DON'T PANIC.... well, maybe a little bit.

[Vulgarian]

'Jamu' groups oppose House's decision to import ingredients for 'COVID-19 cure' - National - The Jakarta Post

Producers and developers of Indonesian herbal medicine have taken issue with legislators for referring only to personal testimonials in deciding to import ingredients from China for a "COVID-19 cure".

www.thejakartapost.com

 

[harryopal1]

Even with the arrival of an effective vaccine it seems improbable that it will be produced in sufficient quantities to be available to cover whole populations. To be effective then it will doubtless be directed at areas closest to established clusters and still require continuing lock-down strategies and presumably the development of "herd" immunity.

We are already seeing growing frustration with lock-downs and the impact on peoples' livelihood. The extent to which countries can maintain effective strategies depends very much on the strength of their economies to cope with the financial impact. Ultimately even the wealthiest countries with financial resources must reach a point where a combination of growing civilian unrest and the ever increasing negative economic burden will test their resolve.

Countries with parlous economies will rather more quickly quit lock-down and these other management programs. Lebanon today is reported to have rioting in protest at the crumbling economy.

It seems that unless there is containment within the next 12 months or less, most countries will fall back on "herd' immunity as an affordable financial and social cost. With millions out of work and out of money those unaffected by the virus will become enraged by continuing lock-downs and other containment strategies. At that point we can assume governments will feel it expedient to quickly revert to "saving" the economy and viability as a nation state.

My guess is patience will have run out in most places around the world by the end of this year or even sooner unless there is a dramatic upturn in successfully dealing with the Covid 19 pandemic.

 

[Bad_azz]

In a philosophical way, can anything be really known at all? But there is strong evidence for this.



Relevant links to scientific papers linked in the article.

https://www.axios.com/coronavirus-virus-mutation-3c02a0ce-89c0-4866-a869-bad0e538c390.html

Even if it does mutate as fast as flu, creating vaccinations for the next batch should be faster than the first time around.

Strains of the virus that caused the Spanish flu are still around (H1N1), but they have not caused a pandemic of equal force since, in part due to vaccination efforts.

[edit] I just saw that they have Nextstrain data linked in your link didn't get chance to look earlier.
I think when this all ends we should be given honourary PHDs in virology, data collection, infection management and other associated fields hahahaha!

https://nextstrain.org/ncov/north-a...STdgXlPnCfHF-yipk9OZGHhxTezv4onMQs&l=unrooted

 

[dafluff]

Another drug shows promise in fighting Covid-19. Based on preliminary results in France and China. What is really interesting is that it shows benefit even in moderate or severe cases.

The study, carried out by the Paris university hospital trust (AP-HP), looked at 129 people hospitalised with moderate or severe viral pneumonia, which occurs in 5 to 10 per cent of Covid-19 patients.

Half received two injections of tocilizumab as well as standard treatment with antibiotics, while the control group received only standard treatment.

While the results are yet to be published, those involved in the research said it showed clear "clinical benefit" of tocilizumab treatment.

Arthritis drug tocilizumab shows 'significant' promise in severe Covid-19 cases: Study

PARIS (AFP) - The arthritis drug tocilizumab has shown early promise in preventing extreme inflammation in gravely ill Covid-19 patients, according to a French clinical study. Read more at straitstimes.com.

www.straitstimes.com

Another study in China on the same drug also concurs:

Within 5 d after tocilizumab, 15 of the 20 patients (75.0%) had lowered their oxygen intake, and 1 patient needed no oxygen therapy. CT scans manifested that the lung lesion opacity absorbed in 19 patients (90.5%). The percentage of lymphocytes in peripheral blood, which decreased in 85.0% of patients (17/20) before treatment (mean, 15.52 ± 8.89%), returned to normal in 52.6% of patients (10/19) on the fifth day after treatment. Abnormally elevated C-reactive protein decreased significantly in 84.2% of patients (16/19). No obvious adverse reactions were observed. All patients have been discharged on average 15.1 d after giving tocilizumab. Preliminary data show that tocilizumab, which improved the clinical outcome immediately in severe and critical COVID-19 patients, is an effective treatment to reduce mortality.

Effective treatment of severe COVID-19 patients with tocilizumab

In patients with coronavirus disease 2019, a large number of T lymphocytes and mononuclear macrophages are activated, producing cytokines such as interleukin-6 (IL-6), which bind to the IL-6 receptor on the target cells, causing the cytokine storm and severe inflammatory responses in lungs and...

www.pnas.org

 

[dafluff]

Also some good news: Positive tests of Korean patients who tested negative before are probably not reinfections, rather they are detecting fragments of dead virus still shedding from damaged cells.

