An article highlighting all the comorbidities – remember the data shows you can have 1 but if you have multiple the odds shift exponentially to fatality…. https://www.popsci.com/story/health/covid-19-coronavirus-risk-factors-severe/

“COVID-19 patients have 90-times higher risk of hospitalization if they are between the ages of 65-74 as compared to 18-29 year olds.”

“According to the CDC, currently having cancer of any kind puts you at risk of a severe case of COVID-19. Whether or not risks are higher for people with a history of cancer is still up in the air. In two Lancet studies, somewhere between 13 and 28 percent of COVID-19 patients who had cancer died.”

“Chronic kidney disease is when your kidneys, which normally filter wastes, toxins, and excess fluid out of your blood, can no longer get the job done. Excess fluid and waste in the bloodstream put a patient at risk of heart disease and stroke, according to the CDC. In the worst-case scenarios, a patient will need dialysis or a kidney transplant. The most at-risk kidney disease patients for COVID-19 are those who are immunosuppressed due to a transplant, or who do in-center hemodialysis treatments multiple times a week.”

“Having COPD, including emphysema and chronic bronchitis, puts you at a higher risk of developing a severe case of COVID-19. In one analysis of 1,590 Chinese ICU patients, 62.5 percent of severe cases had a history of COPD and 25 percent of those who died were COPD patients. In non-severe cases, COPD patients made up 15 percent, and of surviving patients, they made up only three percent.”

“Having a BMI of 30 or higher puts a patient at a higher risk of a severe case of COVID-19. Studies have shown that more than 75 percent of hospitalized COVID-19 patients were overweight or obese, and that compared to peers with a “healthy” BMI, they had a higher chance of ICU visits or death.”

“Patients with heart failure and other serious heart diseases are at risk of struggling with a complicated or severe case of COVID-19. Respiratory complications from the disease can force the heart to work harder. The virus can also attack the heart directly, which puts these patients at higher risk of complications, according to Scripps Hospital.”

“Sickle cell disease puts you at a higher risk of a serious case of COVID-19. One study found that 69 percent of people with sickle cell disease who were infected with COVID-19 were hospitalized, 11 percent were admitted to the intensive care unit, and 7 percent died, all of which are higher than the general population’s rate.”

“Patients with type two diabetes are at a higher risk of experiencing a dangerous case of COVID-19. Poor glucose control, the hallmark of diabetes, can lead to all sorts of issues with the kidney, heart, liver, and nervous system. In one study, patients with type two diabetes and COVID-19 infections suffered a death rate of 260 per 100,000, which is double the fatality rate of those with type one diabetes and nearly 10 times higher than that of patients without diabetes.”

“CF patients are less likely to catch the disease at all, since these patients are likely to already practice social distancing due to their high risk of catching dangerous lung infections.”

“High blood pressure, especially if not managed with medication and a careful lifestyle, can put a person at a higher risk of severe COVID-19. One study has found that hypertension patients have twice as much risk of death from COVID-19 as those without the disease, and those who are not currently taking medication for hypertension put themselves at even greater risk.”

“Dementia likely does not add to the risk of COVID-19 in and of itself, according to the Alzheimer’s Association.”

“mortality was significantly higher in cirrhosis patients with COVID-19 than those hospitalized for bacterial infections.”

“Lancet study in the UK shows that patients with type one were at less risk than those with type two, and more research is needed.”

The US leads but still under 1K

New leader for the US Missouri 129

Miami-Dade FL still leads all counties at 22 – Missouri just has multiple county reporting for it to lead all US.

Even though Miami-Dade and/or LA typically lead all US counties they are dropping in deaths – confirmation is holding steady now for both. LA is at 12.5% confirmed per capita – this seems like a herd immunity in effect even though they have lockdowns – clearly not working. Miami-Dade is only 6.6% so there is a lot more confirmations that could happen for Miami-Dade.

UK is confirming 15500 per day on 7 day moving avg. with a fatality rate of 1.3% – which is significantly better than back in March which was over 10% – but nonetheless death are rising now 61 deaths per day compared to peak of 943.

There are discussions that covid-19 is no more deadly than the flu. There is some truth to that statement depending on your perspective of deadly. Many note deadly and lethal as direct impact of what is being compared – e.g. deadliest snake is the banded sea snake – BUT the odds of getting a bite from a banded sea snake is very small – but if you did it would be very lethal. Hypothesis: IF the flu could have spread as much as covid we would likely see the same amount of deaths. Why would I make that claim? Well IF covid was more lethal than a hypothesis is that the age breakdown of deaths should be more distributed and not look similar to the common flu…..well its very close in the US….

Death breakdown for covid 65+(79%) 50-64 (15.6%) https://covid.cdc.gov/covid-data-tracker/#demographicsvs flu 65+(78%) 50-64 (16.6%) https://www.cdc.gov/flu/about/burden/2018-2019.html – amazingly close I was really not expecting it to be this close!

The big difference has to be virulent nature not the fatality rate. Covid-19 spreads so much more than the flu. Nonetheless I still contend I would not like to get the covid-19/flu/ or even the cold so I would do what I can within reason to not get it (adopt healthy lifestyle (majority whole foods, exercise, no alcohol/smoking) – take Vitamin C,D, and Zinc – wear a mask in public spaces – be aware of ventilation if need be purchase equipment to clean air and modify hvac for more fresh air)

We have talked about BCG vaccine helping the immune system to fight of covid – NPR is covering it again now under the concept of live attenuated vaccine will boost immunity – which BCG is – also the nasal flu spray – https://www.npr.org/sections/health-shots/2020/10/08/917831035/could-the-live-flu-vaccine-help-you-fight-off-covid-19

“There’s a chance the vaccine could offer some protection against COVID-19 itself, says virologist Robert Gallo, who directs the Institute of Human Virology at the University of Maryland School of Medicine and is chairman of the Global Virus Network.

