Can touching a barbell in the gym get you sick with the coronavirus?

[Michael Scally MD]

[OA] Human Mobility Restrictions and the Spread of the Novel Coronavirus (2019-nCoV) in China

We quantify the causal impact of human mobility restrictions, particularly the lockdown of the city of Wuhan on January 23, 2020, on the containment and delay of the spread of the Novel Coronavirus (2019-nCoV). We employ a set of difference-in-differences (DID) estimations to disentangle the lockdown effect on human mobility reductions from other confounding effects including panic effect, virus effect, and the Spring Festival effect.

We find that the lockdown of Wuhan reduced inflow into Wuhan by 76.64%, outflows from Wuhan by 56.35%, and within-Wuhan movements by 54.15%. We also estimate the dynamic effects of up to 22 lagged population inflows from Wuhan and other Hubei cities, the epicenter of the 2019-nCoV outbreak, on the destination cities' new infection cases.

We find, using simulations with these estimates, that the lockdown of the city of Wuhan on January 23, 2020 contributed significantly to reducing the total infection cases outside of Wuhan, even with the social distancing measures later imposed by other cities.

We find that the COVID-19 cases would be 64.81% higher in the 347 Chinese cities outside Hubei province, and 52.64% higher in the 16 non-Wuhan cities inside Hubei, in the counterfactual world in which the city of Wuhan were not locked down from January 23, 2020.

We also find that there were substantial undocumented infection cases in the early days of the 2019-nCoV outbreak in Wuhan and other cities of Hubei province, but over time, the gap between the officially reported cases and our estimated “actual” cases narrows significantly.

We also find evidence that enhanced social distancing policies in the 63 Chinese cities outside Hubei province are effective in reducing the impact of population inflows from the epicenter cities in Hubei province on the spread of 2019-nCoV virus in the destination cities elsewhere.

Fang H, Wang L, Yang Y. Human Mobility Restrictions and the Spread of the Novel Coronavirus (2019-nCoV) in China. National Bureau of Economic Research Working Paper Series 2020;No. 26906. Human Mobility Restrictions and the Spread of the Novel Coronavirus (2019-nCoV) in China

 

[Michael Scally MD]

 

[Michael Scally MD]

The first word you see is where you're going in April ...

 

[Michael Scally MD]

In this study, we estimated key parameters of the SARS-CoV-2 epidemic, using an analytically solvable model of the exponential phase of spread and of the impact of interventions. Our estimate of R0 is lower than many previous published estimates. These studies assumed SARS-like generation times; however, the emerging evidence for shorter generation times for COVID-19 implies a smaller R0.

This means a smaller fraction of transmissions need to be blocked for sustained epidemic suppression (R < 1). However, it does not mean sustained epidemic suppression will be easier to achieve because each individual’s transmissions occur in a shorter window of time after their infection, and a greater fraction of them occurs before the warning sign of symptoms.

Specifically, our approaches suggest that between a third and a half of transmissions occur from pre-symptomatic individuals. This is in line with estimates of 48% of transmission being pre-symptomatic in Singapore and 62% in Tianjin, China, and 44% in transmission pairs from various countries.

Our infectiousness model suggests that the total contribution to R0 from pre-symptomatics is 0.9 (0.2 - 1.1), almost enough to sustain an epidemic on its own. For SARS, the corresponding estimate was almost zero, immediately telling us that different containment strategies will be needed for COVID-19.

Transmission occurring rapidly and before symptoms, as we have found, implies that the epidemic is highly unlikely to be contained by solely isolating symptomatic individuals. …


Ferretti L, Wymant C, Kendall M, et al. Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science 2020:eabb6936. Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing

The newly emergent human virus SARS-CoV-2 is resulting in high fatality rates and incapacitated health systems. Preventing further transmission is a priority. We analyzed key parameters of epidemic spread to estimate the contribution of different transmission routes and determine requirements for case isolation and contact-tracing needed to stop the epidemic.