Committee members found little reason to believe that those cases could be COVID-19 reinfections or reactivations, which would have made global efforts to contain the virus much more daunting.

“The tests detected the ribonucleic acid of the dead virus,” said Oh, a Seoul National University hospital doctor, at a press conference Thursday held at the National Medical Center.

He went on to explain that in PCR tests, or polymerase chain reaction tests, used for COVID-19 diagnosis, genetic materials of the virus amplify during testing, whether it is from a live virus or just from fragments of dead virus cells that can take months to clear from recovered patients.

http://www.koreaherald.com/view.php?ud=20200429000724

 

[fastpitch17]

If big pharma finds a vaccine, you can bet that it goes to whomever is willing to pay their price or the highest bidder since supplies will be limited. As for treatments if a working one is ever supported by the medical community as the go to one, there will of course be an immediate rise in price due to demand. The days of for the public's good went away after the Polio vaccine.

 

[centurion]

There was a lot of discussion about Jakarta burials increase in March, as a crown argument that the disease is spreading and that end of the world will be soon here. Now is May 1st and burials are almost same as in April 2019. Does it mean that the pandemic is near its end in Jakarta?

https://pertamananpemakaman.jakarta...impiXGYvfb3AT_FNCYeuZIflNvrJ6Mz6c9epskQ03JYtE

 

[Helpful Herbert]

It says 4377 for April 2020 whereas for April 2019 it was 2790. Also the data says 29 deaths for May and we have only just reached lunchtime on 1st May, so I don't think it's on the way down just yet.

 

[dafluff]

There was a lot of discussion about Jakarta burials increase in March, as a crown argument that the disease is spreading and that end of the world will be soon here. Now is May 1st and burials are almost same as in April 2019. Does it mean that the pandemic is near its end in Jakarta?

https://pertamananpemakaman.jakarta...impiXGYvfb3AT_FNCYeuZIflNvrJ6Mz6c9epskQ03JYtE

They just updated, so Mar deaths is 4422, Apr deaths is 4377. Average deaths before that about 2800.

Well, at least its not increasing.

There is also the possibility that some of the increase is due to normal deaths that are now buried in Jakarta proper, because they are not able to travel to their home villages due to PSBB.

 

[dafluff]

These are Jakarta burials with Covid-19 protocol. It looks like it is trending slightly down, maybe effects of PSBB, or effect of people leaving Jakarta to their home villages, etc....

 

[centurion]

This one is obviously nearer to reality, as the number of deaths from confirmed and suspected cases gives better estimate. So whole Indonesia would be like x0.7 or x2.

 

[centurion]

Another retrospective study about hydroxychloroquine in China published 1 May, almost undetected in media, claiming reducing deaths 90% in critically ill patients, preventing cytokine storm and viral replication, and also recommending Tocilizumab.

https://www.medrxiv.org/content/10.1101/2020.04.27.20073379v1.full.pdf


From the other side, 2 other studies report arrhythmias in 90% of critically ill patients.

https://www.dailymail.co.uk/health/...angerous-heart-arrhythmia-covid-patients.html

Whom to believe now?

 

[R Cameron]

I have not seen any news articles on what Indonesian hospitals are doing for care and drugs being tried for treatment, does anyone know that?

 

[dafluff]

I have not seen any news articles on what Indonesian hospitals are doing for care and drugs being tried for treatment, does anyone know that?

Mostly just symptomatic treatment, although I've seen some reports of Cholroquine, Tamiflu and high does intravenous Vitamin C being used.

Also clinical trials to start in 22 hospitals with 3 groups: Hydroxychloroquine, lopinavir/ritonaviraluvia and control group.

Uji Klinis Obat Covid-19 Dilaksanakan di 22 Rumah Sakit di Indonesia, Simak Informasi Berikut

Sebanyak 22 rumah sakit akan ikuti solidarity trial yang diadakan WHO. Simak informasi berikut...

www.kompas.com

 

[El_Goretto]

Why do they have to do clinical trials in Indonesia too. Hasn't this medicine been trialed already by credible labs or hospitals overseas?

 

[R Cameron]

Why do they have to do clinical trials in Indonesia too. Hasn't this medicine been trialed already by credible labs or hospitals overseas?

from dafluff's link:

Solidarity Trial merupakan program WHO yang melibatkan lebih dari 100 negara untuk melakukan uji klinis terhadap 4 obat, yang diharap mampu digunakan sebagai obat Covid-19.

