Coronavirus Health - Health and Wellbeing

[AsleepInYorkshire]

It doesn't relate directly to Covid 19 but to my mind raises questions about the idea of herd immunity.

The Herd Immunity that may be most likely is the herd immunity we have to the common cold. We are not immune - far from it - but we cope. The cold is generally a mild to moderate and illness of fairly short duration, that very rarely kills or does lasting harm.

Yet it is said that when Europeans first went to the Americas, the common cold devastated native populations there. To the Europeans it was a common cold, something the immune system was adapted to cope with. To the native Americans it was a novel virus imported by the newcomers.

I would suggest that a plausible longer-term prospect for covid is that once it is no longer novel, it becomes just another common cold. We can still catch it, but the disease is no longer serious.

That would be fine for the population in general, but looks like bad news for individuals isolating to avoid it.

Spanish Flu killed 20-30 million in 1918-20. It's still available to catch today. Covid 19 will as you have deduced "just" be another virus to add to the list of "stuff" we can catch. Herd immunity as you have pointed out doesn't mean we can't get the "damn thing" - more it suggests an ability to deal with the illness with reduced symptoms and [perhaps] improved mortality. I am convinced that over the next two years we will see several "spikes" in mortality rates.

Ultimately this is an economic battle and it's not one we can win without significant loss of life. We simply do not have the economic muscle to remain in lockdown for sustained periods of time. Several industries will feel some very significant downward pressure. For example, tourism, oil & air travel.

Whilst the government and in particular Boris and his cabinet are following the science I would [suggest/hope - delete as appropriate] that they are also aware of the need to return to normal trading conditions as soon as possible or face the mother of all [recessions/depressions - delete as appropriate].

AiYn'U

[UncleEbenezer]

Moderator Message:
RS: Post removed as too political for this board.

[sg31]

Spanish Flu killed 20-30 million in 1918-20. It's still available to catch today. Covid 19 will as you have deduced "just" be another virus to add to the list of "stuff" we can catch. Herd immunity as you have pointed out doesn't mean we can't get the "damn thing" - more it suggests an ability to deal with the illness with reduced symptoms and [perhaps] improved mortality. I am convinced that over the next two years we will see several "spikes" in mortality rates.

Ultimately this is an economic battle and it's not one we can win without significant loss of life. We simply do not have the economic muscle to remain in lockdown for sustained periods of time. Several industries will feel some very significant downward pressure. For example, tourism, oil & air travel.

Whilst the government and in particular Boris and his cabinet are following the science I would [suggest/hope - delete as appropriate] that they are also aware of the need to return to normal trading conditions as soon as possible or face the mother of all [recessions/depressions - delete as appropriate].

AiYn'U

That's not my understanding of the term 'herd immunity'.

The protection given to a community against an epidemic of a contagious disease when a sufficient number of the population are immunised or otherwise develop immunity to it.

One person with an illness might infect 4 other people, those four infect 16 and so on. If 80% are immune there's only a 20% chance of each of those people actually developing the illness. In effect the infection rate drops below one and the illness dies out.

I accept we can't stay in lock down indefinitely but we daren't risk removing restrictions too quickly because that way we will get back to the exponential curve and the NHS will not cope. I hope we will drive the infection down to a very low level and then instigate mass testing. Quarantine those infected and trace their contacts. The Government already has statistics showing the increase in the infection rate by relaxing various restrictions, if we can keep the infection rate down we can get something like 'normal' and not lose control.

If we let things rip too early we will be back in lock down and need to suffer this all over again only worse.

[look]

a brazilian doctor (female) treats severe cases with anticoagulants. I think it was heparin.
27 cases, 25 already went home.
I think they received other meds before, she said she wants to give it earlier.

I think there will be many doctors around the world who have given their patients paracetamol and most already went home. Unless you have a link with more details, it is pointless and on a par with Trump's speculations on disinfectants.

John

this is new news, not one politician spoke about.
the doctors should search in the internet to find texts where other doctors tell their experiences and knowledge.
search elnara, anti coagulants and works related to the disease.

the doctor used it only in critical patients, and from 27 patients, 25 went home and 2 are still in the hospital.
it' seems you are a member of the virus army.

[redsturgeon]

I think there will be many doctors around the world who have given their patients paracetamol and most already went home. Unless you have a link with more details, it is pointless and on a par with Trump's speculations on disinfectants.

