CharonY

There is a difference between let's conduct a trial to see if it works vs. "just ask your doctor to take it. I think it works." One is following procedure and creating scientific evidence. The other one is pushing gut feeling.

The suppression of free speech by the Chinese government is definitely wrong. However, I am skeptical regarding large-scale misinformation for several reasons. The biggest one is that one strictly follows the data, everything we learned from China so far largely lines up with models with data from other countries. For example, if they were covering up deaths, by now we would see an unexplained shift in fatality rates outside China, but that does not seem to be the case. They did change the reporting several times, including not counting asymptomatic cases as infected, but it kind of makes sense from a clinical viewpoint, as they isolated all cases but treated symptomatic and asymptomatic cases differently (and moved the former to the latter category once symptoms manifested, it is an inelegant way to avoid double counting). But all it did was to increase the published death rate. So if there is huge cover-up of sorts, it is unclear what they hid, as at least on the scientific side of things regarding the virus nothing has fundamentally changed in our understanding.

The issue there is that the WHO cannot force countries to run their health system in a specific way. Even a single country might report things differently in each province/state/ prefecture. Taiwan had a task force from the SARS days that spring into action. South Korea quickly assembled one. Likewise Singapore. One could have emulated them (or not weakened ones own pandemic response team, for example).

Ultimately we don't know yet. It is atypical to many other respiratory diseases, but a working hypothesis is that it is because children do not mount cytokine storms. Another one is that symptoms are amplified by accumulated lung injuries/damages and that younger folks just have healthier lungs.

Exactly. Children are likely asymptomatic carriers and generally live with folks that are older...

Well from what I have seen the US has been heavily pushing the anti-Chinese narrative and China has responded in kind. Both are crap, but I am not sure whether the saying actually fits well here.

No, not the messing up things. I was more referring to the narrative that they deliberately hid things knowingly. I.e. they knew that they had a spreading disease on their hands and decided to suppress that. The USA also messed things up, but after having all the information that China at that point didn't have. So even without the expectation that the US would have reacted better under the same circumstances, I certainly expect them (or anyone else) to react better with the knowledge at hand. To make the wrong steps based on structural issues in a situation with incomplete information is different from choosing to take the wrong steps when presented with all the information. That is perhaps also a part of it. As long as medical professionals have to work within a system that has strong political influence, it is somewhat expected to have slower reaction times and more mismanagement. The US used to be (much) better in that regard.

I would agree with the the fact that China should not engage in public mudslinging and I am more than dismayed on their attempt to create a new narrative. I do think their failures were structural ones where medical advice was not shielded from political meddling combined with secrecy creating a recipe for disaster that could have ended far worse. That being said, there is at least some level of plausible deniability based on a mix of incompetence, awful reporting structure and error of judgement in an somewhat unknown situation. The US has none of these excuses. And at least the machinery started moving once they were past that point. According to NYtimes reports apparently the Chinese CDC really got memos regarding clusters of unexplained cases of pneumonia by Dec. 30 on 31st a team was dispatched to Wuhan, concurrent with notification of the WHO. The cases that were circulating were only then finally entered into a system that was part of a pandemic warning system (around Jan 3rd). The initial assessment before they were certain that a new disease was in circulation was finished by the 19th and on the 23rd the province was shut down. In-between (on the 12th) Chinese researchers released the full sequence of the virus. So somewhere around that point, the world knew what was coming. While responses have been slow and halting in many parts outside Asia, the US was one of the few Western countries who were still in active denial deep into the process with some first moves being done sometime in March, way after Italy was hit badly. With regard to the WHO, not sure what they could have done much better. When they raised alarm regarding SARS they were criticized for damaging the economy. In the link above there is a report on the payment status March 31st. And from it it looks like that in their balance 31-Dec-19 was 71mill and only 29 was collected leaving 41 mill as outstanding from their previous balance. Maybe they have paid it since then. China has an outstanding bill for 2020 but paid for 2019. From a quick look it appears that only few countries had outstanding bills for that year (most in the Middle East, from the looks of it). But again, the commitment does not seem an arbitrary pledge, rather it appears to be something that is based on agreement of its member states.

No, if one is infected but e.g. with such a low amount that the body did not build up memory, a vaccine that triggers a stronger response can be beneficial. However, a person that has been exposed to sufficient viruses and/or vaccine would mount a faster and stronger response once the virus pops up again and thereby have a higher likelihood to clear the virus before it actually manages to go into hiding.

And even with the missteps and structural issues in China, at least they had the excuse that it was a new disease that they had to identify and develop a diagnostic tool against. Once they decided to move, it was incredibly fast (the scientific side of things) and perhaps needlessly harsh. But a few months in, seeing all that is happening and virtually no response is something else entirely. As I have stated before, the CDC is usually on top of these things and if they were the ones handling it without interference, I would think that if the outbreak was in the US, the outcome would have been better. Yet seeing what the current administration has done (or rather not done), I am not so sure.

It is quite a bit more complex than that but it would require a lengthier explanation. Simply put is that while adaptive (as well as innate) responses can clear infections, obviously. However, at the same time pathogens have mechanisms that can delay or evade responses. Viruses replicate intracellularly, so once they managed to get into cells, they can remain hidden until the cells produces viral particles. There are also various strategies that keep those particles hidden from the host for longer. Simply speaking, if there are only few particles around who are not slipping into cells yet the immune system can clear them. But it is essentially a race between how well the virus hides and replicates vs the immune system finding viruses and infected cells.

That is my assumption as well. There is currently a concerted effort to blame China and WHO for all the mismanagement that happened in the US.

