Another focused study – this time a cruise ship departing from Argentina mid March 2020 – https://thorax.bmj.com/content/early/2020/05/27/thoraxjnl-2020-215091

“Of the 217 passengers and crew on board, 128 tested positive for COVID-19 on reverse transcription–PCR (59%). Of the COVID-19-positive patients, 19% (24) were symptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients).”

“The ship departed mid-March 2020, after the global COVID-19 pandemic was declared by the WHO, with all 128 passengers and 95 crew screened for COVID-19 symptoms, and body temperatures were taken before boarding. No passengers or crew that had transited through China, Macau, Hong Kong, Taiwan, Japan, South Korea or Iran in the previous 3 weeks were permitted to board, given that these countries were where COVID-19 infection was most prevalent at the time. Multiple hand hygiene stations were positioned throughout the ship and especially in the dining area.”

“The first recorded fever on board the ship was a febrile passenger on day 8. Isolation protocols were immediately commenced, with all passengers confined to cabins and surgical masks issued to all. Full personal protective equipment was used for any contact with any febrile patients, and N95 masks were worn for any contact with passengers in their cabins. The crew still performed duties, including meal services to the cabin doors three times a day, but rooms were not serviced. Expedition staff helped with crew duties at meal service.

Further fevers were detected in three crew on day 10, two passengers and one crew on day 11, and three passengers on day 12.”

“Rapid testing kits for COVID-19 (VivaDiag qSARS-CoV-2 IgM/IgG) were delivered on board and performed on six passengers and crew, who had initial fevers. All returned negative results on day 14. Permission to dock was refused by Uruguayan officials until formal nasal swab testing for COVID-19 real-time reverse transcription PCR (RT-PCR) testing was performed on all on board.

Three additional passengers and crew developed fever on day 14, but with mild cough and lethargy only. One of these passengers, a 68-year-old man who was a lifelong non-smoker with no comorbidities, deteriorated and required urgent medical evacuation to a hospital in Montevideo on day 17. He was intubated and ventilated and tested positive for COVID-19 (RT-PCR).

A total of eight passengers and crew were medically evacuated from the ship to hospitals in Montevideo, all for impending respiratory failure, including a 70-year-old woman with chronic obstructive pulmonary disease (evacuated day 20), a 65-year-old woman with no comorbidities (evacuated day 21), and two crew and one passenger evacuated on day 22. A seventh passenger, a 68-year-old man, developed fever on day 23 (15 days after cabin isolation) and was evacuated for hypoxaemia on day 24. One of the two ship physicians required medical evacuation on day 27 also for hypoxaemia. All evacuated patients subsequently tested positive on 2019-nCoV RT-PCR.

The Uruguayan Ministry of Health provided on board SARS-CoV-2 virus testing of all passengers and crew, which occurred on 3 April (day 20; Atgen-Diagnostica, Montevideo) with CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel.

Of the 217 passengers and crew on board, 128 tested positive for COVID-19 (59%). These included all passengers who tested negative on the VivaDiag qSARS-CoV-IgM/IgG Rapid Test. There were 10 instances where two passengers sharing a cabin recorded positive and negative results.”

“From the departure date in mid-March 2020 and for the next 28 days, the expedition cruise ship had no outside human contact and was thus a totally isolated environment in this sense.”

“We conclude from this observational study that

The prevalence of COVID-19 on affected cruise ships is likely to be significantly underestimated, and strategies are needed to assess and monitor all passengers to prevent community transmission after disembarkation.1

Rapid Ab COVID-19 testing of patients in the acute phase is unreliable.2

The majority of COVID-19-positive patients were asymptomatic (81%).

The presence of discordant COVID-19 results in numerous cabins suggests that there may be a significant false-negative rate with RT-PCR testing. Follow-up testing is being performed to determine this.

The timing of symptoms in some passengers (day 24) suggests that there may have been cross contamination after cabin isolation.”

Big takeaway not highlighted in the report is the mortality rates are very low even with elderly on board. I have emailed the author to discover the treatment approach used. It is very interesting how a 2K 20 floor building is not the same condition as a cruise ship. It would be interesting to understand the ventilation and being a noncruise person I suspect there are certain dining hours where most people gather? Perhaps with the asymptomatic people and before the initial discovery they were gathering and chatting and laughing in a dining hall for an hour or more – this is all that is needed to get most people infected as noted in the restaurant study. Compared to a building most people on the floors don’t comingle particularly a mixture of commercial and residential. I suspect with opening of restaurants and people gathering this needs to be highlighted. Keep the gathering outdoors on a breezy day – a solution to pollution is dilution…

Not the best news – but it looks like IF using similar coronavirus immunity is limited around 6-12 months – https://www.researchgate.net/publication/341467148_Human_coronavirus_reinfection_dynamics_lessons_for_SARS-CoV-2

“In conclusion, seasonal human coronaviruses have little in common, apart from causing common cold.Still,they all seem to induce a short‐lasting immunity with rapid loss of antibodies. This may well be a general denominator for human coronaviruses.”