The key is getting the right flu vaccine, says Gallo, who was one of the main scientists credited with discovering HIV. "The vaccine has to have a live virus in it. The virus is attenuated so it doesn’t cause disease, but otherwise the virus is alive."

A live virus may sound a bit terrifying, but it’s a standard way to make safe and effective vaccines. In fact, you’ve probably already had a few "live, attenuated" vaccines in your lifetime, such as the measles vaccine or oral polio vaccine.”

“vaccine for tuberculosis. It’s called bacille Calmette-Guerin, or BCG, and it contains a live, but weakened, strain of TB from cows.

When doctors in Sweden first started using BCG back in the 1920s, they noticed not only that the vaccine reduced a child’s risk from dying of TB, but also that children who got it had a mortality rate from all causes that was almost three times lower than unvaccinated children. Since the 1970s, scientists in West Africa have documented a similar pattern with both the BCG vaccine and the live measles vaccine. In other words, the vaccines were doing something to boost the immune system’s response to many kinds of pathogens.

Recently, doctors in the Netherlands directly tested the BCG vaccine against a placebo, to see if it could help volunteers fight off a weakened form of yellow fever. The conclusion? People who received the BCG vaccine mounted a stronger immune response against the virus and cleared out the virus more effectively than those who received the placebo, the study reported.”

“Scientists have had a hard time believing the evidence because the idea goes against the way they thought vaccines work, says immunologist Zhou Xing at McMasters University in Ontario. "It’s a new concept that has emerged in the field of immunology over the past five to 10 years or so."

In general, vaccines work by tricking the body to produce antibodies. These molecules are very specific. They typically target and neutralize only one type of infection.

Live vaccines also work through antibodies, but they likely do something else, as well. They supercharge our body’s front-line defenders — the cells that first recognize an invader and try to clear it out before the infection gets out of control, Zhou says. Specifically, scientists think live vaccines epigenetically reprogram immune cells in the bone marrow, called myeloid cells.”

“No one believes the protection will be as strong — or as long-lived — as that provided by a specific COVID-19 vaccine, says Dr. Moshe Arditi, who leads one of the trials at Cedars Sinai in Los Angeles.

But, he says, the BCG vaccine has several advantages to a specific vaccine. It’s cheap. A dose only costs a few dollars. And we already know it’s safe. "More than 130 million kids every year — every year — receive the BCG vaccine so the safety profile has been very strong," Arditi says.

So the BCG vaccine could be approved — and available — by early next year, he says. "It could be a bridge until we have a safe, effective COVID-19 vaccine."”

“the flu vaccine comes in two major forms: a shot or a nasal spray. The shot, which is approved for all people above age 6 months who don’t have contraindications, contains an inactivated virus or components of the virus. The nasal spray (FluMist), which is approved for people ages 2 to 49, contains live, attenuated flu viruses.

"You watch," Gallo says. "People who get the live flu vaccine will also be protected against the COVID-19. That’s the hypothesis."

However, even if you get a vaccine, you should still exercise all the same cautious you would otherwise: Wear a mask, keep your distance, wash your hands and avoid large indoor gatherings.”

Compelling to get the nasal flu spray…..but IF you take it better take it when you can afford to be slightly sick – right now I have no time….

No country over 1K – impressive for midweek reporting

FL leads the US at 164

Interestingly the leading county is Shelby TN at 33

Big 4 all still trending down in deaths

UK at the level of deaths in March….hopefully will flatten out vs. what it did on the first wave

Good news – riding the coat tails of Trump regenron monoclonal antibody – this is Eli Lilly version – https://investor.lilly.com/news-releases/news-release-details/lilly-provides-comprehensive-update-progress-sars-cov-2

“An exploratory analysis showed that the proportion of patients with persistent high viral load at day 7 for combination therapy was lower (3.0 percent) versus placebo (20.8 percent), corresponding to a nominal p value of p<0.0001 without multiplicity adjustment”

“The rate of COVID-related hospitalization and ER visits was lower for patients treated with combination therapy (0.9 percent) versus placebo (5.8 percent), a relative risk reduction of 84.5 percent (p=0.049)”

No discussion of cost….

Media discussion – election timing one hopes not playing with peoples emotions but not so sure – Headlines CNN “Only two US states report a decline of new cases and nationwide hospitalizations are increasing” https://www.cnn.com/2020/10/08/health/us-coronavirus-thursday/

Axios “Coronavirus infections rise in 23 states and D.C.” https://www.axios.com/coronavirus-23-states-dc-e11cfce1-6c0b-4dd0-a118-8978f74ce303.html

Both are factually correct. The only piece is the perspective of deaths and how things have improved. Very similar to the case in TX in July with increase hospitalization many said we would see large deaths – which never occurred in Harris County. Below is Wisconsin which clearly shows increase in confirmations and also continued testing. Hospitalization is rising – but correspondingly the fatality rates are still dropping. IF the hospitals are overwhelming one should see the fatality rate increase else they are just over hospitalizing. As seen in the Houston/Harris county case the hospital modified its criteria for hospitalization with only a slight variation of fatality rate. When scarcity occurs its human nature to maximize better.

Hospital revenue is very dependent on elective procedures they don’t have much choice of additional revenue as they are hemorrhaging as a business. Operating room accounts for up to 65% of hospital profit margin. Their inclination to over hospitalized to balance out revenue is very high. This doesn’t make it wrong it just out of more caution than usual – then as bed fills they will likely become more strict with criteria but not to the point beyond reasonable. IF the deaths rise then you know they went beyond that point AND IF you become more strict and fatality don’t rise you know you over hospitalized. Note as beds got full in early July in Houston the amount of hospitalized starting going down even though confirmation rose. Fatality rates stayed the same if not slightly down.

