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Another possible cure for coronavirus, found in sheep dip: Ivermectin

A single treatment able to effect ∼5000-fold reduction in virus at 48h in cell culture.”

–Caly et al 2020

It’s another day in freaky chemistry — researchers at Monash University found that one of the main components of sheep drench is also very good at reducing Coronavirus, at least in test tubes. Ivermectin’s an unsung hero of the world of biochemistry, called a “Wonder Drug” and a “Blockbuster” because it works against  roundworms, lungworms, mites, lice, scabies and hornflies, as well as cattle-ticks. Most importantly, it kills the worm that causes River Blindness, saving the vision of thousands in sub-saharan Africa, and places like Ecuador.

That’s doesn’t mean it will work in vivo — and it may be a month before human trials begin so we can find out.

Possibly, in a few months you might be able to kill off Coronavirus and deworm yourself at the same time.

Though the human experiment is already probably happening in countries where it is being used already and coronavirus is circulating. Surely we can track those cases?

And at least in Australia, unlike Chloroquine — which we don’t have much of — with 70 million sheep I can’t see us running out of sheep dip.  (If indeed Ivermectin turns out to be useful against coronavirus). They won’t run out in New Zealand either where there are 6 sheep for every person.

How long will it be before some unfortunate sod drinks sheep drench  like the man who drank fish tank cleaner.

Coronavirus breakthrough as scientists discover a drug used to treat HEAD LICE can kill COVID-19 cells

      • Researchers at Monash University found Ivermectin can kills COVID-19 cells
  • The anti-parasite drug killed off the cells within two days and is widely available

An anti-parasitic head lice drug available around the world has been found to kill COVID-19 in the lab within 48 hours.

A Monash University-led study has shown a single dose of the drug Ivermectin could stop the SARS-CoV-2 virus growing in cell culture.

‘We found that even a single dose could essentially remove all viral RNA (effectively removed all genetic material of the virus) by 48 hours and that even at 24 hours there was a really significant reduction in it,’ Monash Biomedicine Discovery Institute’s Dr Kylie Wagstaff said on Friday.

The cost of Ivermectin is around 15c in the third world, and $50 for one round for a human in New York.  (Still a lot cheaper than a $5000 a day ICU bed.)

…Merck has donated well over 2.5 billion Mectizan® tablets for Onchocerciasis treatment, with in excess of 700 million treatments authorised. Currently, some 80–90 million people are taking the drug annually through MDA in Africa, Latin America and Yemen. A further 300 million total treatments have been approved for lymphatic filariasis, with around 90 million treatments being administered annually (Fig. (Fig.8 ).8 ).

The drug was discovered in 1975 derived from a microbe in Japanese soil. By 2011 some $4 billion dollars worth of Ivermectin have been donated to the third world.

It is used humans, even in children:

Ivermectin, while paralyzing body-wall and pharyngeal muscle in nematodes has no such impact in mammals, as it cannot cross the blood-brain barrier into the mammalian Central Nervous System, where GABA receptors are located.

It can be taken orally to kill head lice. It just means a lot of safety testing has been done already.

Why antiviral and antiparasitic?

Invermectin

When Ivvermectin binds to “Imp B” the viral protein can’t get across the BPC into the nucleus.

There is no obvious reason why these should be connected, but apparently  Ivermectin is useful against other viruses too, including HIV, Dengue, West Nile, and influenza. (As an nice spin off from covid-19 we might find ways to cure the flu.)

RNA viruses seem to need to use a molecule called “importin” to get themselves into the nucleus of the cell, and Ivermectin blocks that.

 Ivermectin has since been confirmed to inhibit IN nuclear import and HIV-1 replication5. Other actions of ivermectin have been reported7, but ivermectin has been shown to inhibit nuclear import of host (eg.8,9) and viral proteins, including simian virus SV40 large tumour antigen (T-ag) and dengue virus (DENV) non-structural protein 55, 6. Importantly, it has been demonstrated to limit infection by RNA viruses such as DENV 1-44, West Nile Virus10, Venezuelan equine encephalitis virus (VEEV)3 and influenza2, with this broad spectrum activity believed to be due to the reliance by many different RNA viruses on IMPα/β1 during infection11,12

 – ScienceDirect

But to show how fickle these things can be, even though it made it to phase III clinical trials against Dengue in Thailand, and it reduced the viral count in vivo, it still didn’t produce a clinical benefit.

So keep a sober mind that reducing viral loads in test tubes may not translate into saving lives in the ICU ward.

But even if Ivermectin is not the answer — something else will be, and hammering this virus is helping us buy the time to find what that is. We will figure this out and it may be sooner than people think.

There’s never been a time like this, with modern biotech, a trillion dollar life-and-death-carrot, and labs focused on this all around the world.

h/t Steve McIntyre @ClimateAudit, via Willie S, Another Ian, Bill in Oz, El Gordo, OriginalSteve

REFERENCE

Caly, L. et al (2020) The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitrohttps://doi.org/10.1016/j.antiviral.2020.104787

 

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Weekend Unthreaded

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Make Your Own Mask: DIY No-sew 2 minute and high quality sewn HEPA options

Ignore the mixed, junk messaging, if the WHO tells you not to wear a mask, that’s President Xi speaking. It’s a reason to wear one. We should all be wearing masks in public. It may be the cheapest way to reduce the R0, and get us out of coronavirus-jail fast.

