Corona virus general questions mega thread

[MigL]

Aren't allergies an over-reaction of your immune system to everyday 'allergens' that don't bother most people ?
So you'll be over-reacting to both, your allergens, and any exposure to Covid-19.

Either way, you're in for a miserable time.
( I developed an allergy to ragweed pollen in my 30s, but it was almost gone by my 50s )

[CharonY]

Just now, J.C.MacSwell said:

Seasonal allergies kicking in...is this a good thing if exposed to the virus with the immune system on hyperdrive...a bad thing with the immune system distracted with the extra load...or could go either way?

I do not have any real expertise on that, but the connection is complex and different pathways are activated (I'd have to ask my wife for more insights).  But on the outcome levels there is evidence that if you are already suffering from inflammation, virus infection can have worse outcomes. Conversely respiratory diseases seem to make folks more susceptible to things like asthma (or at least worsen symptoms). But the immune system is notoriously complex. It is perhaps not surprising that we do not fully understand allergies yet, for example (with quite a few uncertainties regarding regarding the hygiene hypothesis, for example). 

It should also be acknowledged that immune responses need to be modulated properly. It is not a system that works better the stronger its responses are. In fact, certain aspects can result in damages themselves (cytokine storms have made the press a while connected with the swine flu pandemic, for example).

 

[J.C.MacSwell]

2 hours ago, MigL said:

Aren't allergies an over-reaction of your immune system to everyday 'allergens' that don't bother most people ?
So you'll be over-reacting to both, your allergens, and any exposure to Covid-19.

Either way, you're in for a miserable time.
( I developed an allergy to ragweed pollen in my 30s, but it was almost gone by my 50s )

 I would over-react to Covid 19?

Still have ragweed/hay fever allergies myself, but significantly less in the last 10 years. I seem to now react to other things now though not extremely.

I also have noticeable inflammation much of the time, but get significantly less colds and flu since that started, and shake them fairly quickly when I do (anecdotal and could be just coincidence, plus half those years I've had flu shots...)

31 minutes ago, CharonY said:

I do not have any real expertise on that, but the connection is complex and different pathways are activated (I'd have to ask my wife for more insights).  But on the outcome levels there is evidence that if you are already suffering from inflammation, virus infection can have worse outcomes. Conversely respiratory diseases seem to make folks more susceptible to things like asthma (or at least worsen symptoms). But the immune system is notoriously complex. It is perhaps not surprising that we do not fully understand allergies yet, for example (with quite a few uncertainties regarding regarding the hygiene hypothesis, for example). 

It should also be acknowledged that immune responses need to be modulated properly. It is not a system that works better the stronger its responses are. In fact, certain aspects can result in damages themselves (cytokine storms have made the press a while connected with the swine flu pandemic, for example).

 

I googled that and Spanish Flu came up. I knew most died from bacterial pneumonia. That's likely why?

Edited April 6, 2020 by J.C.MacSwell

[CharonY]

12 minutes ago, J.C.MacSwell said:

from bacterial pneumonia. That's likely why?

Ah, no. Cytokines are signalling molecules produced by your body. Some of them are proinflammatory and are produced as response to infections. If they get too high while reacting to an infection the inflammation response of your body can start to cause damage. These responses tend to be stronger in younger folks (or conversely, in older folks immune responses are often muted). In very bad cases theses pro-inflammatory responses can lead to death, which has happened during the Spanish flu as well as Swine flu, which caused many of the deaths among younger folks.

[J.C.MacSwell]

42 minutes ago, CharonY said:

Ah, no. Cytokines are signalling molecules produced by your body. Some of them are proinflammatory and are produced as response to infections. If they get too high while reacting to an infection the inflammation response of your body can start to cause damage. These responses tend to be stronger in younger folks (or conversely, in older folks immune responses are often muted). In very bad cases theses pro-inflammatory responses can lead to death, which has happened during the Spanish flu as well as Swine flu, which caused many of the deaths among younger folks.

No?

Here is a quote from the article I googled. It doesn't contradict what you are saying except your conclusion. (if I'm interpreting it correctly, the "lead to death" is by pneumonia )

"Many of the people dying from Covid-19 are succumbing to a form of pneumonia, which takes hold as the immune system is weakened from fighting the virus.

This is something that it shares with Spanish flu...

Doctors have described the Spanish flu as the “greatest medical holocaust in history”. It was not just the fact it killed so many, it was that so many of its victims were young and healthy. Normally, a healthy immune system can deal reasonably well with flu, but this version struck so quickly that it overwhelmed the immune system, causing a massive over-reaction known as a cytokine storm, flooding the lungs with fluid which became the perfect reservoir for secondary infections."

https://www.bbc.com/future/article/20200302-coronavirus-what-can-we-learn-from-the-spanish-flu

In any case, thank God the Covid 19 has not been as devastating to our young people...(now if we can only get the little bleeps to stay isolated!)

