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# COVID-19 outbreak (caused by SARS-CoV-2)

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25 minutes ago, Casio said:

Not having any understanding of this problem, which seems to be spreading according to the TV news (UK) my main concern (obviously) being me is to ask what is the likely chances of not being infected given that I work with three other UK individuals in a small business. We all live local and we deal with the public in reception each day but most are regular local customers. I've always had a salad lunch and a cooked meal for evening meal. I don't travel much anyway and most of the time stay local to where I live. Is there anything specific to watch out for?

Have a read of this Telegraph article: It gives a summary of the current situation and presently recommended actions:

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23 hours ago, John Cuthber said:

Through what mechanism?

Chloroquine might be getting new life as an antiviral treatment for the novel coronavirus that emerged in Wuhan, China in late 2019 and has infected some 25,000 people in more than 25 countries. For decades, the drug was a front-line treatment and prophylactic for malaria.

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10 hours ago, John Cuthber said:

The concentration of quinine in (modern) tonic water is tiny.

It's not nearly enough to influence malaria and it seems odd that it might treat a viral infection.

At least it will cause no harm, depending on what was mixed with it that is.

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2 hours ago, LaurieAG said:

At least it will cause no harm, depending on what was mixed with it that is.

Good point.

In my case it's generally mixed with gin.

Alcohol isn't going to help the immune system at all.

So a G&T probably isn't a good idea overall.

Having said that, I really hope quinine ( or chloroquine) works as a treatment for coronavirus.

It's cheap.

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VIRAL LOAD / HEALTHCARE WORKERS / LACK OF SLEEP COMPROMISING THE IMMUNE SYSTEM

Viral load, also known as viral burdenviral titre or viral titer, is a numerical expression of the quantity of virus in a given volume. It is often expressed as viral particles, or infectious particles per mL depending on the type of assay. A higher viral burden, titre, or viral load often correlates with the severity of an active viral infection.

A doctor on youtube posted about this the other day.  When examining the patterns of fatalities due to COVID-19, so far the WHO has reported that 4/5 patients suffer a mild infection, and then recover. (https://www.theguardian.com/world/2020/feb/17/coronavirus-causes-mild-disease-in-four-in-five-patients-says-who

Most of the deaths have been elderly patients or those with previously compromised immune systems.  Most of the young patients who have died have been healthcare workers on the front lines.  In fact the death rate so far is lower than SARS.

The doctor made the point that healthcare workers are working around the clock and not getting enough sleep.  This lack of sleep takes a massive toll on the immune system, preventing it from fighting the infection.  On the other hand, most young people who are not healthcare workers who contract the virus have time to properly rest and recover, letting their immune systems function adequately and eliminate the virus.

It seems this lack of sleep is a major contributing factor to the deaths of the young healthcare workers - i.e. the doctor who died this week). https://www.theguardian.com/world/2020/feb/21/coronavirus-kills-wuhan-doctor-hundreds-infected-china-prisons

I wonder if those who are locked in with their members family are similarly afflicted, due to the inability to get away from an infected environment.

Would appreciate the insight of someone with a degree in medicine.

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Did not see sleep deprivation cited as major factor in the linked Guardian article and in any case suggest caution in putting too much faith in Guardian.  But you are correct - sleep deprivation is certainly a factor affecting immune function - e.g. https://academic.oup.com/sleep/article/38/9/1353/2417971

"Locked in with" affected family members would expose one to the virus - not sure what this has to do with sleep deprivation.    If caring for family members disruptssleep - then we'd assume that would increase risk.

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8 hours ago, PhilGeis said:

Did not see sleep deprivation cited as major factor in the linked Guardian article and in any case suggest caution in putting too much faith in Guardian.  But you are correct - sleep deprivation is certainly a factor affecting immune function - e.g. https://academic.oup.com/sleep/article/38/9/1353/2417971

Sleep is the cornerstone of good health.  Great TED Talk by Matt Walker : "Sleep is Your Superpower" goes into detail.

8 hours ago, PhilGeis said:

"Locked in with" affected family members would expose one to the virus - not sure what this has to do with sleep deprivation.    If caring for family members disruptssleep - then we'd assume that would increase risk.

My point was that the different family members wouldn't be able to escape reinfection from those around them.  So in effect their immune system might rid the body partially of the virus only to have the viral load increased again by being around others (such as elderly parents or grandparents) who still carried it.   No doubt they would be in close proximity to each other, attempting to care for their siblings / parents etc, and thus continuously contracting the virus over and over again.

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11 hours ago, John Cuthber said:

It's cheap.