We conclude that viral spread is too fast to be contained by manual contact tracing, but could be controlled if this process was faster, more efficient and happened at scale. A contact-tracing App which builds a memory of proximity contacts and immediately notifies contacts of positive cases can achieve epidemic control if used by enough people.

By targeting recommendations to only those at risk, epidemics could be contained without need for mass quarantines (‘lock-downs’) that are harmful to society. We discuss the ethical requirements for an intervention of this kind.

 

[Michael Scally MD]

Comparing Chloroquine Trials
Comparing Chloroquine Trials

One minor side effect of the pandemic is that perhaps more people will learn about what drug research and clinical trials can really be like. Today’s example: we have a clinical trial of hydroxychloroquine from Wuhan that has just published on a preprint server. What’s good is that this one is blinded, randomized, and controlled (like the earlier hydroxychloroquine which one I blogged about here from Zhejiang University, so we can actually talk about it rather than just spend all our time wondering what the heck is going on.

…

So my opinion of this latest study is “cautious approval”, and that probably sums up my feelings about hydroxychloroquine as a therapy in the Covid-19 epidemic in general. It’s a long way from “This is the cure and it’s unethical to disagree”, that’s for sure. More data will be coming, and we’ll revisit the topic then.


Chen Z, Hu J, Zhang Z, et al. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. medRxiv 2020:2020.03.22.20040758. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial

Aims: Studies have indicated that chloroquine (CQ) shows antagonism against COVID-19 in vitro. However, evidence regarding its effects in patients is limited. This study aims to evaluate the efficacy of hydroxychloroquine (HCQ) in the treatment of patients with COVID-19.

Main methods: From February 4 to February 28, 2020, 62 patients suffering from COVID-19 were diagnosed and admitted to Renmin Hospital of Wuhan University. All participants were randomized in a parallel-group trial, 31 patients were assigned to receive an additional 5-day HCQ (400 mg/d) treatment, Time to clinical recovery (TTCR), clinical characteristics, and radiological results were assessed at baseline and 5 days after treatment to evaluate the effect of HCQ.

Key findings: For the 62 COVID-19 patients, 46.8% (29 of 62) were male and 53.2% (33 of 62) were female, the mean age was 44.7 (15.3) years. No difference in the age and sex distribution between the control group and the HCQ group. But for TTCR, the body temperature recovery time and the cough remission time were significantly shortened in the HCQ treatment group. Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32). Notably, all 4 patients progressed to severe illness that occurred in the control group. However, there were 2 patients with mild adverse reactions in the HCQ treatment group. Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia.

 

[ickyrica]

The first word you see is where you're going in April ...

View attachment 127744

Gawd I wanna slap you rn! Hope you're staying safe in your neck of the woods.

 

[Michael Scally MD]

If You Have Coronavirus Symptoms, Assume You Have the Illness, Even if You Test Negative
If You Have Coronavirus Symptoms, Assume You Have the Illness, Even if You Test Negative

The problem may be with the test. Current coronavirus tests may have a particularly high rate of missing infections. The good news is that the tests appear to be highly specific: If your test comes back positive, it is almost certain you have the infection.

False-negative test results — tests that indicate you are not infected, when you are — seem to be uncomfortably common. Increasingly, and disturbingly, I hear a growing number of anecdotal stories from my fellow doctors of patients testing negative for coronavirus and then testing positive — or people who are almost certainly infected who are testing negative.

Unfortunately, we have very little public data on the false-negative rate for these tests in clinical practice. Research coming out of China indicates that the false-negative rate may be around 30 percent. Some of my colleagues, experts in laboratory medicine, express concerns the false-negative rate in this country could be even higher. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections

So, where does that leave us? Even with more testing, we are likely to be underestimating the spread of the virus. For now, we should assume that anyone could be carrying the virus. If you have had likely exposures and symptoms suggest Covid-19 infection, you probably have it — even if your test is negative. We should all continue to practice the behaviors — rigorous hand washing, not touching the face, social distancing — that impede its spread. And we need better information about the performance of these tests — including any new tests that are introduced — in the real world.