  1. Countries which wear masks have lower transmission. Taiwan, Japan, Hong Kong, South Korea. UPDATE: Australia’s Deputy Chief Medical Officer says Australians shouldn’t use masks because they are not clever enough to use them properly or something like that. Seriously.  Don’t wait for bureaucrats to get the message right.
  2. It protects other people from those who don’t even have symptoms who are shedding virus.
  3. It protects you: It reduces your chance of breathing in droplets of virus that float in the air. Viruses are tiny, but studies show that masks work, even a thin surgical mask prevented nearly 3 out 4 parents from catching influenza from their infected children. The N95 style are better but any mask is better than nothing.
  4. There are no guarantees -- the virus can sneak in the side, and still enter through your eyes (wear glasses to reduce at least to stop you touching your eyes). Goggles are better.
  5. Take it off very carefully. Assume the front is contaminated. Don’t touch the front, hold it by the straps, and take off the bottom strap first. Let the mask fall forward. Be wary of shaking loose particles and then breathing them in. Think about where you will put it before you take it off and do it there. Here are short CDC instructions on mask use. The CDC video on donning and doffing. There are longer CDC instructions on fitting N95 masks.  Wash hands before, after, and every ten minutes for the rest of the year. Don’t get OCD. ;-)
  6. To reuse: Boil cloth masks for 5 minutes to sterilize, or steam it. If it can’t be washed, hang outside in the sun for 48 hours, or leave it on a hot car dashboard.

Survival times of Coronavirus are shorter on cardboard and material compared to hard surfaces. I’m guessing porous material (like paper, card or cotton) dry and dehydrate the virus. For masks, the word is that the best material to use (apart from a HEPA filter) is a tight weave cotton sheet (a high thread count) — which might be better than synthetic material because of its ability to absorb water.

DIY: No sewing, disposable paper mask, suggested by Hong Kong’s consumer council

MATERIALS:  Paper towels, tissue paper, rubber bands, masking tape, hole punch, binder clips aka “bulldog clips”, (plus glasses, wire and a clear plastic file folder if you want to make a face shield!)

 

DIY: Five minute masks, no-sew, bed sheet, safety pin style.

Skip to 2:20 for instructions. A paper clip can be threaded into the pre-stitched hems of a bed sheet. Uses 13 inch x 5 inch pieces. Washable as long as the clips don’t rust.

DIY: Just fold it — the ultra simple Japanese style

This Japanese no-sew mask uses something that looks like a tea towel or handkerchief. It can be done with a bandana.

MATERIALS: Cotton tea towel, plus two elastic bands. 2 mins — plus fiddling to get it the right length to fit.

Best quality, sewn mask with HEPA filter

If you can sew, this is what Dr. Ryan Southworth is asking home handy-people to make for use on the front line.  If you don’t have a machine, this could still be hand sewn. (It’s not impossible. I still have a hand sewn item my grandmother made which I keep just because of the incredibly fine stitching. Once upon a time, not so long ago, it’s all people could do.)

MATERIALS: Hepa vacuum cleaner bags, Hot glue, pipe cleaners, elastic, thread, scissors.

..

This is another style designed by a lab technician using hot glue, or heat sealing, and good quality filters. These are professional quality disposable masks.

For serious sewing types – the Olsen Mask is designed for hospital use: See the Youtube from UnityPoint Health, Cedar Rapids. The Olsen Mask is meant as a backup for frontline teams, and has complete patterns online. The hospital will provide materials. They will be reusable and washable.

Then there are people who are even using bra cups: Eg this woman.

OK, so we look weird in the shops. Think how relaxing it will be at home for the next two weeks where you don’t have to wonder if every dry cough is the start of something bad.

Related Posts

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Wear masks, flush the air, microdroplets suspend for hours

Closed rooms with many people talking are hot-beds of infection. Invisible clouds of virus hang suspended in the air. Open the windows. Turn up the airflow. Wear masks. (Wear goggles too, if you are high risk, the virus can get in through the wet surface of your eyes).

Blow that virus outdoors where the sun will fry it. We need to change the way we handle air in planes and on cruise ships, and public transport — even when there is no pandemic.

This is why I am not shopping without PPE. Make a mask.  Mail order and delivery is so much safer. Do carpark pick ups.  It’s also why eating uncooked fruit and vege that people may have breathed on is still a risk. The virus will likely survive 28 days in the fridge at 4 degrees C and even longer in the freezer.  At 40 degrees it will last about 6 hours. Time will not protect you unless things are warm. 

When I did research in a lab, if we wanted to save viruses we’d put them in a freezer (minus 70C).

A virus is more like a chemical than a living thing.

Thanks to MichaelSmithNews.

Heat helps bacteria but heat “kills” viruses by shaking them apart on a molecular level. I’m putting mail in plastic bags and leaving it in the Australian sun, or a hot car.

h/t Richard K (with thanks to his son for working on the front line)

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Friday Open Thread

Just remind me if I forget OK?

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No doubt about it: 12 days after lockdowns, quarantines and isolation, Coronavirus slows

Ancient technology wins: Not only are quarantine and isolation measures useful, they’re the best tools we have.

Some people don’t seem to realize that the only reason the daily growth of infections is slowing anywhere, is thanks to drastic quarantine measures or changes in human behaviour. We can see this in graphs from Italy, Spain, Norway, South Korea, Switzerland, Germany, and China, but not in Sweden or Brazil where there’s not much quarantine and not much slowing of growth curves either. In all of the former, the big meaningful actions were followed around 12 days later by an obvious slow down.

Willis Eschenbach, for example, wondered If Lockdowns Worked, but counted subdivisions of any quarantine type action as a measure of the severity when it’s more a measure of the wordsmithiness or indecision of leaders.

To see if major action matters, it’s better to look at the dates that borders, schools and shops were closed. The graphs of daily new cases below show that around 12 days later in so many countries, the growth in cases slows too. The delay is due to both the incubation period of Covid-19 and testing. By the time a lockdown is declared (or any such measure) a large expansion in cases is already “in the can”.