Unfortunately it is also toxic. According to Wikipedia:

"Common side effects include headache, ringing in the ears, trouble seeing, and sweating. More severe side effects include deafness, low blood platelets, and an irregular heartbeat. Use can make one more prone to sunburn. While it is unclear if use during pregnancy causes harm to the baby, use to treat malaria during pregnancy is still recommended."

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On 2/20/2020 at 9:07 PM, StringJunky said:

Have a read of this Telegraph article: It gives a summary of the current situation and presently recommended actions:

In fairness to what the above link says it is reasonable then to use common sense and keep clean, and ensuring that people with cold and flu like symptoms are kept at arms length.

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35 minutes ago, Casio said:

In fairness to what the above link says it is reasonable then to use common sense and keep clean, and ensuring that people with cold and flu like symptoms are kept at arms length.

Yes, basically.

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11 hours ago, Alex_Krycek said:

My point was that the different family members wouldn't be able to escape reinfection from those around them.  So in effect their immune system might rid the body partially of the virus only to have the viral load increased again by being around others (such as elderly parents or grandparents) who still carried it.   No doubt they would be in close proximity to each other, attempting to care for their siblings / parents etc, and thus continuously contracting the virus over and over again.

The main risk is getting infected in the first place, and being in close proximity to infected folks is a huge risk factor. However, overcoming an infection usually provides a level of immunity against the same pathogen a cycle of re-infection is rather unlikely. However, folks could be more susceptible to other infections.

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10 hours ago, CharonY said:

The main risk is getting infected in the first place, and being in close proximity to infected folks is a huge risk factor. However, overcoming an infection usually provides a level of immunity against the same pathogen a cycle of re-infection is rather unlikely. However, folks could be more susceptible to other infections.

Good point.  So what about viral load?   Obviously fighting the infection means reducing the viral load, until eventually the virus is eliminated from the body.

But what happens when A.) the body is struggling to fight the virus in the first place, and B.) the patient is continuously exposed to others with the virus (family members in close proximity), thus reintroducing the virus to the patient again and again, and thus not giving their body a chance to eliminate it.

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The viral load us generated by replication inside the host. Whatever additional is obtained externally is usually negligible at that point.

To put some rough numbers based on influenza, I believe the total exposure in presence of a patient for 8h was about 10E6 copies. The viral load of a patient was about 10E9 per ml, IIRC. Even if off by an order of magnitude, the difference is rather clear.

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Can some one, please, explain me (I am a forensic doctor) if the virus has a supposedly such low rate death (2% aprox. Some "experts" say that flu virus is much worst) WHY all this overreaction: cities isolated, army in the streets, people histerically escaping and so on?

Are they telling us the truth? Do they know something we don't know yet? Thanks a lot !

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5 minutes ago, Mike Tannenbaum said:

Can some one, please, explain me (I am a forensic doctor) if the virus has a supposedly such low rate death (2% aprox. Some "experts" say that flu virus is much worst) WHY all this overreaction: cities isolated, army in the streets, people histerically escaping and so on?

Read the thread.

Sorry, read this thread.

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I just came across a paper modeling infection numbers in Wuhan under a number of assumption regarding the effectiveness of control measures. They predict that assuming effective intervention, the peak could be reached by late February (with up to 84k cases). Or conversely, if a peak is not observed at that point it could indicate insufficient control to reduce the effective reproductive number.

(Wang et al. Cell Discovery 6:10 2020)

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8 hours ago, CharonY said:

I just came across a paper modeling infection numbers in Wuhan under a number of assumption regarding the effectiveness of control measures. They predict that assuming effective intervention, the peak could be reached by late February (with up to 84k cases). Or conversely, if a peak is not observed at that point it could indicate insufficient control to reduce the effective reproductive number.

(Wang et al. Cell Discovery 6:10 2020)

That may be the case for China but other area's may have their own separate peaks depending on their respective containment activities. I went to a Medical Center and a Chemist today and both had signs asking people who had a fever/cough and who had been to China in the past 14 days to contact the staff immediately on entry.

The John Hopkins University Data shows Total Confirmed: 80,147, total Deaths: 2,699, Total Recovered: 27,657 and the ratio of Recovered/Confirmed is currently 34.51%.

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15 hours ago, LaurieAG said:

That may be the case for China but other area's may have their own separate peaks depending on their respective containment activities.

Well, of course. The study was modeling spread in Wuhan using numbers from Wuhan...