The membership fees are calculated based on wealth and population of the country (I do not know the exact formula, though). I.e. it is a share that the nations agreed on and where the USA decides to break the agreement for PR reasons. It should be noted that the USA has not paid its last membership fees, either (whereas China apparently has). https://www.who.int/about/finances-accountability/funding/assessed-contributions/en/ It does seem that Trump is indeed running the US like one of his companies. And that is not a good thing.

Oh I am sure he just needs to blame it on Obama and he is golden.

No, evolution in the technical sense does not apply here (evolution is a process describing gene pool changes within a population over generations). The adaptive response needs the target from the virus (or something identical you synthesize using the genetic code of the virus) .

I am not sure what you mean here. Perhaps some clarifications (in case that is the issue). An antigen is basically any substance to which antibodies can bind to. Once antibodies bind to the foreign substance they can eliminated following a number of pathways. An artificial antigen would essentially be the same protein (or parts of it, technically you just need a good epitope) but synthesized in vitro, rather than taking a virus and take fragments of it. However, the structure and sequence would identical to the real thing (for the biding site) in order to work.

After SARS folks started working on therapeutics and vaccines. However, quite a few studies were ended or stopped once it became clear that SARS appeared to be fairly contained, so research funding stopped or was severely reduced. The clinicals are the expensive bit so often if money is lacking, they do not continue. The good news is that current therapeutics in pipelines are often based on previous data collected on SARS-CoV or other coronaviruses. Otherwise the start would be much slower. It depends on what is being the antigen. Often folks concentrate on essential proteins such as the spike protein as if that one changes significantly, the virus may have a harder time to infect. These essential proteins are therefore often conserved (which means that the amino acid sequenece of the proteins is going to change less than non-conserved proteins).

There are several mechanisms, including the courts, senate and house. You have seen what happened during the impeachment trial, for example, which would be the ultimate policing action against the president.

No doubt, trying things on the fly and in the middle of an emergency is not something take lightly. There will be an urgent need for mental health care. That is not the reason per se, as obviously in both RNA and DNA viruses the genetic material needs to be amplified and both can incorporate errors. There are a few mechanisms, such as polymerases, exoribonucleases and other enzymes that may proofreading functions and thereby reduce mutations. Coronaviruses have such functions and therefore have a lower mutation rate compared to other RNA viruses and put them in the upper range of DNA viruses (~10^-7 - 10^-6 for SARS-CoV, I believe similar for SARS-CoV-2). The mutations are not necessarily in the spike protein, if that is what you are asking. Mutations are going to accumulate in areas that do not inhibit the ability of the virus to propagate. In fact, some of the mutations observed are "silent" meaning that the codon changes, but as a whole still codes for the same amino acid (this includes mutations in the spike and nucleocapsid genes). These mutations are unlikely to result in significant phenotypic differences.

Yes there were two studies I have seen, one showing modest effects, but again only in cases with mild symptoms (making it harder to assess whether it is useful, especially based on small cohorts), whereas the other one got a note that it is being on hold, not sure why yet.

Data from some compassionate uses of treatments are starting to come up. I do not the time to follow them closely, but the antiviral Remdesivir seems to show beneficial effects in a small cohort of 61 patients. The important bit here is that among the cohort were folks with stronger symptoms with 57% being on ventilators, and 8% even being on ECMO (in comparison hydroxycholoroquine, showed no beneficial effect for patients with such advanced symptoms). In 68% of the patients improvement in oxygen-support were detected. However, a controlled trial will be necessary to ascertain that these improvements are indeed due to the drug. The antiviral used for HIV/AIDS treatment (LPV/r) did not seem to show any benefits or at best very weak ones. For favipiravir one recently published study seems to be on hold, so no idea what the issue is there. But from another weak benefits were reported.

Certain key numbers, such as infectious doses are still missing for proper evaluation. The fairly low reproductive number is at least one hint that widespread airborne transmission is probably not a driving infections. That being said, it is not wrong to take precautions, of course.

That is not a case of reinfection (or at least that is not the assumption). Rather it is likely that the titer slipped below detection limit and then increased above in the specimen. This is especially likely when the levels hover near the limit of detection.

For the first part, it is certainly of interest to some, as a number of folks have collected the existing data. For the second, the issue is probably urgency. The data would need to be collected in situations that are currently overburdened and there are only limited capabilities to do additional testing. Once the situation winds down (as it has in China) I am sure folks will try to collect more data in general and figure out the relevance of co-morbidities. At the same time, folks are actually collecting as much data as they can. And again, often it means more work for medical staff as they need to collect the data, code it appropriately on top of the work they need to do. As with all research it often boils down to expected impact, available personnel and funding. Though for the latter, there is a lot of money injected into everything COVID-19 related.

Most tests require isolation of RNA. It is a bit difficult and requires a lab (not to mention the subsequent RT-PCR). Antibody based assays are coming but are not optimized yet, and most (that I know of) require lab conditions to yield accurate results. To make it possible for accurate (diagnostic) self testing, they need to be highly optimized and error proof. That takes time and is not a priority, considering that other tests are running low in many areas. I should add that there are lateral flow immunoassays, but they alone are not good for diagnosis of ongoing infections as the immunoresponse is not fully characterized yet. I.e. they may be good if there was a strong response, but a negative test will have uncertainties associated with it. Fundamentally self-tests are also prone to user errors, even with simple tests, which is why even well-established tests (e.g. pregnancy tests) usually require additional confirmation. Here, the uncertainty is higher.