CharonY

An important strategy is to normalize suppression strategies. If this fine during a pandemic it is moreso during regular elections. Trump and the GOP have rebuffed measures such as mail in ballots for a reason.

It is unclear as a) we do not know whether or in which patients influenza may result in different clinical manifestations b) studies are local with small sample sets which makes it difficult to build representative cohorts c) we do not know whether there is a relationship in infection process regardless of clinical outcome. That all being said, there is a paper (but I cannot quite recall the authors) which indicated that the influenza cases went down as COVID-19 went up in Wuhan. I do not recall the precise dates of the patients, so not sure whether it coincided with the shutdown. Edit: And did not come across any studies in the US yet.

As mentioned there are only few reports, mostly on cases with positive outcomes. One by Ding et al. (2020) J Med Vir has not found any more severe clinical indicators. The numbers of co-infection are based on small sample sizes and depending on how the cohorts are built (e.g. severity of symptoms) the outcome may be biased.

Took a look at the first posts and they look very good. Certainly more effort were put into them than I would realistically do. Don't think I would have anything to contribute (unless there are specific questions that went unanswered and I happen to have read something about it or have general molecular biological knowledge that applies). I don't think that there there is a database that would try to deconvolute that information. Given the current situation folks are probably more likely to be tested for COVID-19 than for influenza, meaning that after a positive I suspect that this would take precedence. There are case reports with co-infections reported in small studies (e.g. individual clinics) but I am not aware of large-scale surveys. Within hospitals the cases detected with co-infections were fairly low (but rarely quantified in detail).

There is some data out there, but typical molecular information are derived from animal models, rather than autopsies. It takes time to develop good animal or in vitro models and conduct the experiments. On top of that, creating targeted treatments based on biological information is really, really tricky, and takes even longer. Which is why medical research often skips the deeper biological parts at the beginning and focuses on outcomes instead. The ultimate reason is that biology is one of the most complex subjects out there and there is simply a ton we do not fully understand. Moreover, similar to the overall thrust of the post, more folks are interested in the applied bits. I.e. "treatment for the disease" is going to get more funds than "understanding the fundamentals of host-pathogen interactions", for example. While I may lament that from scientific and research interest point of view, I do see that the long-term research needs to take a seat on the back on this one. That being said, much of the pathophysiology is centered around the mechanisms related to adult respiratory stress syndromes (ARDS). The pattern is very similar to secondary haemophagocytic lymphohistocytosis and related hyperinflammation (or cytokine storm). One strategy is there to use cytokine-inhibition therapies, though they still remain to be tested.

Nope but considering that there are not really large scale reports of relapses, the signs are positive as a whole I'd say.

I think he is (like most folks) videoconferencing. I suspect it is just not exciting and does not draw the same attention as, say, rallies.

Why not both?

I do not think it is. Or rather there is no evidence that it might be the case. Rather the issue many countries is still undertesting and prioritizing tests on folks with symptoms. If you look at more fully tested populations there does not seem to be a vast discrepancy compared to China at comparable time points. On this point, the hygiene hypothesis is mostly used in the context of autoimmune diseases and allergies. I.e. low exposure to foreign substances might result in inbalances that cause the immune system to overreact (I think atrophy is not a good analogy, the responses are strong, but confused). Also when it comes to the adaptive part of the immune system, actual exposure is needed. At least in theory exposure to another related virus might raise imperfect antibodies which may attenuate the infection. But there is no data that suggests that at this point. Finally, especially when comparing to strongly urbanized countries like Taiwan and South Korea, I doubt that there are many differences in terms of hygiene. I think you will find larger differences within each country between, say rural and urban centres. Especially in areas with a lot of of livestock.

I am not sure whether it was the same one that I have seen, but if I understood it correctly these are total positive for virus but asymptomatic cases, rather than exclusively new ones (but I may be mis-remembering and can't find the report now). In their official reports China only listed symptomatic cases (originally via RNA test, later also those with confirmed symptoms via CT but without additional test). While it may have made clinical sense at that time to focus on symptomatic cases, especially since all positive cases were isolated anyway, it is now a liability. Exactly that.

I do not understand the primary process in detail, there seem to be weird state-level rules involved perhaps iNow can provide insights? Edit: Just saw that apparently the governor (a Democrat) tried to postpone but was overturned by the State Supreme Court. Apparently the Federal Supreme Court also blocked extension of mail in ballots, which was heavily criticized by Ruth Bader Ginsburg (a Supreme Court Justice). So apparently it went ahead due to the Republican-controlled legislature. Which is a weird thing, but again, I have not tried to understand the process. I fear I may lose whatever sanity I may have left.

Actually, you would be wrong. While turnout is low, the number of polling stations are often also very limited (perhaps unsurprisingly, especially in areas with many minorities, guess why...). So in certain areas you have long queues and wait times. It is ultimately a tactic to disrupt the democratic process and part of the larger voter suppression strategy.