Even as better tests emerge, we should always put the test result in the context of the other information we have. It’s a lesson that endures throughout medicine: Look at the big picture, not a single piece of data. Triangulate on the truth, using all the sources of information you have, no matter how good a single test. And don’t be shy about questioning a conclusion that doesn’t fully fit the facts.

 

[Michael Scally MD]

The President says we are at war with the coronavirus. It’s a war we should fight to win.

The economy is in the tank, and anywhere from thousands to more than a million American lives are in jeopardy. Most analyses of options and trade-offs assume that both the pandemic and the economic setback must play out over a period of many months for the pandemic and even longer for economic recovery. However, as the economists would say, there is a dominant option, one that simultaneously limits fatalities and gets the economy cranking again in a sustainable way.

That choice begins with a forceful, focused campaign to eradicate Covid-19 in the United States. The aim is not to flatten the curve; the goal is to crush the curve. China did this in Wuhan. We can do it across this country in 10 weeks.

And with enough intelligence about the enemy — where the virus lurks, how quickly it is moving, where it is most threatening, and what its vulnerabilities are — we can begin to re-energize the economy without putting additional lives at risk.

If we take these six steps to mobilize and organize the nation, we can defeat Covid-19 by early June.

1. Establish unified command. …

2. Make millions of diagnostic tests available. …

3. Supply health workers with PPE and equip hospitals to care for a surge in severely ill patients. …

4. Differentiate the population into five groups and treat accordingly. …

· We first need to know who is infected;

· second, who is presumed to be infected (i.e., persons with signs and symptoms consistent with infection who initially test negative);

· third, who has been exposed;

· fourth, who is not known to have been exposed or infected; and

· fifth, who has recovered from infection and is adequately immune.

We should act on the basis of symptoms, examinations, tests (currently, polymerase-chain-reaction assays to detect viral RNA), and exposures to identify those who belong in each of the first four groups. Hospitalize those with severe disease or at high risk.

Establish infirmaries by utilizing empty convention centers, for example, to care for those with mild or moderate disease and at low risk; an isolation infirmary for all patients will decrease transmission to family members.

Convert now-empty hotels into quarantine centers to house those who have been exposed, and separate them from the general population for 2 weeks; this kind of quarantine will remain practical until and unless the epidemic has exploded in a particular city or region.

Being able to identify the fifth group — those who were previously infected, have recovered, and are adequately immune — requires development, validation, and deployment of antibody-based tests. This would be a game-changer in restarting parts of the economy more quickly and safely.

5. Inspire and mobilize the public. …

6. Learn while doing through real-time, fundamental research. …

If we do this, we can relieve Americans of avoidable grief and loss, play our part in the global struggle against Covid-19, and be in a stronger position to help other countries.

If we persist with half-measures against the coronavirus, we risk saddling the economy with a long-term and avoidable burden of anxious consumers, illness, higher medical costs, and constricted business activity.

Fineberg HV. Ten Weeks to Crush the Curve. New England Journal of Medicine 2020. https://doi.org/10.1056/NEJMe2007263

 

[Michael Scally MD]

A prestigious scientific panel told the White House Wednesday night that research shows coronavirus can be spread not just by sneezes or coughs, but also just by talking, or possibly even just breathing.

"While the current [coronavirus] specific research is limited, the results of available studies are consistent with aerosolization of virus from normal breathing," according to the letter, written by Dr. Harvey Fineberg, chairman of a committee with the National Academy of Sciences.

Fineberg told CNN that he will wear start wearing a mask when he goes to the grocery store.

"I'm not going to wear a surgical mask, because clinicians need those," said Fineberg, former dean of the Harvard School of Public Health. "But I have a nice western-style bandana I might wear. Or I have a balaclava. I have some pretty nice options."