John

this is new news, not one politician spoke about.
the doctors should search in the internet to find texts where other doctors tell their experiences and knowledge.
search elnara, anti coagulants and works related to the disease.

the doctor used it only in critical patients, and from 27 patients, 25 went home and 2 are still in the hospital.
it' seems you are a member of the virus army.

We have a protocol here on this website. If you wish to make statements about things that you would like others to consider as reliable facts rather than made up spam then you should quote a source and add a link so that others can check the facts for themselves. It is not good enough for you to say, "look it up for yourself". If you wish this treatment to be discussed seriously then you need to give your sources.

I have explained this to you before.

I am not sure what, "it' seems you are a member of the virus army" means. Can you explain?

John

[look]

elnara negri

https://www.medrxiv.org/content/10.1101 ... 17v2?rss=1

[johnhemming]

Whilst the government and in particular Boris and his cabinet are following the science

The phrase "follow the science" implies that there is a settled scientific position when in this situation there is not as yet. Furthermore there is a political question about the balance between different priorities.

[redsturgeon]

elnara negri

https://www.medrxiv.org/content/10.1101 ... 17v2?rss=1

Thank you.

That is an interesting paper and shows potential promise of the use of Heparin in these ventilated patients.

John

[SalvorHardin]

Good news today from Gilead Sciences about Remdesivir. From the official announcement (Wall Street is up 2% as I type this, even after the announcement of a 4.8% fall in US GDP in 2020 Q1):

"In an exploratory analysis, patients in the study who received remdesivir within 10 days of symptom onset had improved outcomes compared with those treated after more than 10 days of symptoms."

http://investors.gilead.com/news-releas ... -antiviral

"The news on Gilead is really powering the market," said Linda Duessel, senior equity strategist at Federated Hermes in Pittsburgh, Pennsylvania. "While we wait for a vaccine, we are looking out for anything that will help us get back into society, and we're all hanging on this data on a day-by-day basis."

https://finance.yahoo.com/news/us-stock ... 15095.html

"Minutes before this top-line data was released, Gilead said that a National Institute of Allergy and Infectious Diseases clinical trial evaluating remdesivir in hospitalized COVID-19 patients met the study’s primary endpoint. The federal agency is expected to provide additional information about that trial, Gilead said."

https://www.marketwatch.com/story/gilea ... 2020-04-29

Obviously I'm going to be biased as I own quite a few shares in Gilead. That said there's a lot of evidence accumulating that Remdesivir does have some effect on the Wuhan virus. If we don't develop a vaccine, it will be antiviral drugs like this which keep the virus under control in the long run. That's how society deals with HIV; there's no HIV vaccine but there are lots of antiviral drugs (many of which were developed by Gilead).

[sg31]

Hi SH here's the NIH study.

https://www.niaid.nih.gov/news-events/n ... d-covid-19

Preliminary results indicate that patients who received remdesivir had a 31% faster time to recovery than those who received placebo (p<0.001). Specifically, the median time to recovery was 11 days for patients treated with remdesivir compared with 15 days for those who received placebo. Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group (p=0.059).

[tikunetih]

Has this been mentioned already? The snippet quoted below from the Korea Centres for Disease Control and Prevention sounds like a big deal, allaying some concerns:

https://www.theguardian.com/world/2020/ ... e-february

"A clinical expert panel on Wednesday also concluded that recovered coronavirus patients who later test positive for the virus again were not “reactivated” or reinfected, but were false positives.

The head of the committee said the false positives were due to technical limits of PCR testing. The country has so far reported 292 such cases."

[look]

did you already read about the BAT vaccine?

[Itsallaguess]

An interesting development on the testing front -

Scientists working for the US military have designed a new Covid-19 test that could potentially identify carriers before they become infectious and spread the disease, the Guardian has learned.

In what could be a significant breakthrough, project coordinators hope the blood-based test will be able to detect the virus’s presence as early as 24 hours after infection – before people show symptoms and several days before a carrier is considered capable of spreading it to other people. That is also around four days before current tests can detect the virus.

The test has emerged from a project set up by the US military’s Defense Advanced Research Projects Agency (Darpa) aimed at rapid diagnosis of germ or chemical warfare poisoning. It was hurriedly repurposed when the pandemic broke out and the new test is expected to be put forward for emergency use approval (EUA) by the US Food and Drug Administration (FDA) within a week.

https://www.theguardian.com/world/2020/ ... 9-carriers

Cheers,

Itsallaguess

[look]

did you already read about the BAT vaccine?

vaccine for june, if the ruling guys allow it.

https://european-seed.com/2020/04/covid ... echnology/

[redsturgeon]

https://clinicaltrials.gov/ct2/history/ ... udyPageTop

Fascinating look at how you can change a clinical trial as you proceed in order to get the result you want.