If true it does hurt the herd immunity case but it would mean a vaccine would have to be taken every year. They did not highlight IF whether the reinfection was less severe than the first infection which would at least give some credence to herd immunity. However if true the second wave becomes inevitable.

HCQ – really shouldn’t be this controversial – https://amp.theguardian.com/science/2020/may/28/questions-raised-over-hydroxychloroquine-study-which-caused-who-to-halt-trials-for-covid-19?

“If they got this wrong, what else could be wrong?” Cheng said. It was also a “red flag” to him that the paper listed only four authors.

“Usually with studies that report on findings from thousands of patients, you would see a large list of authors on the paper,” he said. “Multiple sources are needed to collect and analyse the data for large studies and you usually see that acknowledged in the list of authors.”

He stressed that even if the paper proved to be problematic, it did not mean hydroxychloroquine was safe or effective in treating Covid-19. No strong studies to date have shown the drug is effective.”

“Cheng said it would be a mistake to stop strong, well-designed clinical trials examining the drug because of questionable data. The Lancet study findings have prompted the leaders of an Australian hydroxychloroquine trial, known as the Ascot trial, to review the future of their study.”

Still the percent impacted was quite small 3.7% in the Lancet study relatively speaking. AND if they use HCQ in early stages vs. late stages I suspect the percent will fall even lower.

S. Dakota will continue with HCQ – https://www.usnews.com/news/best-states/south-dakota/articles/2020-05-28/south-dakota-testing-hydroxychloroquine-to-prevent-covid-19?

“South Dakota is going forward with plans to test using a controversial anti-malaria drug in small doses to prevent COVID-19, Gov. Kristi Noem announced Thursday.”

“Sanford is no longer recommending people with serious cases of COVID-19 take the drug.”

Similar to what Saudi Arabia is doing as noted on previous day blog.

Let me end with a positive boost – I always suspected 10 min (1.2 mile run, 2.5 mile bike ride) was decent enough to get good benefit – even on days I was running late or just not myself I always force myself to do 10 min of something – You do have time for 10/(60×24)x100=0.7% of the entire day…. https://newatlas.com/health-wellbeing/short-bike-rides-death-marker-protein-muscles/

“Through this, the team found that a single, tough session on an exercise bike for around 10 minutes can drive a significant increase in ubiquitin activity, which in turn intensified the removal of worn-out and damaged proteins.”

Brazil leading the way in confirmation and 2nd in deaths 1156. US 1199

Big change with NY deaths dropping to 8th place. PA leading with 108 deaths

County view really is the best way to view this disease. The red spot in Washington in the middle is Yakima county. A search on this lead to noting Yakima has the highest on West Coast https://www.seattletimes.com/seattle-news/yakima-county-has-top-rate-of-coronavirus-cases-on-west-coast/

“Health experts point to a large number of essential workers, a large number of cases in long-term care facilities and a large agricultural workforce living and working in close quarters as the causes. The county has about 250,000 residents.”

Brazil and Mexico representing over 1/3 of global deaths. Brazil is not reporting the amount of testing. Last data feed April 20th.

Brazil has surpassed NY peak on 7 day moving average (958). Mexico now above Belgium peak. India and Russia continue to rise.

Perhaps confirmation bias – but this article sums up the direction all the data is indicating to me – https://www.livemint.com/news/india/covid-may-never-go-away-even-with-a-vaccine-report-11590641440095.html

“There are four endemic coronaviruses that are present, causing the common cold

Experts believe that COVID-19 will become the fifth”

“amid all the uncertainty revolving around the contagion, the persistence of the novel virus is one of the few things we can count on about the future.”

“"This virus is here to stay," Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago was quoted as saying by Post. "The question is, how do we live with it safely?"

“"People keep asking me, ‘What’s the one thing we have to do?’ The one thing we have to do is to understand that there is not one thing. We need a comprehensive battle strategy, meticulously implemented."

“many experts believe this COVID-19 could become relatively benign, causing milder infections as our immune systems develop a memory of responses to the virus. However, that process could take a long time, said Andrew Noymer, a University of California at Irvine epidemiologist.”

“experts believe that people won’t make the shift toward long-range thinking up till the infection spreads more widely and affects someone they know. "It is like people who drive too fast. They come upon the scene of an accident, and for a little while, they drive more carefully, but soon they are back to speeding again," said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

"Contrast that with people who have lost someone to drunk driving," he said. "It mobilizes them and becomes a cause for them. Osterholm continued saying that everyone is eventually going to know someone who got infected or died from it and "that’s what it may take.””