Willis found that masks were useful — which they certainly are but we know that because of scores of medical studies, not because of Japan. (Masks do help, even (maybe) stopping 75% of influenza, and you can make one for yourself).

Japan did a lot more than just wear facemasks. Shinzo Abe shut the entire national school system down from March 2nd. He closed flights from China and South Korea on March 5th. Japanese cases peaked around the 14th of March — twelve days after schools closed, though it was probably due to a lot more than just school closure. The act of announcing something as drastic as that would inspire many behaviour changes, like hand-washing and distancing and working from home, and mask wearing.

Abe made that call, which astonished the schools, when Japan had less than 200 cases. Remember, at the time, Tokyo was still hoping to hold the 2020 Olympic Games in 2020. There was no messing around, and it kept the virus under control.

At some point a thousand PhD’s will pore over all the nations and different responses and they’ll figure out which forms of isolation or lockdown were the winners in the cost benefit stakes. Locking up the old folks may sound good (probably not if you are one), but this horrible virus hits the young, the fit, and even kills children (aged 13). It swallows whole hospitals. (See estimates here too). It’s not viable to sacrifice some in the 30 – 70 group, or give up having working hospitals either. That’s why every nation ends up crushing the curve anyhow

At the moment, we have to hammer that curve, buy us time, and armour up to tackle this properly with treatments, monoclonals, antivirals, tests and proper PPE. Lockdown doesn’t have to last forever: weeks right now, are like gold. Then we beat this thing, one county at a time if we have to.

 

Italy

Italy started mass lockdown on March 10th. On March 11th all non-essential businesses were shut down.

The growth of new daily cases peaked on March 21, 11 days after the mass lockdown began.

Italy

..

Norway

Mass lockdowns were announced on March 15: “Norway takes most far-reaching measures ever experienced in peacetime over coronavirus”.

… and new daily cases peaked 12 days later on March 27th

 

Norway

..

Germany

In late February a few schools were closed in the one town (pop 40,000) where there was a cluster of cases. But travel to Italy was deemed A-OK. By March 8th, events of over 1,000 were banned, but not a lot else. Then on March 12, Donald Trump banned flights from the EU to the US and sent everyone into a flap. At this point some parts of the German government woke up.

On 13 March, most German states decided to close their schools. Some states added wider closures the next day. The national government suddenly ordered 10,000 ventilators. On the 15th of March Bavaria had local elections “luckily” just one day before the same state dissolved into an emergency with very complicated rules. Meanwhile people still flew in freely from Iran. On  March 16th the public got angry and the flights were stopped. Later that same day, the Bavarian rules were extended over the whole country. Shops were mostly shut, buses were out, as was church, playgrounds or tourism. But it wasn’t called a “shutdown”. Finally on March 18th Germany closed borders to Italy, France, Switzerland and Denmark. Though flights to Iran and China apparently continued despite being stopped. The following week the rules got even tighter and curfews were introduced.

Germany peaked (maybe) on March 27th, sort of 11 days after flights were stopped (or not) from Iran and China, shops were shut, and a complicated set of social distancing rules came in.

Sourced from the pandemic timeline in Germany.

Germany

..

 Spain

The Spanish government imposed a nationwide lockdown on March 14th.  Shops and businesses closed and all residents asked to stay home on March 15th. A State of Alarm was declared. In Spain cases peaked March 26th — 12 days after the lockdown was imposed.

spain

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In Switzerland:

Isolation and distancing measures were gradually phased in.

On the 28th of Feb large events with more than 1000 people were closed. On the 6th March Switzerland changed strategy to protect older persons and vulnerable groups. On 13th March classes were stopped. All events were banned of more than 100 people. Borders were partially closed. On 16th March bars and most shops were closed.  March 20 the government announced no lock down policy would be pursued but all events with more than 5 people were banned. Since March 6th the Swiss Government policy was not to test anyone with mild symptoms. The daily new cases peaked on March 20th and has stayed level ever since.

So decisive moves were either to isolate vulnerable people on March 6th or closing schools on March 13. The peak was around March 20.

Swiss

..

Australia

In Australia growth slowed on March 23 and peaked by March 28th (so far). The timeline of quarantine moves was incremental but most Covid cases were related to flights and cruise ships, so the border changes would have been more influential. And flights were banned from Iran on March 1, South Korea on March 5, Italy on March 11. On 13th March all gatherings over 500 were banned. On 15th March all incoming travellers were asked to self isolate for 14 days. On 20th March all borders were closed. On 21st March social distancing rules of 4 m2 per person were introduced. March 23 saw the closure of most cinemas, nightclubs, pubs, casinos. Restaurants ordered to do “Takeaway only”. Schools closed in Victoria from March 24, but parents were withdrawing children across the country even though other schools were technically open.

The peak on March 22 may have related to the reduction in flights from Italy 11 days earlier, though the Ruby Princess Cruise ship adds a lot of noise. I’m not convinced this is an easy peak to tie to any day, but the major action in Australia was in the middle two weeks of March.

 

...

Australian daily new cases (Click to enlarge).

Sweden

In Sweden there’s been no organised quarantine, just partial voluntary withdrawal, and there’s also been no peak yet.

 

sweden

..

Brazil

In Brazil, President Bolsonaro seems to favour doing nothing, but the governors of Sao Paulo and Rio De Janeiro banned gatherings and closed schools and many are pleading for action.

It’s not looking good. Not enough testing for starters.

 

brazil

..


China

On January 23: Wuhan placed under lockdown. Other Chinese provinces would follow during the next week. Despite the doctored official numbers, the rapid growth rate peaked twelve days later on Feb 4th. The spike around Feb 12th was due to definition changes.