Dr. Anthony Fauci, a key member of the White House's coronavirus task force, told CNN Tuesday that the idea of recommending broad use of masks in the US to prevent the spread of coronavirus is under "very active discussion" by the group.

Fineberg, chair of the NAS' Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats, said his letter was sent Wednesday evening in response to a query from Kelvin Droegemeier with the Office of Science and Technology Policy at the White House.

"This letter responds to your question concerning the possibility that [coronavirus] could be spread by conversation, in addition to sneeze/cough-induced droplets," the letter states. "Currently available research supports the possibility that [coronavirus] could be spread via bioaerosols generated directly by patients' exhalation," it continues.

 

[Michael Scally MD]

“Our Goal Should Be to Crush the Curve”
A doctor-scholar who studied the 1976 mishandling of swine flu says the president is wrongly choosing between saving lives and saving the economy.
“Our Goal Should Be to Crush the Curve” — ProPublica

…

Fineberg went on to a distinguished career, including stints as dean of Harvard’s School of Public Health, provost of Harvard and president of the Institute of Medicine (now the National Academy of Medicine). He is currently president of the Gordon and Betty Moore Foundation. (Gordon Moore was a co-founder of Intel.) ProPublica President Richard Tofel, who also studied under Neustadt, spoke with Fineberg this week about lessons from swine flu for the current crisis. The transcript of their conversation has been edited for length and clarity.

…

Why This Coronavirus Is Not Like the Flu, or Even the Swine Flu

First, we need to have adequate numbers of tests available and distributed for diagnosis. We do not have that in place, and it must be within two weeks. Second, we need to provide protective personal equipment to every health professional who is going to be caring for patients. We would not send soldiers into war without body armor. We should not ask our health professionals and attendants to serve without adequate protection. Third, every citizen in the United States has a part to play. We should all be mobilized. Everyone should be maintaining physical distance.

In public, everyone should now be wearing a surgical mask. Surgical masks should be delivered to every American household by the U.S. Postal Service, perhaps also mobilizing and utilizing the Amazons, Walmarts, Costcos, CVS, Walgreens and other major distributors. All should be mobilized to get those surgical masks and hand cleaner in the hands of every American household. The surgical masks do not prevent you from receiving the virus. But if everyone wears them, they will diminish the spread from those who are unknowingly infected to others.

…

 

[Michael Scally MD]

LAREDO, Texas—The Laredo City Council took several actions and issued a new Emergency Ordinance during a special city council meeting on March 31 in an effort to curb the spread of COVID-19. Those actions included extending the mayor’s emergency order, adding a daily curfew for all residents, and implementing a requirement for residents to cover their noses and mouths when required as stated below.

The council approved an extension of the mayor’s emergency order until April 30, 2020.

Starting at 12:01 a.m. on Thursday, April 2, 2020, a curfew will be implemented for all residents from 10:00 p.m. to 5:00 a.m. daily. Residents will be required to stay in their homes during this time and may only leave for essential trips and necessities.

Those who must work during those hours will be exempt from this ordinance, but must show proof such as an I.D. or a letter from their employer. Laredo Police Officers will be enforcing this ordinance and may use their discretion. The penalty for a violation of this section shall be a Class B misdemeanor punishable by a fine not exceeding $1,000, or confinement in jail for a period not exceeding 180 days.

Also beginning at 12:01 a.m. Thursday, April 2, 2020, all persons over the age of five (5) are required to wear some form of covering over their nose and mouth, such as a homemade mask, scarf, bandana, or handkerchief, when: entering into or inside of any building open to the public; when using public transportation, taxis, or ride shares; or when pumping gas.

This does not apply when a person is: engaging in a permissible outside physical activity; that are riding in a personal vehicle; that are in alone in a separate single space; that are with their own shelter group (household members); when doing so poses a greater health, safety or security risk; or for consumption purposes.

