virus is having on the economy. They eagerly compare unemployment and market numbers every morning in the halls, offices and over phone conferences, laughing and mocking Trump as they watch the economy he built crumble. They are actually excited about what the virus is doing to America during an election year and the opportunities it presents to go after Trump. He said that their intention is to drag the shutdown out as long as possible in order to crash the economy (Trump’s strength) right before the election to make Trump look bad. He said Pelosi is ordering/threatening democratic state governors to keep their states shut down as long as possible, assuring them they will be rewarded when they take the Senate and White House.
All at the expense of America.
This isn’t rumor or opinion; this is happening.

Hearing similar stories myself. Can't say I'm the least bit surprised. But I have my suspicions about who will be surprised once this is all said and done.

[Mega]

Re: The Importance of Masks

Trump has sussed all of this............he ensure the public become aware that it was the DNC that kept them closed down MUCH long than required....
If Biden is the DNC "plant" then forget it, he bliz him ....it will be a joke....it will even make Hillary's loss look good.............China hacking?

Mike

[bpr]

Re: French Study on Early Treatment with HCQ+AZ

...at harvard's mgh they're starting prophylactic anticoagulants, remdesivir for a defined subset of patients. they're using acitominophen as a preferred anti-pyretic...

I've so often heard about acitomenophen for the fever... Local stores are out of Tylenol (but not the generic store brand), but what about aspirin as an anti-coagulant and anti-pyretic? Anyone you've heard using or looking into this? Or is it just not profitable enough, or known to be ineffective?