 

[Dave70]

This is too good not to share...

Watch: Food Delivery Man Moved To Tears After Customer Buys Him Cake On His Birthday

For frontliners who continue to work while we remain indoors at home, many sacrifices have to be made for the sake of ensuring that our essential services continue to operate. One such service is of course, food delivery, as many of us staying indoors will come to rely upon for meals every day...

worldofbuzz.com

 

[dafluff]

There are several new research papers that suggest Vitamin D deficiency plays a significant role in Covid-19 outcome for patients.


First paper is from Louisiana (VDI = Vit D insufficiency).

The VDI prevalence in ICU patients was 84.6%, vs. 57.1% in floor patients. Strikingly, 100% of ICU patients less than 75 years old had VDI.

https://www.medrxiv.org/content/10.1101/2020.04.24.20075838v1

Another one from the Philippines:

for each standard deviation increase in serum 25(OH)D, the odds of having a mild clinical outcome rather than a severe outcome were approximately 7.94 times (OR=0.126, p<0.001) while interestingly, the odds of having a mild clinical outcome rather than a critical outcome were approximately 19.61 times (OR=0.051, p<0.001).

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484

And even one from Indonesia:

The odds of death was higher in cases with insufficient Vitamin D status (OR=7.63; p<0.001). When compared to cases with normal Vitamin D status, death was approximately 10.12 times more likely for Vitamin D deficient cases (OR=10.12; p<0.001).

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3585561

Also another paper that explores the role of Vitamin D in suppressing Cytokine Storm

Given that CRP is a surrogate marker for severe COVID-19 and is associated with Vit D deficiency, our finding suggests that Vit D may reduce COVID-19 severity by suppressing cytokine storm in COVID-19 patients

https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v3

Additional citation: this linked-in page where I found these papers compiled together. It has more stuff on Vit D - Covid19 connection.

 

[R Cameron]

There are several new research papers that suggest Vitamin D deficiency plays a significant role in Covid-19 outcome for patients.


First paper is from Louisiana (VDI = Vit D insufficiency).


https://www.medrxiv.org/content/10.1101/2020.04.24.20075838v1

I read the first one from Louisiana and was disappointed to see the small sample size of only 20 cases evaluated. If you extrapolate their numbers:

• 20 recent Covid patients had the bloodwork done which could identify vitamin D deficiency
• 13 were treated in the ICU, of which 11 had vitamin D deficiency
• 7 were floor patients, of which 4 had vitamin D deficiency
• All who were under age 75 had vitamin D deficiency

Questions:

• How many Covid patients were treated at this facility and not given the blood test that would show vitamin D deficiency?
• Is there selection bias? The ratio of floor patients vs. percentage of ICU patients with vitamin D deficiency is relatively close (4/7 vs 11/13, the majority in both cases), were they given that blood test because they had other symptoms or circumstances to suspect a vitamin D deficiency?
• How many were under 75? That's a very important number when making claims like "all patients under 75", and out of this small sample size it may well be only one or two.

Perhaps I will have a chance to look at the others.

 

[dafluff]

I read the first one from Louisiana and was disappointed to see the small sample size of only 20 cases evaluated. If you extrapolate their numbers:

• 20 recent Covid patients had the bloodwork done which could identify vitamin D deficiency
• 13 were treated in the ICU, of which 11 had vitamin D deficiency
• 7 were floor patients, of which 4 had vitamin D deficiency
• All who were under age 75 had vitamin D deficiency

Questions:

• How many Covid patients were treated at this facility and not given the blood test that would show vitamin D deficiency?
• Is there selection bias? The ratio of floor patients vs. percentage of ICU patients with vitamin D deficiency is relatively close (4/7 vs 11/13, the majority in both cases), were they given that blood test because they had other symptoms or circumstances to suspect a vitamin D deficiency?
• How many were under 75? That's a very important number when making claims like "all patients under 75", and out of this small sample size it may well be only one or two.

Perhaps I will have a chance to look at the others.

Yeah, that paper was not that great on account of small sample size. I included it mostly because it is a US based paper, and the tendency to weigh papers from the west more than say from the Philippines or Indonesia. Those 2 papers have a much bigger sample size (212 and 780). For the Indonesian paper, provided that they can do a proper Vit D levels test (which I don't doubt they can), the result should be pretty meaningful.