No different to business strategy and changing technology the key roadblock is the human aspect of it – change management. The LONG RANGE thinking for covid-19 I keep alluding to is our ability to recognize what we feed ourselves each day can and will have a long term impact. We can make better decisions in the near term to our diets which will benefit us for the long run. Unlike all other diseases they take a lot more time to show their impact as a result of our poor diet choices, covid-19 is making it more apparent that one needs to be more cautious on what you feed yourself. The government should step in and regulate our vices of choosing poor food. The data is quite apparent IF you are healthy the odds of fatality shrinks to nearly zero. I would throw another hypothesis – the healthier you are the increase likelihood of being asymptotic/mild symptom. I hope to find the data to prove or disprove this, but IF true who wouldn’t want to be asymptotic to mild symptoms if you caught covid.

Though I do believe the virus is generally spread through the air not contact – it doesn’t mean you should not be worried about surfaces. The ability of the immune system to fight off covid would likely be improved if not fighting off multiple infections.

Brazil set another record – they are now the leader of daily confirmation 20599 – death 1086. US death back up at 1505 – now over 100K deaths in US.

NY once again the leader for the US at 182

County view – we got a flare up in Buena Vista County Iowa red dot in the middle of the map on the confirmation (7 Day MA Confirmation: 430). Looks like a from a pork and turkey plant – https://siouxcityjournal.com/news/local/state-and-regional/buena-vista-county-expecting-jump-in-covid-19-cases/article_1720dd2c-cc40-5d0d-bec0-709b3fe06427.html

“Tyson spokeswoman Liz Croston did not say how many of the 3,100 workers at its Storm Lake pork and turkey plants have previously tested positive for the virus.”

This highlights our food choice also has an impact on others. Driving margins have lead to unhealthy working conditions to many in our food supply chain.

“You have just dined, and however scrupulously the slaughterhouse is concealed in the graceful distance of miles, there is complicity.” Ralph Waldo Emerson

The positive thing many of these food processing facilities the fatality rate has been low (0.4%). https://www.cdc.gov/mmwr/volumes/69/wr/mm6918e3.htm

Even though many headlines note states are open – there are still restrictions. This shows the relative OPEN the states are. Ohio more open than TX now.

US tested almost 4.5% of the population. Mexico and Brazil big piece of the daily death pie.

Brazil now the highest 7 day moving average death vs. all the countries and US states in the complete time series. The only good news for Brazil there are signs of some plateau – but this would indicate 2X+ current death level.

Another opportunity to calc. fatality rate for 65 and under per the testing occurring in Salt Lake, Utah https://www.ksl.com/article/46757474/antibody-testing-shows-many-utahns-had-covid-19-but-did-not-know-it-results-higher-because-of-self-selection

“the rate for those who test positive for COVID-19 antibodies in two communities, after two days of testing, is more than twice that rate at 11%.”

Utah breaks out cases by age – https://coronavirus.utah.gov/case-counts/

Salt Lake County Stat

Currently the stats above show a 1.5% fatality rate (69/4632). However we do have enough to compute the <65 infected.

Utah unlike other states and counties do not break out deaths by age – but we have this article noting over 90% death > 65 https://www.deseret.com/utah/2020/5/11/21254629/pandemic-coronavirus-90-percent-of-covid-19-deaths-in-utah-over-age-65-officials-say

“More than 90% of COVID-19 deaths in Utah over age 65, officials say”

This is almost half of LA and NY county that we calculated before. Same disclaimer as before this does not mean getting covid-19 doesn’t come with long term issues – but the odds of dying when young – even with comorbidities is near zero. If you are healthy and young likely 0.

Of course I suspect this and all the antibody test will be discredited via a garbage headline article like this – https://edition.cnn.com/2020/05/26/health/antibody-tests-cdc-coronavirus-wrong/

“Antibody tests for Covid-19 wrong up to half the time, CDC says”

No CDC does not say it like that – https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antibody-tests-guidelines.html

“For example, in a population where the prevalence is 5%, a test with 90% sensitivity and 95% specificity will yield a positive predictive value of 49%.”

CDC says AN EXAMPLE….IF you use a bad test you get bad results – no duh??

Lets go look at the test available and their efficacy – https://www.fda.gov/medical-devices/emergency-situations-medical-devices/eua-authorized-serology-test-performance

I would go with the Roche or Ortho-Clinical which is near 100% for sensitivity and specificity. The worse on the list is Chembio 77.4% and 87.1% respectively. But to put a headline like the above is just not right. Clearly its important to use devices that work well no matter what you are doing – particularly when health is on the line. I would hope most govt testing places are using the better devices vs. the inferior ones. IF CNN could have done more investigated journalism and identified the test used in the various antibody cases perhaps they could be right in their statement but I am not inclined to believe all these test places decided to use a Chembio test or the like.