Edited April 6, 2020 by J.C.MacSwell

[StringJunky]

12 minutes ago, J.C.MacSwell said:

No?

Here is a quote from the article I googled. It doesn't contradict what you are saying except your conclusion. (if I'm interpreting it correctly, the "lead to death" is by pneumonia )

"Many of the people dying from Covid-19 are succumbing to a form of pneumonia, which takes hold as the immune system is weakened from fighting the virus.

This is something that it shares with Spanish flu...

Doctors have described the Spanish flu as the “greatest medical holocaust in history”. It was not just the fact it killed so many, it was that so many of its victims were young and healthy. Normally, a healthy immune system can deal reasonably well with flu, but this version struck so quickly that it overwhelmed the immune system, causing a massive over-reaction known as a cytokine storm, flooding the lungs with fluid which became the perfect reservoir for secondary infections."

https://www.bbc.com/future/article/20200302-coronavirus-what-can-we-learn-from-the-spanish-flu

 

But doesn't have to be a secondary infection.

Quote

Severe inflammation in the lungs causes the blood vessels in the lungs to become leaky, resulting in inflammatory cells, fluid, and chemicals to fill the air sacs of the lung, essentially drowning a patient from the inside out,”  https://spectrum.ieee.org/the-human-os/biomedical/devices/blood-filtration-tech-removes-harmful-cytokines-covid19-patients

 

[J.C.MacSwell]

6 minutes ago, StringJunky said:

But doesn't have to be a secondary infection.

 

Over 90% of deaths (from what I've read) in the Spanish Flu were from bacterial pneumonia. 

Interesting link for Covid 19 though. A possible solution by filtering cytokines to reduce over-reaction.

[StringJunky]

14 minutes ago, J.C.MacSwell said:

Over 90% of deaths (from what I've read) in the Spanish Flu were from bacterial pneumonia. 

Interesting link for Covid 19 though. A possible solution by filtering cytokines to reduce over-reaction.

For the current disease it's uncertain:

Quote

As COVID-19 becomes more prevalent in the community, pneumonia is more likely to be caused by the COVID-19 virus than bacteria. Viral pneumonia will not respond to the use of antibiotics therefore they should only be offered if bacteria are the likely cause, it is unclear whether the cause is bacterial or viral and symptoms are more concerning or the person is at high risk of developing complications. https://www.nice.org.uk/news/article/nice-publishes-new-covid-19-guidelines-on-severe-asthma-pneumonia-rheumatological-disorders-and-symptom-management

Yes, that idea is interesting concerning filtering.

[CharonY]

55 minutes ago, J.C.MacSwell said:

No?

Here is a quote from the article I googled. It doesn't contradict what you are saying except your conclusion. (if I'm interpreting it correctly, the "lead to death" is by pneumonia )

Well, to be precise it leads to lung damages. While that can make the patient more susceptible to secondary infections, it is not necessarily connected. It ultimately depends on what the patients dies from first (if they die). I also do not think that folks have actually a consensus on whether the 1918 influenza epidemic actually caused things like cytokine storms. There are papers out there that have argued that the vastly different outcomes in various subgroups of patients indicates that host immune intensity actually plays a role (and would also be in agreement with the dominant role of secondary infections. I know that folks like to pick up the Spanish flu due to the large number of deaths, but for a variety of reasons it is not a good reference point (not least because we only have limited pathobiological information from that time).

A cytokine storm in itself can be deadly. In the case where we have good data (as obviously the assumption on the 2019 pandemic are based on forensic reconstruction and indirect evidence), such as the 2009 swine flu pandemic, severe alveolar damage and signs of capillary damages were observed, these then can to lead to organ failure. In addition, the cytokines can also spill into circulation which can cause multi-organ dysfunctions. 

Either way the patient is gets in a really bad shape, which also makes the vulnerable to secondary infections. However, even if isolated in a sterile room, there is a risk of organ failure. The latter usually happens fairly fast, those that survive beyond that point are usually those that are at risk of getting infected.

 

 

[MigL]

One must also keep in mind the general conditions of 1918-19.

Hospitals ( and makeshift field hospitals ) are crowded with injured/wounded young soldiers from the Great War, who have compromised healing abilities.
Into this mix, you start introducing those infected with Spanish Influenza.
Couple that with the lack of anti-bacterial agents, and soon enough hospitals become places where you go to die, not to get well.

[Danijel Gorupec]

2 hours ago, MigL said:

Couple that with the lack of anti-bacterial agents, and soon enough hospitals become places where you go to die, not to get well.