Overall US certainly shows confirmations rising – but no indication of death yet. Even the second surge of confirmation (FL,TX,CA) did not lead to the level of deaths as observed in the first surge. Fatality rates continue to fall. Testing is around 1/3 of the US population now.

I am not saying this is nothing and we should do nothing. No – we should realize the confirmations are rising in the North as a function of people going back inside and heating their homes and not leaving windows open. We need to focus on improving ventilation – getting healthy as comorbidities are direct function of deaths with covid – but realize certain actions would not lead to a different result – massive lockdowns will likely cause more deaths in the long run and not prevent the mass spreading events (people getting together with people they know – church, weddings, bday, graduation, just missing each other, etc…- perhaps the Chinese and other more restrictive society can lockdown but this is not going to happen here) – knowledge and innovation to reduce viral load is the key for the US.

Great news on non-covid research – https://www.usnews.com/news/health-news/articles/2020-10-07/treatment-reverses-young-mans-type-1-diabetes-will-it-last

“After starting a drug that’s officially approved to treat a type of blood cancer, a young man with type 1 diabetes was able to stop using insulin.”

We don’t want to crowd out this type of research due to covid.

Even though confirmations have been rising in younger ages – deaths are not changing in age group.

Over time its not changing….under 55 the odds are in their favor

No country above 1K

Leading state FL

Leading county is LA at 28

The good news for Europe the fatality rates are much lower than in the beginning – even UK is averaging close to 1% vs. 10+% in the first wave

Lets think harder on what is being reported….

Some interesting stats thrown out by media on S. Dakota – https://abcnews.go.com/US/south-dakota-gov-kristi-noem-lockdowns-useless-states/story?id=73451385

“South Dakota had the second highest number of new cases per capita — behind North Dakota — according to The COVID Tracking Project. But on Tuesday, South Dakota rose to first place, with the highest positivity rate of any state over the past 14 days, at 23.64%, the tracking project said.

The national average rate over the same 14-day span was just 4.7%.”

“The state saw its worst month on record for active cases in September with residents between the ages of 20 and 39 making up for the bulk of positive diagnoses.”

IF the article attempted to balance the discussion they would also note that S. Dakota has one of the lowest fatality rates in the country. They would also give a perspective on what the last 2 weeks are relative to the past. To filter the last two weeks without perspective is pure statistical manipulation to push an agenda. Why would NY, CA, FL, TX, and AZ have large confirmations per capita the last two weeks – they are all coming off their big wave of confirmations. A non-lockdown approach WILL get more confirmation – it is supposed to be about managing the hospitals AT LEAST that’s how it was sold in the beginning for lockdowns. As noted but not explained or highlighted the bulk of positive diagnoses 20-39 therefore IF what we know is true it should be limited hospital visits and a stronger society base of immunity. S. Dakota is far away from being even close to the eastern states such as CT, MA, NJ and NY – in the statistic category which ultimately matters – Death

It is impressive S. Dakota and N. Dakota recent PER CAPITA weekly confirmations – however in terms of perspective to other states which did have lockdowns its IMPRESSIVE it is not higher as of right now – SHOULDN’T lockdowns/quarantine REDUCE confirmations more than without? Perhaps the Dakota’s will surpass the other states peaks as it continues to get cold – time will tell. However deaths need to also be monitored as that is the ultimate statistical category – but for the effectiveness of quarantine confirmations would be a good statistic to watch. I think human behavior which cannot be policed well – at least in US – will eventually cause rise in confirmations regardless of quarantine rules. We are lot more social in the US and the spread is not from some stranger its from a get together with friends and relatives which policing is near to impossible.

S.Dakota did see temps below freezing last week which could explain the rise – its ventilation!

FINALLY CDC is on the bandwagon – https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

“Avoid crowded indoor spaces and ensure indoor spaces are properly ventilated by bringing in outdoor air as much as possible. In general, being outdoors and in spaces with good ventilation reduces the risk of exposure to infectious respiratory droplets.”

State and local officials need to push the agenda to bring more outdoor air – make business and landlord show the amount of outdoor air that is being brought in by the HVAC – force adjusting the economizer – increase local building requirements.

Vaccine in China is progressing well – https://in.reuters.com/article/health-coronavirus-china-vaccine-idINKBN26S0FK

“A Chinese experimental coronavirus vaccine being developed by the Institute of Medical Biology under the Chinese Academy of Medical Sciences was shown to be safe in an early stage clinical trial, researchers said.

In a Phase 1 trial of 191 healthy participants aged between 18 and 59, vaccination with the group’s experimental shot showed no severe adverse reactions, its researchers said on Tuesday in a paper posted on medRxiv preprint server ahead of peer review.”

“China has at least four experimental vaccines in the final stage of clinical trials.”

Another day under 1K for the US

Leading state TX with 91

Leading county in Texas border county Hidalgo at 18 – still the leading county for all US is LA at 27

The big 4 continue to decline in deaths and flattening out in confirmations.

The comforts of modern society explains the recent uptick in Europe – see temp charts below. We have to use more energy – open windows – increase ventilation in buildings – your own home probably okay not to increase ventilation IF you don’t have anyone coming over.