Impact of media and sensationalism is real – https://www.theguardian.com/world/2020/may/25/who-world-health-organization-hydroxychloroquine-trial-trump-coronavirus-safety-fears

“The WHO’s director-general Tedros Adhanom Ghebreyesus said in light of a paper published last week in the Lancet that showed people taking hydroxychloroquine were at higher risk of death and heart problems than those who were not, it would pause the hydroxychloroquine arm of its solidarity global clinical trial.”

As noted in the study we are talking about 3.7% of those who had heart issue while taking HCQ. This was also NOT a study but a big data exercise. This article does try to balance the hype by noting a rebuttal at the end.

“A controversial French doctor who has promoted the use of hydroxychloroquine and chloroquine for coronavirus said on Monday he stood by his belief the drugs could help patients recover. He also rejected the Lancet study of the records of 96,000 patients across hundreds of hospitals.

“How can a messy study done with ‘big data’ change what we see?”, Prof Didier Raoult asked in a video posted on the website of his infectious diseases hospital in Marseille.

“Here we have had 4,000 people go through our hospital, you don’t think I’m going to change because there are people who do ‘big data’, which is a kind of completely delusional fantasy,” he said.”

We have a new leader of daily death – Brazil 1039…US 693…Mexico 501

NY is leading US deaths again but under 100 – only 73

Looks like Cook County IL coming down. LA county still is hot spot. Zooming into the NE you can see the dark red of NYC.

Opening states so far not showing much issue in terms of death – in fact down. Confirmation are staying flat – expected growth.

Brazil and Mexico shows no sign of abating.

Brazil is a clear outlier now. Mexico is right behind. India and Russia are both climbing steadily in daily deaths.

A very promising option for testing – an actual leading indicator –

https://www.medrxiv.org/content/10.1101/2020.05.19.20105999v1.full.pdf

“We produced a SARS-CoV-2 RNA concentration time course in primary sewage sludge

during a COVID-19 outbreak in the New Haven, CT metropolitan area. Approximately 200,000

people are served by the treatment facility and COVID-19 total documented cases by testing rose

from less than 29 to 2,609 during the March 19 to May 1, 2020 surveillance period. Our results

demonstrate: (1) the utility of SARS-CoV-2 primary sludge monitoring to accurately track

outbreaks in a community and (2) primary sludge SARS-CoV-2 RNA concentrations can be a

leading indicator over other commonly used epidemiology approaches including summarized

COVID-19 test results and hospital admissions.”

“Within the US, approximately 16,000 treatment plants serve more than 250,000,000 people.”

“Jurisdictions can use primary sludge SARS-CoV-2

concentrations to preempt community outbreak dynamics or provide an additional basis for

easing restrictions, especially when there are limitations in clinical testing. Raw wastewater and

sludge-based surveillance is particularly useful for low and middle-income countries where

clinical testing capacity is limited.”

Not only can sewage plants be used to understand the trend in Covid but one could also at least use them to isolate areas/region to allocate more precise testing. This is something they could not do in 1918 – lets be more advance!

US deaths amazingly low but likely due to holiday – 500. Brazil 807

NY leads again with 88. CA leading the way for confirmation.

County view showing the growth in S. Ca and Cook County. For death view besides NYC region – Cook County IL and NV (Washoe and Clark) and LA CA are the prominent ones.

On a global map of death per capita – one can see Sweden sticking out to neighbors – plus Portugal sticking out on the positive end. Many articles discussing Portugal and their ability to quarantine with much less cases vs. Spain. Spain revised death down by almost 2K – not sure what lead to that.

France is dropping quickly in deaths. UK is still gliding down. Brazil and Mexico continue to climb. Russia death has quietly climbed to be higher than Italy – higher than Belgium peak daily death.

Big day – US is not the #1 reporting death country – the dubious record goes to Brazil (653). Russia deaths relatively high 153.

NY back in the lead at 110

Hospitals in open states seem to be fair. At some point if you don’t utilize the ICU you over invested and not appropriately utilizing your assets.

Brazil is now second place in terms of the amount of confirmation even though they have barely tested.

Brazil leading the 7 day MA daily death chart. India and Mexico climbing

Time to do a data delv….

Below is a plot of 300+ deaths area where the US states are broken out as individual countries. Sorted by fatality rate. So we are looking to see if there is a “better” treatment option – not focused on a containment option which would be sorted by confirmation related data not deaths.

The lowest is Saudia Arabia and Russia next – with the worse being Belgium, France, Italy, UK, and Hungary.

Saudi Arabia does have the advantages of age – but suspect population density is skewed as we covering a lot of deserts. I need to get a data source for population density by city by country – nonetheless likely in the middle of the pack here. Still we have plenty of countries younger or very close who are doing a lot worse Mexico, Algeria, Phillipines, Egypt, S. Africa. India, Peru, etc…

What is Saudi Arabia treatment plan? https://www.moh.gov.sa/Ministry/MediaCenter/Publications/Documents/MOH-therapeutic-protocol-for-COVID-19.pdf

PCR with mild-moderate symptoms -hmmm but in the US we ridicule and crush the use of HCQ?