China

Beware “official” Chinese figures.

In South Korea

On Feb 18th patient #31 went to religious meetings and cases escalated. By Feb 20th the streets of Daegu were empty. South Korean officials tracked and isolated cases at military bases, at the church group, and one hospital. Interviews were done on, wow, 230,000 members of the church at the centre of the outbreak which accounted for 60% of the national cases. The outbreak peaked by March 3rd, 12 days after the streets of Daegu were emptied.

Most infections in March were from travellers. South Korea put in stronger self isolation measures for travellers from April 1. Timeline for South Korea.

South Korea

..Worldometer

 The bell curve is all man-made

In a natural exponential growth situation with no lockdowns the infections keep spreading until most of the population has had it. This will eventually produce “that flattening” on a log graph, but we’re not remotely there yet (we are not even close). That only starts to happen when we reach well over half the population.

When graphing infectious growth on a log graph, any curve away from linear towards horizontal is good news.

And crushing an exponential daily growth curve down is no mean feat.

Things everyone needs to know:

Masks do help, even (maybe) stopping 75% of influenza, and you can make them

Stop with the fatalism: Don’t flatten it, Crush The Curve on Coronavirus

 

 

______________________________________________

Coronavirus Background: ☀ The Demographics: the young are spared, but the severity increases with age, and slightly more for men than women. ☀ The Ro is 2 – 3 and exponential curves are steep. How Coronavirus kills: why the number of ICU units matters so much. ☀ Illness progression: Dry coughs and Fevers, Aches. In 15% of people, by day 5 breathing trouble starts. In 3% (?) by day 8 they may need an ICU (intensive care unit). ☀ The good case of Singapore but the ominous calculations of how fast the ICU beds may run out. ☀ Proof that viruses don’t have wings and we should have stopped all flights so much earlier. ☀ The story of how American Samoa avoided Flu Deaths with quarantine in 1918. ☀ The story of Vo, the Italian town that stopped the virus. ☀ Delay = Death, statistics show mortality rates rise tenfold if hospitals are overwhelmed. ☀

Economics: ☀ The huge impact on the Chinese economy, the awful case of Iran.☀

Beware UN advice:Ethiopian WHO chief was part of China’s debt trap diplomacy ☀

Stats and Data: John Hopkins Live Map Worldometer Coronavirus data in Australia

 

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Coronavirus treatment — antibodies that work in 20 minutes could give protection for 8 weeks

NEWS: A group say they have developed five antibodies from the old SARS antibody stocks that with tweaking can now bind well to the SARS-2 novel coronavirus.

Antibody,

An antibody is a long string of molecules that binds only to the exact target (we hope). Wikimedia Bioconjugator

If they get through all the testing phases and ramp up production, in theory, these could be ready for mass use in September (but everything would need to go right). They could be injected into patients and within 20 minutes these antibodies would bind to the virus and stop it entering cells. The protection might last 8 – 10 weeks before someone would need another dose.

This could be a gamechanger, but beware before anyone gets too excited, this is very early days — “protoplasm” days. There are a lot of steps to rush through.This group have searched and evolved the protein with their supercomputer which has a huge library of antibodies. They claim to be certain it binds to the virus — and to  exactly the right part of the virus, but they haven’t actually done that yet — they’ll send the antibody to a military secure lab to do that. Then it still needs to be tested in tissue culture, animals, and people, and then more people. We don’t want it to bind to any other cells in our bodies, or trigger the wrong immune response. Side effects can include allergies, anaphylaxis, autoimmune disease, and even their own cytokine cascade.

But don’t write it off — the idea is sound, and if this group haven’t got the right combination, some other group will. It’s another reason to do the serious lock down now because there will be a way of defeating this virus. A tool like this will change the odds, save lives and make tracking and tracing contacts so much more effective, so we can wipe it out.

The hunt for antibodies mimics what our own immune systems do

As soon as a human body gets infected our immune system hunts for the right antibody in the toolkit. We have thousands of different ones circulating. Within days, victims are usually starting to mass produce the antibodies that bind to the virus. Survivors of coronavirus will carry some forms of antibodies, likely for a few months after infection at least. Using their blood plasma is one of the few weapons we have right now. NBL players say they will donate plasma, but there is only so much blood one person can give, and plasma comes with other risks like germs we don’t want to share. Plus recovery to covid-19  takes weeks and many recovering people need their own blood.

It’s also how an antivenom or antivenin works — we collect antibodies from a sheep or horse to a snake venom and have them ready to use in case of snake bite.

The idea here is to find then clone the right antibody and produce it en masse — a  monoclonal antibody.

Coronavirus breakthrough: Doctor featured on Netflix’s Pandemic finds COVID-19 ‘cure’

by Ciaran McGrath

, CEO of Distribute Bio, has revealed he and his team have adopted a pioneering approach which offered the potential for dramatic results. He tweeted: “After 9 weeks we have generated extremely potent picomolar  that block known #neutralizing #ACE2 #epitopes, blocking the novel #coronavirus from infecting human cells.”

 Announced in twitter @CurleyJungleJake  

The diagram shows the complicated protein chains that fold into antibodies, which hopefully stick in a lock and key type way to important parts of the virus and stop it getting into cells. Antibodies also act as a flag to other branches of the immune system. This is heavy molecular level chemistry. Is that supercomputer modelling really that good?

Antibodies, SARS, coronavirus

Announced in twitter @CurleyJungleJake

Keep reading  →

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Sweden — going for herd immunity and using the 1918 Flu plan

It’s a big natural experiment

Swedish people are still going to schools, restaurants and gyms. Even the cinemas are running.  Apparently Sweden is taking the punt that there are many asymptomatic infections out there, despite having no data, and not doing any structured screening to get some either.  They are also betting that immunity to this form of coronavirus will last a lot longer than the coronavirus colds where herd immunity is irrelevant one year later.