London Temp

It even got cold in Buenos Aires Argentina

Cold in Brussels

Test and trace and regional lock down was what the best direction in the beginning as showed by S. Korea. However now that we have more data from all ages and types of people with over 35 Million confirmed and 1 million dead – we know a lot more than we did in the beginning. It is time to adapt with new knowledge. The Great Barrington Declaration is that movement to take what we learn and adapt how we respond – https://gbdeclaration.org/

The only thing missing in the declaration is a discussion on personal accountability of personal choices impacting health. We know for a fact certain comorbidity are impactful to the odds of survival. Governments duty is to educate and offer assistance to help make the better personal choice to shift the odds in the favor of their govern body. The public must be educated that they are not powerless and that they can do more beyond wearing a mask but by choosing a healthier lifestyle. Whole foods and limiting process foods would go a long way.

Mechanism to reduce viral load should also be promoted as they are not rocket science nor do cost significant amounts of money – increase ventilation – new filtration mechanism. Our cozy lifestyle is what caused a lot of the infection as seen in the data in 1st world regions.

“Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.

Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.

Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.”

“The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”

“Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.”

“Dr. Martin Kulldorff, professor of medicine at Harvard University, a biostatistician, and epidemiologist with expertise in detecting and monitoring of infectious disease outbreaks and vaccine safety evaluations.

Dr. Sunetra Gupta, professor at Oxford University, an epidemiologist with expertise in immunology, vaccine development, and mathematical modeling of infectious diseases.

Dr. Jay Bhattacharya, professor at Stanford University Medical School, a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations.”

Speaking of school opening – it would seem schools are not the carrier location as many are concerned about – sure there will be school systems not implementing appropriate measures and there will be spreading as much as flu and colds spread in school – but the evidence so far does not show schools create super spreading events. Other activities are leading to increase spreading.

In Texas Bexar had 55% in person compare to Travis at 15% they did observe a spike in confirmation day 25 but that has not lead to any significant change in deaths. El Paso is 20% in person yet they are starting to show a rise in confirmation – its not school.

In Florida Broward has 0% in person whereas Pinellas and Palm Beach 100% in person – and nothing of significance. Palm beach has a slight up tick and confirmation and death but nothing historically big.

CA – its unfortunate they don’t have more dispersion of choices in CA – the most comparable is San Diego at only 20% in person and Santa Clara at 0. No big difference in the two.

In Ohio Lorrain stayed closed for in person school. Stark and Mahoning 100% in person. Mahohing is seeing a spike in confirmation now which is not translating to deaths yet. Mahoning prevention should be examined relative to the other counties that opened up.

In Colorado – Boulder did only 25% in person whereas Adams and El Paso doubled that. Yet it is Boulder with a spike in confirmation – once again proving its not school that is prime spreading event.

In PA Dauphin had 0 in school and Centre had 50% in person. Centre is seeing a spike in confirmation. They should be seriously examining their process compared to the counties that had no issues. So far this has not translated into any deaths.

US below 500 – but Mexico shot up at 2789

Texas leads the US at 117

Once again when Texas leads it usually a border county – this time its Cameron at 70

Big 4 counties are all trending down on deaths

Ireland is also seeing a jump in confirmations – hence perhaps they are looking for another lockdown- the good news deaths so far have not increased as rapidly – https://amp.independent.ie/world-news/coronavirus/nphet-has-recommended-the-highest-level-of-restrictions-for-the-entire-country-39587101.html

Great reporting day even for Sunday – Highest death count Brazil at 365 – US at 337

Highest US state FL at 43

Highest county is actually a tie with Cook IL and Santa Clara CA – at 11

LA deaths from covid has not been this low since April 12th @ 20 deaths on a 7 day moving average. Non-age adjusted fatality rate for LA @ 2.4%

In general the economy is still relatively closed based on state ranking – largely for democrat stronghold states such as CA and NY. FL and AZ are surprisingly very open -both elderly states with significant counties of issues. – https://www.multistate.us/pages/covid-19-state-reopening-guide

There has been a recent trend of opening but still suggest MWh is still behind to what it would be if things would be open

UK covid deaths are rising quite steeply along with a confirmation spike.

Another study to confirm the interaction with the common cold coronavirus and SARS-CoV-2 (virus that causes covid-19) this time focused on B Cells– FYI HCoV is typically the coronavirus that cause the common cold there are are like at least 5 variants of HCoV floating around in society – https://mbio.asm.org/content/11/5/e01991-20

“The idea that circulating HCoVs elicit IgG that cross-reacts with SARS-CoV-2 is supported by the finding that SARS-CoV-2 infection increases IgG titers against the S proteins of multiple HCoVs”

“SARS-CoV-2-reactive memory B cells (MBCs) generated in B cell responses to HCoVs are also likely to be present in non-SARS-CoV-2-exposed individuals. Indeed, MBCs might be more important than preexisting cross-reactive Abs as a source of protection against SARS-CoV-2.”

“MBCs are long-lived cells that continue to provide strong protection when circulating Ab levels wane”

“Notably, 86% of unexposed subjects had IgG against the S2 subunit, reflecting homology with HCoVs, but none had IgG against the highly novel SARS-CoV-2 RBD (6, 8, 24). Abs that target the S2 subunit have been shown to have virus-neutralizing activity, raising the possibility that the presence of preexisting anti-S2 IgG confers some protection against SARS-CoV-2”

“In conclusion, our analysis investigated Ab and MBC immunity to SARS-CoV-2 in unexposed subjects and individuals soon after recovery from SARS-CoV-2 infection. The findings emphasized the novelty of the SARS-CoV-2 S protein RBD in unexposed subjects. However, IgG reactive to the S2 was widespread in unexposed subjects and likely resulted from exposure to HCoVs. Although our approach was unable to directly identify S2-reactive MBCs in the unexposed subjects, we suggest that these cells were present and strongly contributed S2-reactive IgG early in the response to SARS-CoV-2 infection.”

We cannot and should not limit the common cold as it allows “Exercise” for our immune system and the outcome of the common cold is very mild in the grand scheme.