PCR with severe symptoms – ….note the bold no HCQ

PCR with Critical symptoms – no HCQ – but now Remdesivir is showing as a recommendation. Tocilizumab is also showing up. https://health.ucsd.edu/news/releases/Pages/2020-04-29-arthritis-drug-presents-promise-as-treatment-for-covid-19-pneumonia.aspx

“…marketed as Actemra, is an immunosuppressive drug used primarily to treat rheumatoid arthritis and systemic juvenile idiopathic arthritis, a severe form of the disease in children. The monoclonal antibody-based therapy works by blocking cellular receptors for interleukin-6 (IL-6), a small protein or cytokine that plays an important role in triggering inflammation as an early immune response to disease. “

Well to each their own on drawing up conclusions from the presentation of data. I hope we haven’t grown so bureaucratic that we lost sense of doing what is right and not politicizing everything.

NY looks to be working on a “mechanical” solution – https://www.cbsnews.com/news/new-york-city-subway-ultraviolet-light-coronavirus-mta/

“New York City will be testing out ultraviolet lamps that can kill the coronavirus on subways and buses. The Metropolitan Transit Authority (MTA) announced that the $1 million pilot program will begin its first phase on some subways, buses and other facilities early next week.

About 150 dual-headed mobile devices from Denver-based startup Puro Lighting will be deployed at stations and rail yards to see how effective the UVC technology is in those settings, the MTA said. After evaluation, a second phase will expand to the Long Island Rail Road and Metro-North commuter lines.”

I still think they probably need to check out the ventilation system and see if they can draw more fresh air as it seems to not be a contact issue but a viral load issue in the air.

US deaths 1108….Brazil down under 1K 965 – but it is the weekend….France reporting 0 deaths

Once again NY leading the pack (178)….seriously think something went very wrong in NY. There are lots of discussion with Cuomo requirement of nursing homes taking Covid patients. Obviously in hindsight this was not a good idea. Not sure on the initial logic will have to investigate that if time permits.

Deaths are actually falling in the opening states while confirmation holding steady – evolution of treatment?

Still Brazil and Mexico are likely not even halfway done

I have read Brazil has hot spots of death – which would be similar to the US issue with NY.

Interestingly two major reports get published for the long weekend read.

Remdesivir report – https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

The conclusion as stated by the report:

“Remdesivir was superior to placebo in shortening the time to recovery in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection.”

Key points in the study not highlighted but are key takaways

“We conducted a double-blind, randomized, placebo-controlled trial of intravenous remdesivir in adults hospitalized with Covid-19 with evidence of lower respiratory tract involvement.”

Wow – a real study….no back casting statistical magic! Incredible it can be done so quick…

“Serious adverse events were reported for 114 of the 541 patients in the remdesivir group who underwent randomization (21.1%) and 141 of the 522 patients in the placebo group who underwent randomization (27.0%).”

“These preliminary findings support the use of remdesivir for patients who are hospitalized with Covid-19 and require supplemental oxygen therapy. However, given high mortality despite the use of remdesivir, it is clear that treatment with an antiviral drug alone is not likely to be sufficient.”

Author affiliation section – “Gilead Sciences,”

HCQ report – https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext

Conclusion as stated by the report:

“In summary, this multinational, observational, real-world study of patients with COVID-19 requiring hospitalisation found that the use of a regimen containing hydroxychloroquine or chloroquine (with or without a macrolide) was associated with no evidence of benefit, but instead was associated with an increase in the risk of ventricular arrhythmias and a greater hazard for in-hospital death with COVID-19.”

Some takeaways immediately from the summary – NOT a study – another math game.

FYI Macrolide: One in a class of antibiotics that includes Biaxin (Clarithromycin), Zithromax (Azithromycin), Dificid (Fidoximycin), and Erythromycin. The macrolides inhibit the growth of bacteria and are often prescribed to treat rather common bacterial infections.

Two major objectives of the study:

“The primary outcome of interest was the association between use of a treatment regimen containing chloroquine or hydroxychloroquine (with or without a second-generation macrolide) when initiated early after COVID-19 diagnosis with the endpoint of in-hospital mortality. The secondary outcome of interest was the association between these treatment regimens and the occurrence of clinically significant ventricular arrhythmias (defined as the first occurrence of a non-sustained [at least 6 sec] or sustained ventricular tachycardia or ventricular fibrillation) during hospitalisation.”

Still no Zinc combo in the study even though this is what has seemed to be prescribed to those promoting it. And we do have a science journal showing the HCQ ability to allow for better absorption ionic zinc.

Table 1 shows a list of survivors and non survivors and the corresponding stat and %. IN GENERAL the two columns are close except for the following

DON’T BE OBESE – 60.9% of non survivors are obese.