All recommendations are made by the Public Health Agency.  Apparently they are learning from the 1918 influenza spread, and thus successfully “fighting the last war”. Swedish doctors are reportedly not happy about it. Probably because their idea of being doctors is not where you choose which 60 year old mother lives and which one dies, or where the doctors work round the clock and many of them get sick themselves, and some die. Gruelling is not the word.

Gatherings of 50+ people are banned, and the 70+ age group have been told to avoid social contact.

I predict that as the ICU units overflow, or even before, they will move to serious measures like the rest of the world as the inhumanity of the inadequate care becomes obvious. They will be dragged into tightening the rules daily as curves flatten everywhere else, but theirs continues to rise. People will hate it.

See Norway for example which appears to have peaked on March 27th. They are getting on top of the load. Currently Sweden has 4,700 cases and about 240 deaths. But Norway with the same number of cases has only 43 deaths, suggesting Norway is doing a lot more testing, or has a younger caseload.

In the last few hours Swedish authorities have updated their recommendations to vaguely warn people off peak hour buses, to postpone sporting matches, and to tell shops not to let as many people in, but not to let them queue tightly outside either. It won’t be enough. Though Swedish people are doing a part lockdown anyway voluntarily with passenger numbers down 50%. And unlike Italy, they don’t live in multigenerational homes, where teens can come home and infect grandma. Astonishingly 50% of Swede households are single occupants.

But the numbers still climb:

Peaking, Daily New Cases, Coronavirus, graphs, Spain.

….

 

As Swedes watch other countries plateau, politically, they will not be able to allow their own death toll to rise without following suit. Those pressures are growing rapidly.

The Guardian

Panic, though, is exactly what many within Sweden’s scientific and medical community are starting to feel. A petition signed by more than 2,000 doctors, scientists, and professors last week – including the chairman of the Nobel Foundation, Prof Carl-Henrik Heldin – called on the government to introduce more stringent containment measures. “We’re not testing enough, we’re not tracking, we’re not isolating enough – we have let the virus loose,” said Prof Cecilia Söderberg-Nauclér, a virus immunology researcher at the Karolinska Institute. “They are leading us to catastrophe.”

Anders Tegnell, Sweden’s chief epidemiologist, who is leading the government’s handling of the crisis, advocates a strategy of mitigation: allow the virus to spread slowly without overwhelming the health system, and without recourse to draconian restrictions.

The government thinks they can’t stop it, so they’ve decided to let people die,” Söderberg-Nauclér said. “They don’t want to listen to the scientific data that’s presented to them. They trust the Public Health Agency [Folkhälsomyndigheten] blindly, but the data they have is weak – embarrassing even.

Sweden has the lowest number of acute care beds (general hospital beds) per capita in Europe. Interestingly, second lowest acute care beds is the UK, then Denmark, Spain and Italy. The highest number per capita is Germany.

Sweden with 10 million people has only 550 ICU beds which is about 1 ICU bed per 18,000 people (compared to 1 per 12,000 in Australia).

 

Peaking, Daily New Cases, Coronavirus, graphs, Spain.

Hospital beds per 1,000 people in Europe

The definitions of hospital beds and ICU beds are probably different around the world. The US has the lowest number of hospital beds per capita, but almost the highest in the world of Intensive Care Beds (1 per 3,000).

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How about 27 feet of social distancing

How big should that gap be?

The WHO recommends “3 feet”, the CDC recommends 6 feet, but new research shows they got the model wrong and we might need to be 30 feet apart. Not to mention that the cloud of aerosols can wander suspended for hours. So we may need to be 30 feet and three hours apart.

No wonder churches and places where people sing are such high risk events, and why an astonishing 12,000 health workers are infected  with coronavirus in Spain.

They aren’t sure if their new findings  have clinical implications, which says a lot about how much we don’t know. The 27 ft distance applies to sneezes, so if the other party isn’t sneezing you might not have to be so far. Lucky sneezing isn’t that common, though the dry cough is. Personal trainers at 27 feet is going to be tricky.

UPDATE: Some readers ask whether one new study is even worth reporting, accusing me of “scare tactics”. I’ve been reading medical papers now for over 20 years, so forgive me if I found the results here so banal that I didn’t mention that this result is barely new, and very well corroborated. Indeed it is not at all surprising to me that in some circumstances (right temp, humidity and airdraft) these viral particles would stay suspended for hours and travel much more than “6 feet”. In the last two months I’ve seen the same essential results posted by the CDC, Korean Profs, Chinese doctors and for anyone trained in microbiology, this is hardly news. I remain surprised that after ten years of being data driven in a field outside my training and primary interest, readers leap to declare astrological or political when I return to a field I got my degree in. I am still the same skeptic I always was. Stick with the data.

Coronavirus could travel 27 feet

NY Post

MIT associate professor Lydia Bourouiba, who has researched the dynamics of coughs and sneezes for years, warns in newly published research that the current guidelines are based on outdated models from the 1930s.

Rather than the assumed safety of 6 foot, Bourouiba warns that “pathogen-bearing droplets of all sizes can travel 23 to 27 feet.”

Her research, published in the Journal of the American Medical Association, also warns that “droplets that settle along the trajectory can contaminate surfaces” — and “residues or droplet nuclei” may “stay suspended in the air for hours.”