No, I get that. I was just hoping naively that such essential agencies would be left to do their work, especially during emergencies. But similar to FEMA, it does not seem to be the case. Yes and some countries (Swededen, I think for example) have stopped as in addition to low or lack of efficacy, there are also more reports on side effects.

! Moderator Note Asking how to create a virus, while undoubtedly beyond the capabilities of most folks, is runs afoul of or hazardous material/biohazard policies. Please do not open more threads on this topic.

SJ, thanks for the link. I was not aware of that and it is very worrying. I generally hold the CDC in high regard, but that has dampened quite a bit.

There is also the other explanation that he is not able to deal with complex situations. When offered a potential solution, he seized it as in his world things become truth if repeated often enough.

No, silencing as a limited duration, though it is often hard to predict how long. It depends a lot on how effective the RNA is for a given cell line, how much is being used etc.

There is actually also the issue that some practitioners have taken to prescribe it as a prophylaxis agent, without any proven benefit. The broader issue here is probably that especially in times of crisis folks would normally (and perhaps rightfully) assume that the information provided by the government is based on the current best available information and is part of the (inter)national strategy to address the issue. But the current US administration is not stepping back and let the health professionals provide the info (contrast that with the briefings in Canada for a start difference) but rather provides contradicting information. As such it is no unsurprising that folks take it to themselves to do things, unfortunately.

There are also concerns that pitching hydrocholorquine as an unproven drug can (and starts) to cause shortages for their intended use.

Folks, can I ask everyone to stay on topic and/or open a new thread elsewhere to discuss this?

Partially, a lot is also because of the imbalance between public dissemination and the strength of the data. Scientists are usually very critical to overhyping results (and specific endorsement from POTUS could amplify it). There a couple of letters you might find interesting: https://annals.org/aim/fullarticle/2764199/use-hydroxychloroquine-chloroquine-during-covid-19-pandemic-what-every-clinician https://annals.org/aim/fullarticle/2764065/rush-judgment-rapid-reporting-dissemination-results-its-consequences-regarding-use

Well, there are no strong evidence. While numerous treatment options have been and are being tested, so far the reports are at best weak. As perhaps discussed earlier hydroxychloroquine (either alone or in combination) has shown some faster recovery in cohorts with weak symptoms (based on a French and Chinese study). Most recent studies that included patients with more severe symptoms did not see any benefit over placebos. Molina et al (2020) Med et Mal Inf.. It still in pre-proof (i.e. peer reviewed but not typeset yet) so here is also the title, which is pretty clear: "No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection". All were pilot studies, so more studies would be needed to establish effects (or lack thereof) fully. Some researchers find the strong focus on it a bit worrying as the evidence for efficacy is still rather lacking. For vitamin C as well as for plasma treatment I have not seen any trial results yet, so I am not sure how solid the data can be.

Yeah, exhalation through that disc is definitely easier than to breathe through your mask. In the lab we do not use them, but I found that even without a valve, if you can get the area around your nose bridge sealed off very tightly you can minimize fogging.

Well, to be precise it leads to lung damages. While that can make the patient more susceptible to secondary infections, it is not necessarily connected. It ultimately depends on what the patients dies from first (if they die). I also do not think that folks have actually a consensus on whether the 1918 influenza epidemic actually caused things like cytokine storms. There are papers out there that have argued that the vastly different outcomes in various subgroups of patients indicates that host immune intensity actually plays a role (and would also be in agreement with the dominant role of secondary infections. I know that folks like to pick up the Spanish flu due to the large number of deaths, but for a variety of reasons it is not a good reference point (not least because we only have limited pathobiological information from that time). A cytokine storm in itself can be deadly. In the case where we have good data (as obviously the assumption on the 2019 pandemic are based on forensic reconstruction and indirect evidence), such as the 2009 swine flu pandemic, severe alveolar damage and signs of capillary damages were observed, these then can to lead to organ failure. In addition, the cytokines can also spill into circulation which can cause multi-organ dysfunctions. Either way the patient is gets in a really bad shape, which also makes the vulnerable to secondary infections. However, even if isolated in a sterile room, there is a risk of organ failure. The latter usually happens fairly fast, those that survive beyond that point are usually those that are at risk of getting infected.

Ah, no. Cytokines are signalling molecules produced by your body. Some of them are proinflammatory and are produced as response to infections. If they get too high while reacting to an infection the inflammation response of your body can start to cause damage. These responses tend to be stronger in younger folks (or conversely, in older folks immune responses are often muted). In very bad cases theses pro-inflammatory responses can lead to death, which has happened during the Spanish flu as well as Swine flu, which caused many of the deaths among younger folks.