The ONLY proven but not touted enough way to fight covid-19 is to be healthy! Quarantine/lock down seems to not be doing that- In the UK they are gaining weight in a time they need to be getting healthy. – https://covid.joinzoe.com/post/lockdown-weight-gain

“almost a third (29%) of those surveyed gained weight since March 2020.”

“The factors that may have contributed to weight gain during lockdown include increased snacking (35%), decreased levels of physical activity (34%), increased alcohol consumption (27%) and a less healthy diet (19%).”

How about forcing people to eat well and exercise – is that more intrusive than forcing people to not socialize and stay in lock down? Perhaps modification of age lockdown is to change it to health lockdown – initially proposed awhile back – given its easy to test for common comorbidities that would lead to fatal results with covid-19? The good thing for the most part many of those comorbidities can be gone in relatively short time with eating well and exercise. Those not healthy and not going to quarantine/lockdown/wearing mask are adding a large cost to society.

Brazil back on top as the US continues under 1K!

FL leads the US at 74….interestingly to see AZ fall of the map in terms of confirmation.

LA and Miami-Dade tied at 16 to lead all US counties…some 1K+ confirmations in TX counties Harris and Collin

As noted above AZ confirmations have been low – Maricopa has stayed under 400 for quite some time. Death rate in Maricopa coming down now under 9 a day.

Sweden confirmations are slightly rising but unlike all the other European countries their deaths seem to be stabilized at around 2 a day.

This is worthy to mention in terms of President disposition – what is he taking…Big news is that he taking Regenron polyclonal antibody cocktail – but looking underneath he is also taking zinc, vitamin D, melatonin – along with famotidine and daily aspirin – the first 3 we covered in this blog – no brainer low cost abundant minimum side effects – why hasn’t that been pushed more and discussed more vs. vaccine/quarantine/remedesivir – why shouldn’t the general public be taking those 3 – particularly in the counties being impacted (LA, Harris, Miami-Dade, Maricopa)? I take those three daily along with Vitamin C.

Food for thought article – https://reaction.life/we-are-throwing-the-working-class-under-the-bus-an-interview-with-professor-martin-kulldorff/

“In this interview with Reaction’s Deputy Editor Alastair Benn, Martin Kulldorff, Professor of medicine at Harvard Medical School and leading figure in the field of infectious disease epidemiology, argues for an age-targeted response to the Covid-19 pandemic. Lockdowns result in too much collateral damage, he argues, and impose unreasonable costs on the working class and the young in particular. He also has some fascinating comments on the uses and misuses of “the science” in the debate over public health.”

“The older people among us have more than a thousand-fold risk of death compared to the youngest among us. We have to use that in order to deal with this virus. So that means we have to protect the elderly among us and other high-risk persons while we wait for herd immunity which will either come via a vaccine or natural infections or a combination of the two.”

“For older people this is much worse than the annual flu. For children the risks are much less than the annual flu. This is not a dangerous disease for children. We don’t close schools because of the annual flu. We don’t ban people from driving cars because there are people who die in car accidents. We let people live normal lives with standard precautions.”

“Instead of going into panic mode, what we have to do is look at the particular disease and respond with public health measures that minimise the deaths. We haven’t done that.”

In general the democrats want the quarantine/lockdowns and republicans want to open up – and the democrats have themed themselves for the working class – IF the below logic holds true it is quite ironic…

“The burden is primarily being put on young children who have not been able to access education. Instead of protecting the elderly and letting young people live their lives, we are protecting professionals who can work from home while older working class people, who work out in society, are getting infected and some of them are dying, even though they are at higher risk. Basically, we are throwing the working class under the bus.”

“In personal medicine, with a single patient, we want to postpone death. In an epidemic, it is futile to do that unless we can postpone it until we have a vaccine or treatment. That might be a reason to do it but it is not a reason in and of itself to lockdown.”

“Among my colleagues who I spoke with who are infectious disease epidemiologists, the majority are in favour of an age-targeted strategy. A minority are in favour of lockdowns and contact tracing. Those are the two different philosophies”

I also think one can have evolved by initially going with lockdown because we had no idea …know the data is pretty clear the impact is the elder by 1000 fold lots of people have been confirmed in all age group now….given new knowledge one can move to age-targeted strategy?….

So true…if only….

“it is critical in a pandemic that we keep it apolitical. As a public health scientist I have to put my own political beliefs aside. I want to get out to as many as possible the right public health message that will minimalise mortality in the population as a whole. Some scientists have failed to do that. They have been mixing their public health message with their political beliefs. That is very damaging both for our pandemic response and general trust in scientists.”

“There is a difference between those who want to pursue an age-targeted approach and those who want to do a lockdown combined with testing and isolation. Testing and isolation is a very common way to deal with infectious disease outbreaks. When we had an Ebola outbreak in the US there were a few cases so we had to isolate them and then we had to check all their contacts and isolate other people. For many infectious diseases this is the right approach. But it doesn’t work for Influenza. It doesn’t work for Covid-19 or Measles before we had a vaccine. By definition, it doesn’t work in pandemics.

Maybe if you do very extreme measures and you keep lockdowns forever until there is a vaccine or a cure, then contact tracing can do a little bit on top of that. For example, that has happened in New Zealand. But that strategy does require a lockdown until we have a vaccine, which may never happen.”

“If there had been a quick cure it might have been worth hunkering down for a while. From the bottom of my heart, I wish that had been the case. But I was right and a cure has not come along in a few months.

There are many costs. In the US, childhood vaccination rates plummeted in the Spring. That might lead to outbreaks of preventable diseases some time in the future. Cardiovascular disease outcomes have been worsening. Cancer screenings are not happening. That will not increase mortality this year because if you get cancer this year, you won’t die this year. But someone who might have lived 15 or 20 years might now only live 3 years.”