There are also a few summary reports (e.g. Wu and McGoogan, Jama 2020):

Based on Feb 11 data on the Chinese cohort:

Quote

72 314 Cases (as of February 11, 2020)

• Age distribution (N = 44 672)

• ≥80 years: 3% (1408 cases)

• 30-79 years: 87% (38 680 cases)

• 20-29 years: 8% (3619 cases)

• 10-19 years: 1% (549 cases)

• <10 years: 1% (416 cases)

• Spectrum of disease (N = 44 415)

• Mild: 81% (36 160 cases)

• Severe: 14% (6168 cases)

• Critical: 5% (2087 cases)

• Case-fatality rate

• 2.3% (1023 of 44 672 confirmed cases)

• 14.8% in patients aged ≥80 years (208 of 1408)

• 8.0% in patients aged 70-79 years (312 of 3918)

• 49.0% in critical cases (1023 of 2087)

• Health care personnel infected

• 3.8% (1716 of 44 672)

• 63% in Wuhan (1080 of 1716)

• 14.8% cases classified as severe or critical (247 of 1668)

• 5 deaths

No deaths in those 9 or younger and no deaths among mild and severe cases. For a couple of days now the spread in China seems to be slowing; there are still new infections, but the number of cases reported as recovered is increasing, resulting in a net decrease of ongoing cases. It requires further monitoring, but if that trend continues the peak in Wuhan might be slightly lower than anticipated. On the other hand the question is how well containment will work outside of China. So far cases are still relatively low (compared to within China) but the occurrence of unsuspected cases has created worries about further spread.

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Just to add numbers: The city of Wuhan had the highest number of active cases on 02-18 with 50.6k active cases and last numbers indicate 43.3k. Cumulatively they are at 64.7k cases.

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The latest data from John Hopkins shows the rate of Confirmed Infections/Recoveries to be 37.04% (Confirmed: 80,994, Deaths: 2760, Recovered: 30,000).

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19 hours ago, CharonY said:

Just to add numbers: The city of Wuhan had the highest number of active cases on 02-18 with 50.6k active cases and last numbers indicate 43.3k. Cumulatively they are at 64.7k cases.

Just wanted to point out that I got the data wrong. The above numbers are for the province of Hubei, not city of Wuhan. For Wuhan currently there are only 33530 active cases (47441 cumulative).

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On 2/21/2020 at 5:00 AM, John Cuthber said:

Having said that, I really hope quinine ( or chloroquine) works as a treatment for coronavirus.

It's cheap.

From Wikipedia about chloroquine:

It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[5] It is available as a generic medication.[1] The wholesale cost in the developing world is about US$0.04.[6] In the United States, it costs about US$5.30 per dose.[1]

Does not matter if cheap, will squeeze wallets no matter what :

Edited by Externet

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The fact that America needs to sort out its healthcare system isn't really the point here.

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Quinine/chloroquine efficacy vs viral replication - including coronavirus , is not new.  Authors of recent report on Chinese epidemic coronavirus ignored/missed a review that wasn't very encouraging.

Quinine/chloroquine efficacy vs. viral (Zika, herpes simplex, dengue, influenza) replication is apparently well known - e.g. .  https://escholarship.org/uc/item/8ws167fr  and  https://www.ncbi.nlm.nih.gov/pubmed/30055216  and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192383/.   These reports date as far back as  the 1970's - https://link.springer.com/article/10.1007/BF01250299.  Most report in vitro efficacy but and efficacy was shown vs CORONAVIRUS in vivo in live animal model  > 10 years ago - https://aac.asm.org/content/53/8/3416.short

Typically, news media report this as NEW and EXCITING.  Zhang et al in their recent report of efficacy vs the Chinese epidemic  coronavirus offer "Chloroquine, a widely-used anti-malarial and autoimmune disease drug, has recently been reported as a potential broadspectrum antiviral drug.8,9 Chloroquine is known to block virus infection by increasing endosomal pH required for virus/ cell fusion, as well as interfering with the glycosylation of cellular receptors of SARS-CoV.10 "    Ref # 9 reported in efficacy in vivo animal model vs. influenza virus in  2013.

recent review of limited clinical testing did not encourage.

Microorganisms 2020, 8(1), 85; https://doi.org/10.3390/microorganisms8010085

Review
The Use of Antimalarial Drugs against Viral Infection
Nevertheless, some drugs have already been used in several clinical trials, as summarized in Table 1. Most of them regard the use of antimalarial drugs against HIV infection, but some of them failed, and for others, the final results are not available. Although these outcomes can seem discouraging, at least four clinical trials deserve attention: The one on the use of AS against HCMV, with particular regard to the drug-resistant strains, the one targeting CHIKV with CQ, and the other two very innovative and ongoing trials on the use of AS against HPV for the treatment of anal and cervical intraepithelial high-grade neoplasia.
Based on these observations, we can state that the use of antimalarial drugs might be useful, especially in cases of antiviral resistance and in light of the emergence of many viruses against which effective drugs are not available.

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On 2/19/2020 at 3:41 AM, iNow said:

Ha.   The New York Times is listed as "neutral / balanced".

The chart must not measure their coverage of Bernie Sanders.

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