Sneezing

Keep reading  →

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Australia’s very low death rate is due to younger patients, plenty of tests

Right now Australia has one of the lowest death rates from coronavirus in the world. With 4,561 cases but only 19 deaths, the clumsy Case Fatality Rate is only 0.4%  –  lower even than Germany. While some commentators think that’s a reason to ease up it may be partly due to temporary good geographical luck. Plus winter is coming…

1. Australians with Coronavirus are younger (for the moment).

Most infections in Australia came from overseas travel — something the 20 to 70 year olds do a lot of, but apparently the 80+ age group aren’t flying on 20 hour long haul trips across the Pacific. (Last week the most common source of Australia’s cases was the USA, especially Aspen). This week the main source is Europe, and the nation called “cruise ships”.  If and when the virus starts to spread among the older cohorts the death rates will rise. (Unless we figure out that treatment first).

 

Compare the ages groups of patients in Korea and Italy. Fully 40% of Italian (known) cases are 70+.

Statista — demographics of Italian and South Korean cases

 

Demographics Italy, Korea

Italy and South Korean demographics

Fortune

As of March 14, South Korea reported that nearly 30% of its confirmed coronavirus cases were in patients ages 20 to 29. In Italy, by comparison, 3.7% of coronavirus patients fell into that age range, according to a report from Andreas Backhaus, a research fellow at the Centre for European Policy Studies.

 

2.  Australia has done a lot of testing –

Australia has tested 230,000 people or about 1% of the population, and since most of those tests were aimed at travellers they have found the infected younger cohort, unlike countries with less testing. Australia has done slightly more tests per capita than South Korea (which has done about 400,000 tests on a population of 52m).

Germany also also has low rates — largely due to lots of testing and a younger group of patients

Keep reading  →

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Coronavirus: Signs of peaks in the West

Good. Real signs of the flattening of new daily cases of Coronavirus or #CCPVirus in Italy, and possibly in Spain. Instead, ponder that if Italy didn’t slow the spread the 6,500 new cases on March 21 could have become 17,000 new cases every day by now.

Italy appears to have peaked — starting on March 21st — but may need to stop keeping sick people at home

On March 9th when Italy had about 9,000 cases in total, and 500 deaths, the government declared a quarantine across the whole nation. By March 11 everything that could be shut down, was. These changes appear, finally, to have stopped the exponential growth in new cases about 10 days later. But even after three weeks of lockdown there are still 5000 new people getting infected every day. One professor, Andrew Chrisanti, thinks it is because they are telling infected people to stay home instead of isolating them from their families. Presumably if Italians live in larger extended families, they must get the infected out of homes.

“In our opinion, the infections are happening at home.” Crisanti helped coordinate the coronavirus response in Italy’s affluent northeastern region of Veneto, where blanket testing was introduced at the start of Italy’s outbreak in the second half of February. That helped identify cases and limit contagion much more successfully than in the neighboring Lombardy region where only people with severe symptoms are tested, and only in hospitals.

Lombardy has since been hit with 6,360 registered coronavirus deaths, far more than any other Italian region, whereas Veneto has recorded just 392 fatalities. However, the Lombardy outbreak was much bigger from the outset. – Stefano Bernabi, Reuters

In the three weeks since the nationwide quarantine was called, the total cases expanded from 9,000 to 100,000, and deaths increased from 500 to 10,000.

Numbers and graphs from Worldmeter

Spain — may be peaking now.

Too early to tell.

Peaking, Daily New Cases, Coronavirus, graphs, Germany.

….

 

France is still rising

Peaking, Daily New Cases, Coronavirus, graphs, USA, UK, Australia.

….

 

The UK is expecting numbers to rise rapidly in the next two weeks

“It was announced today one in four NHS doctors are off work sick or in isolation. Professor Andrew Goddard, president of the Royal College of Physicians, said about 25 per cent of the doctor workforce is off, either with coronavirus or because a family member or housemate is ill.”

Peaking, Daily New Cases, Coronavirus, graphs, UK.

….

 

USA — 20,000 new infections a day — growing 16% a day

Australia

This is likely a real plateau, but due to slowing down international arrivals — it may be temporary. Community spread could still take off in the next few weeks. Since we aren’t testing “out there” we don’t know. And with 900 House Parties in Brisbane on the weekend (that we know of) the virus might be quietly partying too.

Thanks to some luck, Australia has closed borders, mandatory quarantine, mostly closed schools, and a lot of people are staying home, so perhaps the toll won’t rise further. Watch this space. In this case luck means –  we’re lucky it’s not winter. We’re lucky those infected are in younger age groups so the death rate is lower. Mostly we’re lucky we could learn some harsh lessons from Italy, Spain and the rest of the world first, and still get away with being unprepared and incompetent.

Now is not the time to lift the restrictions. But here’s hoping we don’t need them for too many weeks.

Peaking, Daily New Cases, Coronavirus, graphs, Spain.

….

Keep reading  →

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Korean professor surprised Western people don’t wear masks which are “very effective”

Professor Kim Woo-Ju, Professor Infectious Diseases, Korea, says that masks are “definitely effective”. “I find it quite odd” that the west people don’t wear masks.” “People wearing a mask have a significantly lower chance of getting infected than those who don’t.” WHO says not to wear masks, he says “I disagree.”

Around the middle of the interview he says that one of the reasons Korea has  low rate of infection is because they wear masks — as good as N95 (P2) — this is the same type as what the doctors wear.

He says Korea, and all the South East Asian countries are also experienced because they went through the SARS and MERS outbreaks. They knew what to do, they knew they needed tests fast.

He speaks well. h/t MichaelSmithNews. (via Annie ) and Chiefio somewhere (via Bill in Oz)

“In 30 years of pandemics, Ebola, MERS, Swine Flu … the Covid-19 epidemic is the most challenging”.