We might have cases even today where hospitals spread the thing (being overcrowded and lacking protection gear). I was suspecting this might be happening in Italy because the virus seemed to spread strongly even after applying rigorous public measures. Now finally the spread rate started to respond to the measures, so maybe it was not hospitals after all. What do you think?

By the way, did we finally stop the Spanish flu by developing a vaccine or by 'heard immunity"?

[Not_Too_Open_Minded]

I've seen some very interesting treatments. The malaria drug hydrochloroquine and paired with azithromycin. Considering one is immunosuppressive anti-parasite. The other is antibacterial. They actual seem to be working. 

Intravenous vitamin C also has some solid data behind helping patients in critical condition. 

Plasma transfusions with people who've recovered from covid19, for their antibodies is underway right now. Will be exciting to see how this works. 

Besides those 3 I'm not very familiar with any that sound promising or show signs of success. Please list what your aware of or might reccomend. 

I've recently found out there's a microbiome in our lungs. I would like to see if there's any breathing treatments or lung bacteria transplants that could help. 

[Strange]

1 hour ago, Not_Too_Open_Minded said:

I've seen some very interesting treatments. The malaria drug hydrochloroquine and paired with azithromycin. Considering one is immunosuppressive anti-parasite. The other is antibacterial. They actual seem to be working. 

Intravenous vitamin C also has some solid data behind helping patients in critical condition.

I am not aware of any good evidence for this. Can you provide a reliable source.

 

[CharonY]

Well, there are no strong evidence. While numerous treatment options have been and are being tested, so far the reports are at best weak. As perhaps discussed earlier hydroxychloroquine (either alone or in combination) has shown some faster recovery in cohorts with weak symptoms (based on a French and Chinese study). Most recent studies that included patients with more severe symptoms did not see any benefit over placebos. 

Molina et al (2020) Med et Mal Inf.. It still in pre-proof (i.e. peer reviewed but not typeset yet) so here is also the title, which is pretty clear: "No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection".

All were pilot studies, so more studies would be needed to establish effects (or lack thereof) fully. Some researchers find the strong focus on it a bit worrying as the evidence for efficacy is still rather lacking.

For vitamin C as well as for plasma treatment I have not seen any trial results yet, so I am not sure how solid the data can be.

 

[StringJunky]

1 hour ago, CharonY said:

Well, there are no strong evidence. While numerous treatment options have been and are being tested, so far the reports are at best weak. As perhaps discussed earlier hydrochloroquinone (either alone or in combination) has shown some faster recovery in cohorts with weak symptoms (based on a French and Chinese study). Most recent studies that included patients with more severe symptoms did not see any benefit over placebos. 

Molina et al (2020) Med et Mal Inf.. It still in pre-proof (i.e. peer reviewed but not typeset yet) so here is also the title, which is pretty clear: "No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection".

All were pilot studies, so more studies would be needed to establish effects (or lack thereof) fully. Some researchers find the strong focus on it a bit worrying as the evidence for efficacy is still rather lacking.

For vitamin C as well as for plasma treatment I have not seen any trial results yet, so I am not sure how solid the data can be.

 

Is this because Trump is promoting it without foundation but has influence in what they look at?

[CharonY]

Just now, StringJunky said:

Is this because Trump is promoting it without foundation but has influence in what they look at?

Partially, a lot is also because of the imbalance between public dissemination and the strength of the data. Scientists are usually very critical to overhyping results (and specific endorsement from POTUS could amplify it). There a couple of letters you might find interesting:

https://annals.org/aim/fullarticle/2764199/use-hydroxychloroquine-chloroquine-during-covid-19-pandemic-what-every-clinician

https://annals.org/aim/fullarticle/2764065/rush-judgment-rapid-reporting-dissemination-results-its-consequences-regarding-use

[StringJunky]

30 minutes ago, CharonY said:

Partially, a lot is also because of the imbalance between public dissemination and the strength of the data. Scientists are usually very critical to overhyping results (and specific endorsement from POTUS could amplify it). There a couple of letters you might find interesting:

https://annals.org/aim/fullarticle/2764199/use-hydroxychloroquine-chloroquine-during-covid-19-pandemic-what-every-clinician

https://annals.org/aim/fullarticle/2764065/rush-judgment-rapid-reporting-dissemination-results-its-consequences-regarding-use

Yes, reading those it would seem, being a cheerleader, he is causing more problems than solving.

[Phi for All]

!

Moderator Note

Posts regarding a Trump connection to Hydroxychloroquine have been split to here.