Heart disease, diabetes,hypertension are other issues to concern yourself.

This part of table 1 is very interesting which I presume is where they are drawing the conclusion of HCQ failed

And outcomes show don’t get on ventilator….

Having this ventricular arrhthmia is associated 3.7% of those not surviving! This is the big second conclusion? the concern of the 3.7% of the non surviving group? This is the side effect that HCQ could cause.

Once again 53 Million+ people have taken HCQ – here is the advisory report from CDC to recommend those going to certain countries to take HCQ — https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/Hydroxychloroquine.pdf No mentioned of heart issues – now perhaps the extension is with this particular virus with HCQ is causing this adverse reaction this perhaps could be the concern – but 3.7% in non survivor category and 1% in survivor category I would think there are bigger adverse reactions to concern about – note remdesivir 21% serious adverse reaction.

I do think the authors did a good job stating the limitations of the study but those who want to see a certain thing will not even note the limitations.

“Our study has several limitations. The association of decreased survival with hydroxychloroquine or chloroquine treatment regimens should be interpreted cautiously. Due to the observational study design, we cannot exclude the possibility of unmeasured confounding factors, although we have reassuringly noted consistency between the primary analysis and the propensity score matched analyses. Nevertheless, a cause-and-effect relationship between drug therapy and survival should not be inferred. These data do not apply to the use of any treatment regimen used in the ambulatory, out-of-hospital setting. Randomised clinical trials will be required before any conclusion can be reached regarding benefit or harm of these agents in COVID-19 patients. We also note that although we evaluated the relationship of the drug treatment regimens with the occurrence of ventricular arrhythmias, we did not measure QT intervals, nor did we stratify the arrhythmia pattern (such as torsade de pointes). We also did not establish if the association of increased risk of in-hospital death with use of the drug regimens is linked directly to their cardiovascular risk, nor did we conduct a drug dose-response analysis of the observed risks. Even if these limitations suggest a conservative interpretation of the findings, we believe that the absence of any observed benefit could still represent a reasonable explanation.”

On the other side of the world in India we have – https://theprint.in/health/hcq-breakthrough-icmr-finds-its-effective-in-preventing-coronavirus-expands-its-use/427583/?

“Three studies find that hydroxychloroquine reduces chances of contracting Covid, so ICMR allows more frontline workers to take it as a preventive drug.”

“National Institute of Virology in Pune has found in laboratory testing that HCQ reduces the viral load.”

“ICMR also analysed data collected previously, known as retrospective case-control analysis, and found “a significant” relationship between “the number of doses taken and frequency of occurrence of Covid-19 infection in symptomatic healthcare workers who were tested for SARS-CoV-2 infection”.”

“Another observational study was conducted among 334 healthcare workers at the country’s largest public hospital, New Delhi’s All India Institute of Medical Sciences (AIIMS). The 248 workers who took HCQ as preventive drug for an average of six weeks had lower incidence of the infection than those not taking the pill.”

“The ICMR had earlier announced that some side effects, such as abdominal pain and nausea, have been observed in healthcare workers who were administered HCQ.”

As noted by the CDC!

“The anti-malaria drug is often blamed for triggering irregular heartbeat.

However, in the final results of the studies (HCQ prophylaxis among 1,323 healthcare workers), the ICMR found mild adverse effects such as nausea in 8.9 per cent workers, abdominal pain in 7.3 per cent, vomiting in 1.5 per cent, low blood sugar (hypoglycaemia) in 1.7 per cent and cardio-vascular effects in 1.9 per cent.

The advisory states the drug should be discontinued if it causes the “rare” side effects related to the heart, such as cardiomyopathy, a disease which makes it harder for heart to pump blood to the entire body, and heart-rate disorders.

The advisory mentions that HCQ, in rare cases, can cause visual disturbance, including “blurring of vision, which is usually self-limiting and improves on discontinuation of the drug”.

ICMR has clarified that “for the above cited reasons — heart and vision — the drug has to be given under strict medical supervision with an informed consent”.

Once again I doubt HCQ is some all encompassing solve all case drug given all the data – BUT to exclude it for a physician choices of treating their patient in some combination is highly concerning to me. The risk is very limited considering cost as part of the risk equation vs. a drug who is 1000X the cost and has 21% serious adverse reaction plus shown to only help in reducing timing – mortality reduction is not statistically valid… Things that make you go hmmmmmm

US 1277 – Brazil 1001 – they better start doing something there it is not looking good for them.

PA (141) took the lead from NY (139)

So far nothing to report in the opened states in May – so far looks fine.

Hoping the testing data for Brazil is stale.

Brazil has surpassed Spain 7 day MA daily death peak. France is taking a big dive down.

Busy today trying to find detail information on county level and mapping with antibody testing as the fatality rates for under 50 in NY are quite low. Once again I would caution to not consider death as the only issue as lifetime of feeling weak or not 100% is something to consider. This part of the equation is yet unknown.