The penalty for a violation of this section shall be a Class C misdemeanor punishable by a fine of not more than $1,000.00

 

[Oldschool]

LAREDO, Texas—The Laredo City Council took several actions and issued a new Emergency Ordinance during a special city council meeting on March 31 in an effort to curb the spread of COVID-19. Those actions included extending the mayor’s emergency order, adding a daily curfew for all residents, and implementing a requirement for residents to cover their noses and mouths when required as stated below.

The council approved an extension of the mayor’s emergency order until April 30, 2020.

Starting at 12:01 a.m. on Thursday, April 2, 2020, a curfew will be implemented for all residents from 10:00 p.m. to 5:00 a.m. daily. Residents will be required to stay in their homes during this time and may only leave for essential trips and necessities.

Those who must work during those hours will be exempt from this ordinance, but must show proof such as an I.D. or a letter from their employer. Laredo Police Officers will be enforcing this ordinance and may use their discretion. The penalty for a violation of this section shall be a Class B misdemeanor punishable by a fine not exceeding $1,000, or confinement in jail for a period not exceeding 180 days.

Also beginning at 12:01 a.m. Thursday, April 2, 2020, all persons over the age of five (5) are required to wear some form of covering over their nose and mouth, such as a homemade mask, scarf, bandana, or handkerchief, when: entering into or inside of any building open to the public; when using public transportation, taxis, or ride shares; or when pumping gas.

This does not apply when a person is: engaging in a permissible outside physical activity; that are riding in a personal vehicle; that are in alone in a separate single space; that are with their own shelter group (household members); when doing so poses a greater health, safety or security risk; or for consumption purposes.

The penalty for a violation of this section shall be a Class C misdemeanor punishable by a fine of not more than $1,000.00

Now all the wanted cartel members will be able to go shopping!!!

 

[Michael Scally MD]

The White House is expected to announce a new policy, based on guidance from the Centers for Disease Control and Prevention, that would urge Americans to wear cloth masks in an effort to prevent coronavirus spread, according to a federal official familiar with the policy.

In a draft document obtained by STAT, the CDC recommended that the public use homemade face coverings when in public, reserving higher-grade protective equipment like N95 masks for hospitals and health care workers, who have faced severe shortages in personal protective equipment as the coronavirus pandemic has accelerated through the United States.

Such face coverings, according to the draft guidance, would not be intended to protect the wearer, but rather prevent the wearer from unknowingly spreading the disease when in public. Individuals should wear face coverings in public settings like grocery stores, the guidance said. Children under the age of 2 and people experiencing trouble breathing would be excluded from the mask guidelines.

The guidance would serve as an attempt to prevent Americans from unknowingly spreading coronavirus before they experience symptoms. Evidence has shown that those infected with coronavirus are sometimes contagious two days before the onset of symptoms.

The official cautioned that the recommendations were not yet final, and that the White House could still alter its final recommendation.

 

[ickyrica]

Patriots' plane ferries a million masks to U.S. from China

 

[Michael Scally MD]

We Need 1 Million Tests a Week
If the country hopes to end social distancing and regional lockdowns, the only solution is to build a comprehensive testing infrastructure.
We Need 1 Million Tests a Week

Although President Trump claimed yesterday that coronavirus testing is no longer a problem, the fact is that the U.S. is still not testing enough. A recent report from the American Enterprise Institute estimates, based on peak demand of past flu seasons, that we need to conduct at least 750,000 tests a week, and this may be a conservative suggestion. Other groups estimate that we need to test more than 1 million people a week. At the moment we’re testing less than half as many people, and not necessarily where the need is greatest.

Testing can no longer “flatten the curve.” It’s too late for that. But once the rate of infections has been slowed by social (really physical) distancing, only a testing scheme far beyond our current capabilities can prevent another surge in infections. If we are going to get out of lockdown, we need to radically improve our testing protocols and infrastructure. And we need to do it fast.

First in line for routine testing should be health-care workers. They have a much greater risk of exposure. They also have a much greater chance of exposing others should they become infected. It’s important to know whether health-care workers are infected before they show symptoms, so they can stop interacting with patients before they spread the disease.