“Suicide is the most direct effect but there are longterm effects too. In the US we have evictions because people cannot afford the rent because they have lost their jobs. Evictions are not good for physical or mental health. Those of us like you and me who are in a privileged position – you are a journalist, I am an academic, we can work from home, our salaries are guaranteed. We are not affected very much compared to the working class. It is really the working class who are bearing the brunt of the burden of lockdowns and extending this pandemic over time. They are also suffering because they are the ones building up the herd immunity that will eventually protect all of us.”

“Cancers can hit anybody out of the blue when they are middle-aged. But in a way, Covid-19 is worse in this respect because we begin to fear each other. We cannot infect each other with cancer. This pandemic and the fear around it has made people fear each other. This is very tragic for children that they have to learn that they cannot be close to each other and that they might infect their parents and grandparents.

This is actually true to some extent of influenza but children are at higher risk of passing on influenza than Covid-19. For children now growing up, this is all they know. How will this experience effect them throughout their lives?

For those of us who are older, we can hopefully revert back to our old patterns of thinking. It is unclear how it will impact on the psychology of our children.”

With the above in mind – https://abcnews.go.com/Health/living-edge-10-households-face-financial-problems-pandemic/story?id=73179882

“Living on the edge: More than 4 in 10 households face serious financial problems during pandemic: POLL”

“Before the coronavirus’ global grip, it already wasn’t easy. Now, Americans enduring the most threadbare fiscal safety nets find themselves on the fault lines exacerbated by the health crisis — with the ground rapidly giving way beneath them.

New polling reveals that those with the smallest financial buffer have sustained a heavy blow. The survey, released Wednesday from NPR, Robert Wood Johnson Foundation, and Harvard’s T.H. Chan School of Public Health, and conducted between July 1 and Aug. 3, finds that the COVID-19 crisis has sent families reeling from the economic fallout.”

“More than four in 10 households across the country report facing serious financial problems due to the COVID-19 outbreak, the survey reveals. More than four in 10 also report having lost employment, been furloughed, or had wages and hours cut. Among those with job or wage losses during the outbreak, two in three homes report severe financial issues.

And those with the slimmest margin for error, the most vulnerable to the virus, have been hit the hardest; as the income bracket shrinks, so grows the economic impact.”

“About a third of households with reported income under $30,000 said they had serious problems affording food, and had missed or delayed paying major bills to ensure enough to eat for everyone.

Broken down by race, that burden disproportionately weighs on Black and brown Americans. Thirty-one percent of Black households and 26% of Latino households say they face serious financial problems, contrasted with 12% of white households. Communities of color, already suffering a disproportionate impact from the virus, are now more financially strapped.”

“One in five households nationwide report facing serious problems paying their mortgage or rent; there too, Black, Latino and low-income households take the greatest share of suffering.”

No doubt Covid-19 is an awful thing to happen. Currently 208K plus lives have died and rising in US – globally over 1 Million – but what we do and how we respond to this adversity will amplify or reduce the overall outcome. We must think the long-game not the short-game as the odds of cure of vaccine is not on your side regardless of development – you still have distribution. Age targeted approach seems to be the clear winner if you want to play the long-game.

FACT Under 55 very small chance of dying from covid AFTER infection. Take the fatality rate (those that die from the confirmed pool (confirmation is rising faster than death so likely smaller than current)) then multiply it by the percent below gives you a proxy of the age based fatality rate. So in AZ case under 55 would be 0.3%. This is likely around 10X higher than the standard flu but 3X lower than dying from a car crash – very sad to say even lower than dying from a gun assault – https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/ In fact to compare it to other events probably need to multiply the number by the percent of getting infected – confirmation rate – as you cant die from it if you don’t get it. You typically do get into a car daily so that’s a given. In Arizona case the confirmed per capita is 3%…lets just double that 6% ….than the odds of dying as individual in AZ under 55 become 0.06 X 0.003 = 0.018%…1in 5555 – close to dying from a bee sting. Should we lock the economy up for those under 55 given those odds for them?

US still stayed under 1000 deaths all week….India on top at 1069

FL leads in death at 110

Miami-Dade leads the US at 30 deaths…big spike in Harris county confirmation 2704 – very bad data from Harris County

Harris county data is a case study in what not to do with data

Unfortunately Spain death back on the rise….Belgium and UK is starting to ramp in deaths

False Positive Equation laid out in this blog – looks to be GP in UK who is generally a skeptic so bear that in mind – https://drmalcolmkendrick.org/2020/09/28/false-positive-tests/amp/?

The numbers he is using is based UK figures – “test test” may have been a good mantra in the beginning but the test itself perhaps needs a test?

“The specificity of a test is defined by the equation:

SP = TN / (TN + FP)

Where SP = specificity, TN = number of true negatives, FP = number of false positives. TN + FP = the total number of tests carried out.

Now the latest Government figures from Monday 7th September state that 350,100 tests were carried out and 2,948 people tested positive 2. So, if we apply the above equation to our PCR test and the Government’s figures, we get:

0.956 = TN / 350,100

Therefore, the number of true negatives is:

TN = 350,100 * 0.956 = 334696

Therefore, the number of false positives, FP we would expect from 350,100 tests is:

FP = 350,100 – 334,696 = 15,404

This is more than five times the number of positive tests reported, which means we cannot have any confidence that any one of those positive tests represents a genuine case.

What these figures show is that it is totally inappropriate to use RT-PCR as a screening test for a virus in an asymptomatic population when the prevalence of the infection is very low.

Even if there were a test with 99% specificity, you would still expect to get 3500 false positives from performing 350,000 tests – which is still greater than the number of “cases” reported. When the number of “cases” is lower than your rate of false positives, then a positive result on its own is virtually meaningless.