Remdesivir trial changed and halted in order to get swift FDA approval.

Basically all the drug does is shorten hospital time by a couple of days in some patients, doesn't cause too many side effects and we don't know much more because the trial was prematurely halted.

Its mode of action mean that it was never going to be any sort of cure but the unhealthy rush to market will probably stop other promising drugs getting as much support as they otherwise might.

Beware the pump and dump on Gilead shares.

John

[Itsallaguess]

https://clinicaltrials.gov/ct2/history/ ... udyPageTop

Fascinating look at how you can change a clinical trial as you proceed in order to get the result you want.

Remdesivir trial changed and halted in order to get swift FDA approval.

Basically all the drug does is shorten hospital time by a couple of days in some patients, doesn't cause too many side effects and we don't know much more because the trial was prematurely halted.

When the 'result you want' is to achieve improved outcomes, then fast-track use of a drug that delivers them seems like a sensible approach, surely?

In a potential scenario where ICU beds might be in short supply, along with the required ventilation kit to go with those beds, and lives are potentially at stake in some places because of this, then I assume shorter ICU stays are likely to be cheaper than building new hospitals....

Additionaly, wouldn't we perhaps to begin to 'know much more' about this particular treatment now that the drug is in wider use, outside of a relatively small trial?

I'm not sure we 'stop learning' about a particular treatment in this scenario John, and I don't buy your view that investigations into other treatments will stall just because a particular drug is being taken on like this....

It's not clear what your alternative to this approach would be, and why such an alternative approach might deliver better results than the one currently being taken here...

Cheers,

Itsallaguess

[redsturgeon]

https://clinicaltrials.gov/ct2/history/ ... udyPageTop

Fascinating look at how you can change a clinical trial as you proceed in order to get the result you want.

Remdesivir trial changed and halted in order to get swift FDA approval.

Basically all the drug does is shorten hospital time by a couple of days in some patients, doesn't cause too many side effects and we don't know much more because the trial was prematurely halted.

When the 'result you want' is to achieve improved outcomes, then fast-track use of a drug that delivers them seems like a sensible approach, surely?

In a potential scenario where ICU beds might be in short supply, along with the required ventilation kit to go with those beds, and lives are potentially at stake in some places because of this, then I assume shorter ICU stays are likely to be cheaper than building new hospitals....

Additionaly, wouldn't we perhaps to begin to 'know much more' about this particular treatment now that the drug is in wider use, outside of a relatively small trial?

I'm not sure we 'stop learning' about a particular treatment in this scenario John, and I don't buy your view that investigations into other treatments will stall just because a particular drug is being taken on like this....

It's not clear what your alternative to this approach would be, and why such an alternative approach might deliver better results than the one currently being taken here...

Cheers,

Itsallaguess

We will see.

I hope it saves lives but I spent 25 years with the pharma industry and I am aware of the shenanigans that can occur.

There's a lot of hope and expectation out there which can cloud judgement.

John

[Itsallaguess]

There's a lot of hope and expectation out there which can cloud judgement.

Of course, but it would seem to be an odd approach to this issue if we were to collectively ignore one of the few treatments to have a positive effect on this virus, and to do so at such a crucial stage of infection, where cutting timescales of any sort is likely to be critical to the outcome of some patients taking the treatment, and other patients potentially waiting for beds or ventilators....

Someone said early on in the outbreak that we were 'in the foothills' of the current wave of the pandemic, and clearly the same could also be said about the development of treatments for it, but surely it's treatments such as this that can at the very least help to provide a pathway through those foothills, and on to better, and more thorough and broader medicines?

I just find it a bit strange that you seem to think that the wider use of this particular treatment is such a negative thing to be doing, and that it's likely to affect other treatments 'getting support'.

Such is the huge global scientific effort in tackling this thing, I would find that simply astonishing if it were true...

If we were on another board, I'd probably ask if Gilead being a US company is influencing your view on this particular treatment at all, but that's probably a topic that's best left for the other place..

Cheers,

Itsallaguess

[redsturgeon]

There's a lot of hope and expectation out there which can cloud judgement.

Of course, but it would seem to be an odd approach to this issue if we were to collectively ignore one of the few treatments to have a positive effect on this virus, and to do so at such a crucial stage of infection, where cutting timescales of any sort is likely to be critical to the outcome of some patients taking the treatment, and other patients potentially waiting for beds or ventilators....