More broadly, we need to implement a scheme by which anyone who is symptomatic at all gets a test, hopefully in a facility set up for that purpose and away from other people. Anytime someone is identified as infected, that person should immediately be put in quarantine. Hotels could be used to isolate the infected.

Just as important, we need a legion of public-health workers to identify all of the infected person’s close contacts, check them for symptoms, and test them. If any of them are positive, the same procedure needs to be carried out again. This “test and trace” system is an essential part of how some Asian countries have kept their outbreaks in check.

“Connecting diagnostic testing to public-health interventions is a cornerstone of outbreak control,” Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, told me. “We would like to get to a point where all of the close contacts of someone with COVID-19 are notified so they can remain at home and be monitored for symptoms.”

We don’t currently have the public-health workforce we need for such a system. But a hiring spree won’t be sufficient. The federal and state governments need to give workers license to conduct tests, report results, and impose quarantines without bureaucracy getting in the way.

The federal government needs to come up with a way to pay for this new workforce as well as for the tests it administers. Our health-care system usually depends on insurance to pay for tests because the benefit is thought to be for the individual. Testing and intervention in this scenario is also for the public good, at the order of public-health entities. Neither individuals nor their insurance providers can reasonably be held responsible for payment. The full cost of this endeavor has yet to be calculated. It will not be a small number, though.

Testing also has to get faster. If they wait days for results, infected people might unwittingly spread the disease. The good news is that companies are already developing faster tests. But we’re also going to need new kinds of tests. Right now we depend on a type of testing that looks for RNA from the virus. In the future, we will also need antibody testing, which will allow us to learn who has been infected in the past and recovered. This capability will, in turn, help us learn who might be immune, and therefore able to provide care and necessary services without fear of becoming sick or spreading the disease.

Unless and until a fast, comprehensive testing regime is in place, we cannot end social distancing. If we do, the virus will spread undetected once more, and we’ll have no choice but to engage in severe social distancing yet again. We have to stop playing catch-up and build a comprehensive testing infrastructure now.

 

[Old]

We Need 1 Million Tests a Week

At 1 million/wk it will only take Americans 6 1/4 years to test all 327,000,000 citizens ... once. Of course the delay in treatment may shorten this by months.

 

[ickyrica]

After ignoring warnings, Israeli ultra-Orthodox hit by virus

Fawkin retahds. As bad as spring breakers, but without youth and cutting edge medical help on their side. Netanyahu has to be kinda happy considering (miserable statement, I know)

 

[Michael Scally MD]

 

[Old]

Transmission occurring rapidly and before symptoms, as we have found, implies that the epidemic is highly unlikely to be contained by solely isolating symptomatic individuals. …

BREAKING NEWS! Covid-19 Prevention: New Study Proves That Social Distancing Of 1 to 3 Meters Is Nothing But Fake News and Misinformation - Thailand Medical News

"Now with more studies emerging that social distancing really does not work, we strongly advocate that individuals and the public worldwide start taking legal actions and class suits against all sites, experts and authorities advocating social distancing of between 1 to 3 meters as these ignorant buffoons are actually endangering the lives of many."

"A new research by qualified experts in their field from the MIT (Massachusetts Institute of Technology) lead by Dr Lydia Bourouiba, an Associate Professor at MIT, have researched the dynamics of exhalations (coughs and sneezes, for instance) for years at The Fluid Dynamics of Disease Transmission Laboratory and found exhalations cause gaseous clouds that can travel up to 27 feet (8.2 meters)."​

 

[ickyrica]

So, after new science comes to light about a disease's transmission, sue the people that have to deal with an emerging global pandemic and make suggested guidelines for public safety? Maybe we use that science to augment current standards rather than place blame for not having a crystal ball and knowing all right off the rip? The fact someone would actually entertain legal action like this other worldly short sighted. Talk about biting the hand that feeds, weak as fuck.