The PCR test is best utilized as a diagnostic test to confirm the diagnosis of an infection based on clinical signs and symptoms. It certainly should not be used as a screening test when there is low prevalence of disease and should NEVER be used as the sole determinant in the diagnosis of a case. One source of false positives is the persistence of fragments of viral RNA long after a patient may have recovered and is no longer infective. These fragments will be amplified by PCR and will give a positive result that is indistinguishable from a genuine case. We’ve had a patient whose swabs have been testing positive in our lab every week for over 3 months!”

As noted in the other article on PCR (https://covid19mathblog.com/2020/09/covid-9-28-20/) solution proposed was a cell culture test after the positivity test to test for infection – currently long time line for results and limited lab capabilities but I am sure there is some genius out there that can solve this process issue – its not a science issue.

Remember the HCQ scandal – well here is a well written timeline of events and the debacle and some of the ramifications from allowing this paper to make the rounds – at some point perhaps it can be made into a movie – https://www.the-scientist.com/features/the-surgisphere-scandal-what-went-wrong–67955?

“It sounds absurd that an obscure US company with a hastily constructed website could have driven international health policy and brought major clinical trials to a halt within the span of a few weeks. Yet that’s what happened earlier this year, when Illinois-based Surgisphere Corporation began a publishing spree that would trigger one of the largest scientific scandals of the COVID-19 pandemic to date. At the heart of the deception was a paper published in The Lancet on May 22 that suggested hydroxychloroquine, an antimalarial drug promoted by US President Donald Trump and others as a therapy for COVID-19, was associated with an increased risk of death in patients hospitalized with the disease. ”

“The study was a medical and political bombshell. News outlets analyzed the implications for what they referred to as the “drug touted by Trump.” Within days, public health bodies including the World Health Organization (WHO) and the UK Medicines and Healthcare products Regulatory Agency (MHRA) instructed organizers of clinical trials of hydroxychloroquine as a COVID-19 treatment or prophylaxis to suspend recruitment, while the French government reversed an earlier decree allowing the drug to be prescribed to patients hospitalized with the virus.”

“Desai’s astonishing influence on COVID-19 policy was dependent on multiple parties, Cooper notes, from the institutions that employed him to the coauthors on his research studies, the journals that published the work, and the organizations that issued public health decisions based on his research.”

“An investigation by The Scientist points to a series of missed opportunities to halt Surgisphere’s progress—in some cases stemming from people’s failure to check implausible claims made by Desai or from a pattern of ignoring warnings of problematic data or behavior. While a few parties have since accepted some responsibility and outlined plans to avoid similar situations in the future, the majority have not.”

US continues to be under 1K – but we have a new leader in deaths out of nowhere Argentina reports 3351 deaths – this type of batch reporting makes time series data almost useless.

https://nationalpost.com/pmn/health-pmn/argentinas-coronavirus-death-toll-leaps-above-20000-as-new-data-added

“Argentina’s coronavirus death toll leapt above 20,000 on Thursday as a large number of previously untallied fatalities were added to the total, emphasizing how the country has gone from regional role model to one of the worst-hit in the world.

The South American nation, which slowed the spread of the virus with a strict lockdown in March, reported 14,001 new COVID-19 cases to take the total confirmed infections to 765,002, one of the 10 highest in the world.”

“Argentina’s rolling 7-day average of daily cases and fatalities has continued to rise, even as other countries in the region have seen the spread of the virus slow in recent weeks as governments look to reopen their battered economies.”

Lockdowns don’t work or do they? What is the metric to say they work?

FL leads the US in deaths at 127

This time the leading county is LA at 34. Deaths in FL seems dispersed vs. the usual Miami-Dade. Wake NC reported 17666 but at the same time some negatives in other counties – looks like a data revision occurring in NC as the overall state numbers seem reasonable.

After the data revisions and all Harris county back to being one of the best fatality rates at under 2% (1.82%).

Interestingly Argentina never observed a lull in confirms or deaths – they have been steadily rising throughout the year and now with the data update a spike.

A VERY BIG DEAL report which has supported a hypothesis that the common cold has assisted in building immunity and it’s the T cells not the antibodies will likely be the key. Those who live in ultraclean environment less likely to by asymptomatic and will develop a more severe response to SARS-CoV-2 – the virus that causes covid-19. https://www.nature.com/articles/s41590-020-00808-x?utm_source=twitter&utm_medium=social&utm_content=organic&utm_campaign=NGMT_USG_JC01_GL_NRJournals

“SARS-CoV-2-specific peptides enabled detection of post-infectious T cell immunity, even in seronegative convalescent individuals. Cross-reactive SARS-CoV-2 peptides revealed pre-existing T cell responses in 81% of unexposed individuals and validated similarity with common cold coronaviruses, providing a functional basis for heterologous immunity in SARS-CoV-2 infection. Diversity of SARS-CoV-2 T cell responses was associated with mild symptoms of COVID-19, providing evidence that immunity requires recognition of multiple epitopes. Together, the proposed SARS-CoV-2 T cell epitopes enable identification of heterologous and post-infectious T cell immunity and facilitate development of diagnostic, preventive and therapeutic measures for COVID-19.”