Someone said early on in the outbreak that we were 'in the foothills' of the current wave of the pandemic, and clearly the same could also be said about the development of treatments for it, but surely it's treatments such as this that can at the very least help to provide a pathway through those foothills, and on to better, and more thorough and broader medicines?

I just find it a bit strange that you seem to think that the wider use of this particular treatment is such a negative thing to be doing, and that it's likely to affect other treatments 'getting support'.

Such is the huge global scientific effort in tackling this thing, I would find that simply astonishing if it were true...

If we were on another board, I'd probably ask if Gilead being a US company is influencing your view on this particular treatment at all, but that's probably a topic that's best left for the other place..

Cheers,

Itsallaguess

I'm not suggesting we should ignore this drug or any of the others being looked at but we try to keep things in perspective. This drug is not and can never be the silver bullet. The best we can hope is for some shortening of hospital stay.

Here is the earlier study from China published in the Lancet
https://www.thelancet.com/journals/lanc ... 9/fulltext

Between Feb 6, 2020, and March 12, 2020, 237 patients were enrolled and randomly assigned to a treatment group (158 to remdesivir and 79 to placebo); one patient in the placebo group who withdrew after randomisation was not included in the ITT population. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87–1·75]). Although not statistically significant, patients receiving remdesivir had a numerically faster time to clinical improvement than those receiving placebo among patients with symptom duration of 10 days or less (hazard ratio 1·52 [0·95–2·43]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early.

My experience in the industry over many years has shown me that there are many ways to both design, manage and interpret clinical trials results to give you the outcome that you desire. All I am doing is suggesting caution in the interpretation of one study.

I have nothing against the fact that Gilead is a US company, in fact one of our biggest customers is a large US pharmco for whom I have nothing but respect and whose ethics I consider at least on a par with the UK company I worked for over many years. I would be posing the same caveats no matter what nationality Gilead was. On the other hand I would suggest it doubtful that a non US company would have received FDA approval quite as quickly.

I see the use of remdesivir in a similar light to Tamiflu from Roche, which shortens flu symptoms by a day or so but at a significant cost and with potential side effects in some patients. On a cost benefit analysis it is a close call.

If you have a drug that suddenly everyone wants to use then there is little doubt in my mind that some effect will be created that limits the availability of patients for testing with other medications since once someone is being treated with remdesivir they would not be eligible for a study of another drug except in combination.

I hope that the current research continues apace with all potential candidates being studied and fully funded. Sometimes though overhyping in this field can have knock on effects (see shortages of hydroxychloroquine cause by Trump's tweets), see also

https://www.healio.com/infectious-disea ... y-covid-19


John

[SalvorHardin]

I just find it a bit strange that you seem to think that the wider use of this particular treatment is such a negative thing to be doing, and that it's likely to affect other treatments 'getting support'.

Such is the huge global scientific effort in tackling this thing, I would find that simply astonishing if it were true...

If we were on another board, I'd probably ask if Gilead being a US company is influencing your view on this particular treatment at all, but that's probably a topic that's best left for the other place.

The idea that because Remdesivir has been approved that lots of other treatments will get less attention is pretty weird, especially because it isn't a magic bullet that stops it in its tracks. Governments, Universities and companies all over the world are working on a variety of treatments and the likelihood is that many will fail and some will work with varying degrees of success. The amount of prestige, goodwill and money to be made ensures this.

A lot of the negativity around Remdesivir is because Donald Trump recently praised it. Shortly afterwards a lot of negative articles and comments started to appear. Lots of people want it to fail now that Trump has spoken out in favour of it. Many of these are also desperate for the hydroxychloroquine-based treatments to fail. They don't want a successful drug if Trump has mentioned it. This isn't just loonies on Twitter; a lot of the media is highly negative because of Trump (and in part because many journalists are scientifically illiterate and innumerate).

There are also plenty of academics wanting research to fail. A good example is the women's studies lecturer at Oxford who recently wrote about not wanting the Oxford vaccine team to succeed because, erm, racism.

https://www.spiked-online.com/2020/04/2 ... niversity/

Naturally after Dr. Fauci praised Remdesivir lots of Trump supporters have started to oppose it. So we've got people on both sides condemning it for political reasons.

"The first drug shown to help treat coronavirus patients is likely to get official permission to be used “really quickly,” Dr. Anthony Fauci said Thursday, calling it a “very important first step.”"

https://nypost.com/2020/04/30/dr-fauci- ... y-quickly/