The best so far I have found in Los Angeles County – they have a great dashboard – unfortunately it is not open to DB access – so I had to manually pull the data.

http://dashboard.publichealth.lacounty.gov/covid19_surveillance_dashboard/

In combination with – https://news.usc.edu/168987/antibody-testing-results-covid-19-infections-los-angeles-county/

Results:

Now I still wasn’t able to remove comorbidity deaths to see IF you were under 65 and healthy what could this mean to you…..I suspect it would make the numbers much lower! Eerily similar to NY result on the Avg – note NY was under 50 (0.09%)

Stay tune as we search the net for more specific data but so far being young (this case under 65) and healthy and you will be a good spot beyond the obvious….still wear a mask!… go outside…eat healthy…take vitamin C and D..zinc occasionally….and your odds will approach zero in terms of fatality at relative little cost and great rewards. Trust me being healthy gives you more reward than avoiding covid deaths ?

I am a big time buyer of there is a mechanical mitigation mechanism to reducing covid contagion that is not extremely costly or complex. The study with a 14.5 hour flight and no infection gives me hope – it does look that airplanes do recirculate air but no more than 50% – https://www.ncbi.nlm.nih.gov/books/NBK143720/

First step are being proposed by REHVA is The Federation of European Heating, Ventilation and Air Conditioning associations founded in 1963. – https://www.rehva.eu/activities/covid-19-guidance

You can see their main focus is to push for 100% outdoor air units. Now this is not always available or perhaps ideal due to humidity hence I see a system that mixes more fresh air and some recirculation with UV might be the answer.

“Would you recommend the installation of UV air treatment systems or ionisation units in an existing air handling unit (AHU), given that they won’t increase pressure losses?

Answer

Such installations (UV systems, ionisation units etc.) are more relevant for healthcare facilities. REHVA guidance targets common non-residential buildings and in this case, outdoor air is NOT a contamination source. Therefore, UV-treatment of outdoor air in air handling units is not necessary. This is the reason we do not recommend UV-applications.”

US daily death fell some 1263….however Brazil (1188) is not looking good and there are only signs it will get worse same for Mexico….

NY leader but at only 107…IL leading the way in confirmation.

The open states since May – Ex-Il as IL probably needs to do something as there were not good signs to begin with to be opening up. Currently no major trend changes.

As noted before opening is very subjective – this is a measure of opening and you can see even Texas is not rated as 100% open.

Brazil has still barely tested similar to Mexico. IF you don’t test you cant figure out where you need to focus and contain.

Brazil has now topped Italy peak and no sign of stopping next Spain then Italy then NY…..Mexico is topping Belgium.

Looks like the NY county death pull is rolled up into 1 for NYC – into NY county. We will work with the source data to rectify this. In the meantime the new correction for fatality rate for NYC below assuming 20% infection per the antibody study.

20934/(8.4 Million x 0.2) =1.2%

Therefore IF you were to get confirmed in NYC your chances of death is 1.2%. Once again this is not age adjusted. IF we age adjust it and ASSUME all deaths under 50 in NYC then

https://covid19tracker.health.ny.gov/views/NYS-COVID19-Tracker/NYSDOHCOVID-19Tracker-Fatalities?%3Aembed=yes&%3Atoolbar=no&%3Atabs=n

(815+307+85+10+4)/(8.4 Million x 0.757(%pop under 50) x 0.2)=0.09%

Under 50 in NYC who get confirmed for every 1000 1 may die.

The CDC has updated its site – and is leaning towards my latest hypothesis in that the spread is not likely from contact. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

“The virus spreads easily between people

How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious, like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, which means it goes from person-to-person without stopping.

The virus that causes COVID-19 is spreading very easily and sustainably between people. Information from the ongoing COVID-19 pandemic suggest that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious.

The virus does not spread easily in other ways

COVID-19 is a new disease and we are still learning about how it spreads. It may be possible for COVID-19 to spread in other ways, but these are not thought to be the main ways the virus spreads.

From touching surfaces or objects. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about this virus.

From animals to people. At this time, the risk of COVID-19 spreading from animals to people is considered to be low. Learn about COVID-19 and pets and other animals.

From people to animals. It appears that the virus that causes COVID-19 can spread from people to animals in some situations. CDC is aware of a small number of pets worldwide, including cats and dogs, reported to be infected with the virus that causes COVID-19, mostly after close contact with people with COVID-19. Learn what you should do if you have pets.”

This is a good thing as then it means just because someone was sick in a room that room is not necessarily completely contaminated e.g. elevator. However IF the person is in the room with you for an extended time period that’s another issue.

This article support Dr. Kory testimony – https://nationalinterest.org/blog/reboot/coronavirus-blocking-deadly-cytokine-storm-key-treating-virus-156086

“The killer is not the virus but the immune response.”