  • In the 80+ age group the death rate is 11%
  • With the largest number of tests anywhere, they find 20% have no symptoms. But it is still not random testing. And the number may be different in other countries due to genes, climate (which affects vitamin D levels) or diet.
  • About 30% of cases the patients cannot smell or taste. That can last 5 – 10 days. (It’s good to know their senses come back).
  • They are seeing reactivation of cases released from hospital — people who tested negative and have been released. This is occurring a week or later and is very unusual. (5 – 6 minutes)
  • At 5 – 10 degrees and 30% humidity the virus can survive a long time at least 5 – 7 days on a table.
  • 20% of their new cases in Korea are from flights.
  • Anti-virals are the most promising form of treatment, including the anti-HIV and Chloroquine related ones. He didn’t rave about them, but said they are somewhat useful.

Airborne transmission can happen in churches or where people are singing and shouting loudly. The airborne droplets can stay elevated longer, can dry out, and that means people will be infected much further away. This explains why churches or mosques can be the largest sources of infection. Presumably rock concerts would be too.

They use phones to track people in self quarantine and expect them to enter their symptoms daily. (!)

Schools have been delayed, but many young people are still studying at academies at night time and people are still going to night clubs, but 10% of their cases are in their 20-something group.

As I said last week some people are making their own masks

Does anyone here want to make masks and sell them to readers? I’m happy to connect up supply and demand if you know someone with a sewing machine. There must be a way to solve this. If we got people wearing masks and it reduced spread by 50% that means we all get out of this faster…. (and in that last post there was a study of Australian parents looking after kids with influenza and if they wore masks they prevented 3 out of 4 infections in parents.) 

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We Can Hammer Coronavirus in weeks instead we Rush to War Unarmoured

If you only read one serious page about how to deal with this crisis read Coronavirus: The Hammer and the Dance. The countries that “get this” approach will be the first to recover.

It’s all the things I’ve been suggesting but done on big scale with an expert team.

What I call the Slow Bleed is officially known as Mitigation. It’s the 6 month Flu strategy that kills people and the economy.

When I said Crush the Curve, they call it The Hammer, the hardest form of suppression. The Dance is the delicate recovery process until we get a vaccine, a treatment or a nicer mutant version of the virus.

Hammer and Dance with coronavirus

1. Hammer and Dance — there is a better plan   (click to enlarge)

 

Eventually we’ll all get to the Hammer Crush approach because the alternative is so horrible.

Even Imperial College concludes that slow “Mitigation” is just not viable: in the UK the demand for ICU beds would exceed capacity 8-fold, and there would be something like a quarter of a million UK deaths, and over a million in the US. They conclude that epidemic suppression is the only strategy, yet their predictions on that are dire. Their March 16 report has a chilling dystopian graph that hammers the infection then bounces up and down through cycles of suppression and release. But it ignores the key advantages of buying us time. We are not doomed to repeat each infection cycle. Right now we are unprepared, unarmoured, but some are headed into battle already — there aren’t enough beds, ventilators, specialists, drugs, masks, results, trials, or anything but guesses and hints. A two month pause would help so much more. Even a two week pause would.

Stanford Engineer Tomas Pueyo and a “group of normal citizens” which includes epidemiologists and experts have spelled it out in detail. It’s already been translated into 30 languages, and almost 35,000 people have signed their Petition to the Whitehouse.

At the moment Spain, Italy are facing the fight of their lives, but some of the rest of the West are almost giving up without a fight.

The red line in the graph below is not an error

The red line marks the size of the ICU capacity. This is the size of the challenge we face and it’s why there is no other realistic choice. Would we like to have a hospital system, or would we rather stone age luck?

ICE Beds, capacity, Coronavirus

2. Hospitals will be overwhelmed  (click to enlarge)

Their summary:

When you’re done reading the article, this is what you’ll take away:

  • Our healthcare system is already collapsing.
  • Countries have two options: either they fight it hard now, or they will suffer a massive epidemic.
  • If they choose the epidemic, hundreds of thousands will die. In some countries, millions.
  • And that might not even eliminate further waves of infections.
  • If we fight hard now, we will curb the deaths.
  • We will relieve our healthcare system.
  • We will prepare better.
  • We will learn.
  • The world has never learned as fast about anything, ever.
  • And we need it, because we know so little about this virus.
  • All of this will achieve something critical: Buy Us Time.
  • If we choose to fight hard, the fight will be sudden, then gradual.
  • We will be locked in for weeks, not months.
  • Then, we will get more and more freedoms back.
  • It might not be back to normal immediately.
  • But it will be close, and eventually back to normal.
  • And we can do all that while considering the rest of the economy too.

Ok, let’s do this.

Spain, Germany, France and the US all have more cases than Italy when it ordered the lockdown.

Collateral damage could mean 1.5m more deaths in the US

There are 4 million admissions to the ICU in the US every year, and 500k (~13%) of them die. Without ICU beds, that share would likely go much closer to 80%. Even if only 50% died, in a year-long epidemic you go from 500k deaths a year to 2M, so you’re adding 1.5M deaths, just with collateral damage.

The case for South Korea

Because it was started so fast, the hard part was done in three weeks, and it wasn’t as hard as it will be in slower countries.

South Korea, infection control, Coronavirus, daily new cases, graph.

3. South Korea, case-load managed and is now doing the dance to keep it under control.   (click to enlarge)

Feeding this virus comes with a risk

The more mutations there are the more versions of this virus we get:

Not only that, but the best way for this virus to mutate is to have millions of opportunities to do so, which is exactly what a mitigation strategy would provide: hundreds of millions of people infected.

Under a suppression strategy, after the first wave is done, the death toll is in the thousands, and not in the millions.