“Knowledge obtained from the two other zoonotic coronaviruses SARS-CoV-1 and MERS-CoV indicates that coronavirus-specific T cell immunity is an important determinant for recovery and long-term protection12,13,14,15. This T cell-mediated immune response is even more important as studies on humoral immunity to SARS-CoV-1 provided evidence that antibody responses are short-lived and can even cause or aggravate virus-associated lung pathology”

“Alignments of the SARS-CoV-2 T cell epitopes recognized by unexposed individuals revealed similarities to the four seasonal human common cold coronaviruses (HCoV-OC43, HCoV-229E, HCoV-NL63, HCoV-HKU1) with regard to amino acid sequences, physiochemical and/or HLA-binding properties for 14 of 20 (70%) of the epitopes, thereby providing clear evidence for SARS-CoV-2 T cell cross-reactivity (Fig. 5b, Supplementary Tables 10 and 11 and Supplementary Data 1). Together, cross-reactive T cell responses to SARS-CoV-2 HLA class I and HLA-DR T cell epitopes were identified in unexposed individuals. These cross-reactive peptides showed similarity to common cold coronaviruses, providing functional basis for heterologous immunity in SARS-CoV-2 infection. ”

“Of the SARS donors, 100% showed T cell responses to cross-reactive and/or specific ECs (HLA class I 86%, HLA-DR 100%; Fig. 5d,e), whereas 81% of PRE donors showed HLA class I (16%) and/or HLA-DR (77%) T cell responses to cross-reactive ECs”

“SARS-CoV-2 T cell epitopes enabled detection of post-infectious T cell immunity in 100% of individuals convalescing from COVID-19 and revealed pre-existing T cell responses in 81% of unexposed individuals.”

“SARS-CoV-2-specific peptides enable the detection of post-infectious T cell responses, even in seronegative convalescents.”

So the below statement is very important – regardless of age and other variables sex, age, BMI did not correlated well with severity other than the diversity of T cell response to SARS-CoV 2!

“Alike in critically ill patients27, independently of age: high-antibody ratios were significantly associated with disease severity in our collection of convalescent SARS donors (n = 180, group 1 and 2), who in general were in good health and had not been hospitalized (Fig. 6f and Extended Data Fig. 5a). Neither the intensity of SARS-CoV-2-specific nor of cross-reactive T cell responses to HLA class I or HLA-DR ECs correlated with demographics (sex, age or body mass index; Supplementary Tables 12 and 13) or disease severity (Fig. 6g). Rather, diversity of T cell responses in terms of recognition rate of SARS-CoV-2 T cell epitopes (number of recognized epitopes normalized to the total number of tested epitopes in the respective donor) was decreased in patients with more severe COVID-19 symptoms (Fig. 6h and Extended Data Fig. 5b), providing evidence that development of protective immunity requires recognition of multiple SARS-CoV-2 epitopes.”

“determination of immunity to SARS-CoV-2 relies on the detection of SARS-CoV-2 antibody responses. However, despite the high sensitivity reported for several assays there is still a substantial percentage of patients with negative or borderline antibody responses and thus unclear immunity status after SARS-CoV-2 infection28. Our SARS-CoV-2-specific T cell epitopes, which are not recognized by T cells of unexposed donors, allowed for detection of specific T cell responses even in donors without antibody responses, thereby providing evidence for T cell immunity upon infection. In additional analyses of T cell immunity in hospitalized donors, we could prove SARS-CoV-2 T cell responses also in severely ill patients with COVID-19.”

“Using predicted or random SARS-CoV-2-derived peptide pools, very recent studies reported pre-existing SARS-CoV-2-directed T cell responses in small groups of unexposed as well as individuals who are seronegative for SARS-CoV-2, thereby suggesting cross-reactivity between human common cold coronaviruses and SARS-CoV-2 (refs. 18,19,20). In our study we identified and characterized the exact T cell epitopes that govern SARS-CoV-2 cross-reactivity and proved similarity to human common cold coronaviruses regarding individual peptide sequences, physiochemical and HLA-binding properties38,39. Notably, we detected SARS-CoV-2 cross-reactive T cells in 81% of unexposed individuals after a 12-d pre-stimulation. Furthermore, evidence was provided for a lower recognition frequency of cross-reactive HLA-DR EC in hospitalized patients compared to donors with mild COVID-19 course, which might suggest a lack of pre-existing SARS-CoV-2 T cells in severely ill patients”

“The pathophysiological involvement of the immune response in the course of COVID-19 is a matter of intense debate. We showed a correlation of high antibody titers with enhanced COVID-19 symptoms in our cohort of nonhospitalized patients. This finding is in line with recent data describing a correlation of high antibody titers with disease severity in hospitalized patients27. Our data together with a recently published study20 provide evidence that, on the other hand, the intensity of T cell responses does not correlate with disease severity. This finding is of high relevance for the design of vaccines, as it provides evidence that disease-aggravating effects might not hamper the development of prophylactic and therapeutic vaccination approaches aiming to induce SARS-CoV-2-specific T cell responses. In contrast to the intensity of the T cell response, we showed that recognition rates of SARS-CoV-2 T cell epitopes by individual donors were lower in individuals with more severe COVID-19 symptoms. This observation, together with our data on increased T cell epitope recognition rates after SARS-CoV-2 infection compared to pre-existing T cell responses in unexposed individuals and reports from other active or chronic viral infections associating diversity of T cell response with antiviral defense45,46,47, provides evidence that natural development and vaccine-based induction of immunity to SARS-CoV-2 requires recognition of multiple SARS-CoV-2 epitopes”

“our data underline the high importance of the identified T cell epitopes for further studies of SARS-CoV-2 immunity, but also for the development of preventive and therapeutic COVID-19 measures. Using the SARS-CoV-2 T cell epitopes we are currently preparing two clinical studies (EudraCT 2020-002502-75; EudraCT 2020-002519-23) to evaluate a multi-peptide vaccine for induction of broad T cell immunity to SARS-CoV-2 to combat COVID-19.”

US below 1K deaths again and in the middle of the week!

Fl leading the way at 174 for the US

Once again Miami-Dade leading all counties at 37.

I had to change the chart from 1000+ to 2000+ in order to reduce the amount of countries to a readable amount