 

[MigL]

apparently, after 76 days, Wuhan reopened its roads and airport today.
Operations at the airport resumed with 271 scheduled flights, 140 arrivals, and 131 departures.
No international or hi-density ( wide body planes ) flights.

Is that a light I see, at the end of this long tunnel ?

[iNow]

3 minutes ago, MigL said:

Is that a light I see, at the end of this long tunnel ?

We’ll know in 2-3 weeks based on new infection rates 

[Scarlett zou]

On February 4th, Jiao Yahui, deputy director of the Medical and Health Care Administration Bureau of the Chinese Health and Medical Commission, said that as of 24:00 on February 3rd, the nationwide case fatality rate was 2.1%. The fatality rate of confirmed cases in Hubei Province is 3.1%, and the fatality rate of confirmed cases in Wuhan is 4.9%. If Hubei is excluded, the fatality rate in other provinces is 0.16%. According to Michael Ryan, WHO's executive director of health emergencies, the 2% case fatality rate remains a tricky case fatality rate compared to the case fatality rate of seasonal flu or other diseases.
A retrospective study published January 29 in The Lancet showed that COVID-19 infection is more likely to affect older men with comorbidities, and that older age, obesity and comorbidities may be associated with increased mortality.
Although no conclusion can be reached on the mortality rate, the academic community generally believes that the mortality rate of this virus is much lower than the other two coronaviruses: MERS with a mortality rate of one third and SARS with a mortality rate of about one tenth. From a clinical perspective, MERS and SARS appear to be more damaging to lung tissue.

More FAQs

[PhilGeis]

^{Think one must  take China stats with a grain of salt.  WSJ reports China ended Wuhan lockdown - allowing both inbound and outbound traffic.  However some housing complexes are still restricted.  Worrisome - one state news outlet reported 20.000-30.000 new asymptomatic cases - a report that has been deleted.}  

[CharonY]

3 hours ago, PhilGeis said:

^{Think one must  take China stats with a grain of salt.  WSJ reports China ended Wuhan lockdown - allowing both inbound and outbound traffic.  However some housing complexes are still restricted.  Worrisome - one state news outlet reported 20.000-30.000 new asymptomatic cases - a report that has been deleted.}  

I am not sure whether it was the same one that I have seen, but if I understood it correctly these are total positive for virus but asymptomatic cases, rather than exclusively new ones (but I may be mis-remembering and can't find the report now). In their official reports China only listed symptomatic cases (originally via RNA test, later also those with confirmed symptoms via CT but without additional test). While it may have made clinical sense at that time to focus on symptomatic cases, especially since all positive cases were isolated anyway, it is now a liability. 

13 hours ago, iNow said:

We’ll know in 2-3 weeks based on new infection rates 

Exactly that.

[MigL]

Is it accurate to say that China has larger numbers of asymptomatic cases as opposed to Western experience with symptomatic and fatal cases ?

Several years ago, in Walkerton, Ontario, several people died from contaminated drinking water. The saying at the time was " If Mexicans lived in Walkerton, no one would even get diarrhea ", and certainly not die.
The increase in allergies in Western societies has been correlated to our 'cleanliness' ( general contaminants and food prep. and separation ), as has mononucleosis.

Could the fact that we are not subject to the close living conditions and resultant lack of hygienic conditions, have made our immune system much less robust ( like muscle atrophy, if you don't use it, you lose it ) and more prone to serious outcomes, or even death, when others ( China, Korea Taiwan, Vietnam, Thailand etc ) are not affected as severely ?

[CharonY]

8 minutes ago, MigL said:

Is it accurate to say that China has larger numbers of asymptomatic cases as opposed to Western experience with symptomatic and fatal cases ?

I do not think it is. Or rather there is no evidence that it might be the case. Rather the issue many countries is still  undertesting and prioritizing tests on folks with symptoms. If you look at more fully tested populations there does not seem to be a vast discrepancy compared to China at comparable time points.

13 minutes ago, MigL said:

The increase in allergies in Western societies has been correlated to our 'cleanliness' ( general contaminants and food prep. and separation ), as has mononucleosis.

On this point, the hygiene hypothesis is mostly used in the context of autoimmune diseases and allergies. I.e. low exposure to foreign substances might result in inbalances that cause the immune system to overreact (I think atrophy is not a good analogy, the responses are strong, but confused). Also when it comes to the adaptive part of the immune system, actual exposure is needed. At least in theory exposure to another related virus might raise imperfect antibodies which may attenuate the infection. But there is no data that suggests that at this point.

Finally, especially when comparing to strongly urbanized countries like Taiwan and South Korea, I doubt that there are many differences in terms of hygiene. I think you will find larger differences within each country between, say  rural and urban centres. Especially in areas with a lot of of livestock.