“Cell death – a chess game of sacrifice

I study inflammatory response and cell death, which are two principal components of the innate response. White blood cells called macrophages use a set of sensors to recognize the pathogen and produce proteins called cytokines, which trigger inflammation and recruit other cells of the innate immune system for help. In addition, macrophages instruct the adaptive immune system to learn about the pathogen and ultimately produce antibodies.

To survive within the host, successful pathogens silence the inflammatory response. They do this by blocking the ability of macrophages to release cytokines and alert the rest of the immune system. To counteract the virus’s silencing, infected cells commit suicide, or cell death. Although detrimental at the cellular level, cell death is beneficial at the level of the organism because it stops proliferation of the pathogen.”

“Here’s how an overreaction from the immune system can endanger a person fighting off an infection.

“Some of the proteins that trigger inflammation, named chemokines, alert other immune cells – like neutrophils, which are professional microbe eaters – to convene at the site of infections where they can arrive first and digest the pathogen. Others cytokines – such as interleukin 1b, interleukin 6 and tumor necrosis factor – guide neutrophils from the blood vessels to the infected tissue. These cytokines can increase heartbeat, elevate body temperature, trigger blood clots that trap the pathogen and stimulate the neurons in the brain to modulate body temperature, fever, weight loss and other physiological responses that have evolved to kill the virus.

When the production of these same cytokines is uncontrolled, immunologists describe the situation as a “cytokine storm.” During a cytokine storm, the blood vessels widen further (vasolidation), leading to low blood pressure and widespread blood vessel injury. The storm triggers a flood of white blood cells to enter the lungs, which in turn summon more immune cells that target and kill virus-infected cells. The result of this battle is a stew of fluid and dead cells, and subsequent organ failure.”

“Inhibition of tumor necrosis factor can be achieved with FDA-approved antibody drugs like Remicade or Humira or with a soluble receptor such as Enbrel (originally developed by Bruce Beutler) which binds to tumor necrosis factor and prevents it from triggering inflammation. The global market for tumor necrosis factor inhibitors is US$22 billion.

Drugs that block various cytokines are now in clinical trials to test whether they are effective for stopping the deadly spiral in COVID-19.”

Not sure why he didn’t discuss just using steroids as Dr. Kory suggested – perhaps no $? – 2001 study – https://pubmed.ncbi.nlm.nih.gov/11447379/

“Conclusion: These studies indicate that prednisone suppresses multiple components of allergic airway inflammation, including cell recruitment, adhesion molecule expression or release, airway permeability, and production of cytokines potentially involved in airway immunity or remodeling.”

This reports conclude infected New York rates 20+% – https://www.usnews.com/news/national-news/articles/2020-05-20/new-york-expands-coronavirus-testing-as-state-identifies-hot-spots-in-new-york-city?

“Antibody tests of approximately 8,000 people in New York City revealed an infection rate highest in the Bronx borough of New York City. While the overall positive rate is 19.9% for the city, the Bronx has a positive rate of 34%. Brooklyn has a rate of 29% and Queens has a rate of 25%. Rates in the Manhattan and Staten Island boroughs are 20% and 19%, respectively.”

This would drop the fatality rate down to around 6% vs 11% for NYC.

HCQ preliminary results in India https://m.timesofindia.com/city/mumbai/toll-climbs-to-9-cops-on-hcqs-spared-the-worst/amp_articleshow/75845670.cms?

“Around 10,000 policemen over the age of 40 years were to be given the drug, hydroxychloroquine sulphate (HCQS), which was cleared by the ICMR as a drug with the potential to prevent a novel coronavirus infection. “However, only 4,500 of the policemen are taking the medicine diligently,” said Dr Sanjay Kapote of Apollo Clinics, who arranged for the tablets and their distribution across the police stations.

…toll of police personnel who have died in Mumbai in the last 25 days to nine. Meanwhile, on Tuesday, an assistant commissioner of police from the western suburbs tested positive for Covid-19 and has been hospitalised. Three officers attached to Samta Nagar police station in Kandivli (E) have also tested positive.

Dr Kapote said there was no mortality among the 4,500 policemen who took HCQS in Mumbai. “Although some in this group have contracted Covid, they had a mild attack,” he said.”

Evolution – https://www.independent.co.uk/news/wuhan-china-coronavirus-ban-wild-animals-eating-wildlife-trade-markets-a9524606.html?

“Authorities in Wuhan, the epicenter of the coronavirus pandemic, have officially banned the eating of all wild animals”

US deaths 1518. Brazil (876) and Mexico (424) continue to show high death numbers.

Once again NY is the leader at 162 – but IL,PA, MA not far behind.

Interesting to see the 4 corners area of AZ and NM showing up on the county view.

Brazil and Mexico are apparent in the daily death pie chart.

Brazil is about to pass Italy peak 7 day MA death change. Brazil likely over 30+K deaths.