It’s a no brainer, but

Suppression would get us:

  • Fewer total cases of Coronavirus
  • Immediate relief for the healthcare system and the humans who run it
  • Reduction in fatality rate
  • Reduction in collateral damage
  • Ability for infected, isolated and quarantined healthcare workers to get better and back to work. In Italy, healthcare workers represent 8% of all contagions.
The Imperial College graph from mid March shows just how far beyond our hospital capacity we are even with quite serious measures to slow the spread.
Imprisoning the over 70s and closing schools still won’t save us from the Hospital Bed Bomb. That’s why we need to do more, go hard, go fast and wage War from our strongest advantage point — time. Without fresh bodies the virus doesn’t survive longer than a couple of weeks at room temperature. And the hotter it is, the shorter the viral “lifespan”.
ICE Beds, capacity, Coronavirus

4. Imperial College estimates of the effect of various forms of mitigation.  (click to enlarge)

My favourite quote:

What if it turned out that in two months we discovered a treatment for the coronavirus? How stupid would we look if we already had millions of deaths following a mitigation strategy?

The speed of medical research is unprecedented. Labs all over the world are onto this, and because of the huge cost — there is a huge incentive to solve this. Note that the most promising avenues are in mass testing approaches and anti-virals or anti-inflammatory lines.  Vaccine research can not be sped up to the same extent.  There are inevitable bottlenecks in testing and waiting for humans to react and in being sure that all risks are being checked. Testing of other approaches is much faster.

We have The Code. We understand the biological alphabet. We will find a way to treat or neutralize this virus. It’s just a question of when.

South Korea, infection control, Coronavirus, daily new cases, graph.

5. The escalation of medical knowledge    (click to enlarge)

This is no time to just give up

On one side, countries can go the mitigation route: create a massive epidemic, overwhelm the healthcare system, drive the death of millions of people, and release new mutations of this virus in the wild.

On the other, countries can fight. They can lock down for a few weeks to buy us time, create an educated action plan, and control this virus until we have a vaccine.

If you agree with this article and want the US Government to take action, please sign the White House petition to implement a Hammer-and-Dance Suppression strategy.

Here’s the latest mutation map. Many of these changes are just “decoration” — they don’t necessarily change the virus in a meaningful way, but they do mark the “heritage” of each subgroup of viruses.

Evolution is at work in the virus world. We know the virus will mutate to become more infectious, but we don’t know whether it will be more or less deadly.

ICE Beds, capacity, Coronavirus

6. The branching chains of Coronavirus around the world.  (click to enlarge)

Buy Us Time to Fight the Coronavirus and Save Millions of Lives with a Hammer-and-Dance Suppression…

Our healthcare system is collapsing. It will only get worse. Mitigation-”flattening the curve”-isn’t enough. We must…

 Compare these two scenarios

ICE Beds, capacity, Coronavirus

7. Mitigation — The Slow Bleed   (click to enlarge)

Don’t miss that the whole scale changes here

This is not just a bit better, it’s an order of magnitude (or three) better.

Every day we delay starting the hammer means more total deaths and many more days on the other side before the hammer ends and the dance begins. Exponential curves are so unforgiving when they are rising, but they can collapse just as fast on the downside. The further we drag the Ro (rate of infection) down, the faster we bring new cases down.

The payoffs from making Ro close to zero are astronomical at this point. We ought be prepared to throw everything at hammering this flat.

ICE Beds, capacity, Coronavirus

8. The Hammer and Dance (click to enlarge)

This is the group to follow, to share, to discuss:

This article has been the result of a herculean effort by a group of normal citizens working around the clock to find all the relevant research available to structure it into one piece, in case it can help others process all the information that is out there about the coronavirus.

See all the endorsements from Professors, experts and commentators, if you are interested in that sort of thing. Doesn’t show they are right, just that they are not crazy.

On Modelling: It’s still wrong. These are estimated projections, based on assumptions and incomplete information. But data from nations all over the world already shows the trends and patterns are correct. The nations that got on top of things fast are already doing the dance — like  South Korea and Taiwan. The nations that tried the slow bleed reactive approach have had catastrophic outcomes (if not in actual total death –  its been measured in disruption and pain, and we have not even tried to count the collateral losses).

And all the nations that tried mitigating get overwhelmed and end up doing the hammer anyway. It’s inevitable so do it now. It’ll never be faster or more effective than starting today.

There’s a lot more detail at the original — read it all there. Hammer and the Dance

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Weekend Unthreaded

Anyone know where Pat is? We miss him, hope he is OK.

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Bill Gates pandemic warning in 2015

Apparently no one listened to him.

The thing we were always afraid of was a virus that people could shed even if they felt well enough to get on a plane…

He’s right about “the blood of survivors” –  blood contains antibodies to the virus after they recover. So plasma from survivors might help current victims. And that trial will happen in New York.

But we don’t need a “global heath system”. We have that already and it’s worse than useless. Back in January the WHO was telling everyone not to stop flights from China. Absurd WHO declarations became the convenient excuse for weak Chief Medical Officers to recommend exactly the wrong thing. WHO advice worked out well for China, but is currently killing citizens everywhere else.

How cheap and easy closing those borders looks now eh?

China bought the WHO a long time ago. WHO chief, Tedros Adhanom, was recently the Foreign Minister for Ethiopia, which is now securely Debt Trapped on China’s Belt and Road. Even as the CCP suppressed doctors, hid the true statistics, and welded their own citizens in their apartments, Tedros fawned over President Xi.

The petition calling to sack the WHO Chief now has 637,000 signatures.

Call for the resignation of Tedros Adhanom Ghebreyesus, WHO Director General

We don’t want a global health system. We just need sovereign borders.

h/t Steve H, Albert.

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