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Old 04-09-2020, 09:00 PM   #1051
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Once more none of this is helping. Mistakes have been by all, absolutely. The only way we get back our nation is to work together period. I honestly believe that we can do it. I can’t say nor do I believe some things havent been overblown. Things were over blown absolutely, but some were under considered. Hindsight is 20/20 real easy to bitch now, just saying. We are all humans first and Americans second.

I work with those vulnerable, as do some here or family members, they are the most affected by this, stop the blame game. It really hurting those that are mentally and or physically vulnerable.

How many have gone grocery shopping for those in dire need? Or who has volunteered to help out? How many have given up personally if they can so another makes it through? I would think a lot here on this board because this board is amazing in their support. Just go to the real life happens thread.

carry on.

~Dee~
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Old 04-09-2020, 09:25 PM   #1052
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https://dailyvoice.com/new-jersey/wy...covery/786194/


Franklin Lakes Lawyer, His Doc Say Drug Touted By Trump Was Game Changer In COVID-19 Recovery
Cecilia Levine 04/08/2020 11:55 a.m.

Billy Saracino, 47, with his wife Monica and kids, Alexa and William. Saracino greeted by his kids the moment he came out of self-quarantine Friday, April 3.
Billy Saracino of Franklin Lakes believes a major dose of Hydroxychloriquine, the anti-malarial drug touted by President Trump in fighting coronavirus, may be what saved him.

His doctor Robert Bock agrees, and says he's had incredible success in using Hydroxychloriquine to treat his other patients.



However, Bock recognizes that the drug comes with a host of side effects that can be fatal if not for proper administration and supervision.


A dosage of Hydroxychloriquine as soon as a patient's condition worsens, and co-presence of the antibiotic Zithromax are also key in the drug's success, according to Bock.

In Saracino's case, they were all there.

"Hydroxychloriquine is a reasonably well-tolerated drug," said Bock, who has a family practice out of Wayne and is also affiliated with the Atlantic Health System.


"It's a good medicine, but it has to be used in a supervised setting by someone who knows what they’re doing with it."

Saracino woke up with a fever on March 13. It lasted the entire weekend and then broke. Saracino thought that would be the end of it.

He self-quarantined himself out of an abundance of caution, but thought that would be the end of it. Bock treated him for a sinus infection initially, and Saracino was "responding nicely," the doctor said.


But days later, things got bad: Night sweats, chills and body aches.

It was around that time that Saracino's wife saw a story on FOX about Hydrochloriquine's possible effectiveness in treating coronavirus. She took a screenshot of it on her phone and texted it to Saracino, who was on the other side of the house in self-quarantine.

"We went to Dr. Bock and asked him to prescribe it," Saracino said. "Without that article, we'd have no idea about it."

Hydrochloriquine, otherwise known as Plaquenil, is commonly used to treat rheumatic illnesses such as lupus and arthritis, Bock said.


One of the known side effects is that it can cause a delay in heart conduction, meaning electrical impulses in the heart are slowed, the doctor explained.

"People need to monitor their vital signs," Bock said.

Bock told Saracino to order a pulse-ox meter, then wrote him a prescription for Hydroxychloriquine, based on his declining condition.

They did.

The fateful day came on March 20, when Saracino woke up in the middle of the night uncontrollably coughing. His wife immediately called Bock.


At his doctor's urging, Saracino swallowed three pills of Hydroxychloroquine (at 200 mg each), and another three the following morning before he was admitted to Hackensack University Medical Center.

"I had a feeling [Billy's case] was turning bad," said Bock, "so we started him before he went into the hospital."

The key, Bock says, is starting patients early -- before they begin "decompensating."

"Doctors were using Hydroxychloriquine out of desperation trying to find something that would work in fighting coronavirus," Bock said.


"What we’re finding now is that it actually does more if it’s started somewhat earlier, before somebody in the hospital needing a ventilator."

On March 21, Saracino had just enough energy to drive himself to the hospital, as not to infect his worried wife or two kids, 13 and 11. Bock called the hospital ahead to schedule a chest X-ray, but Saracino was so out of breath when he arrived, he was unable to explain to doctors why he was there.

"The place was completely empty -- I was shocked," Saracino recalled. "I got there, pulled in, and they asked through window if I had symptoms."


Workers left a mask and gloves on Saracino's windshield and told him to pull into a certain parking spot, then go into the ER.

There was only one person ahead of Saracino inside, he said. A woman with a fever.

Unable to explain why he was there, hospital workers initially told Saracino to treat his case at home. But then, a man -- who Saracino says may have been a nurse -- took his vitals. They were bad.

Bock suspects Saracino's rising heart rate indicated that his body was starting to decompensate, "and that's why they admitted him," the physician said, "which is a good thing."


Saracino was immediately taken for a chest X-ray, which showed bilateral viral pneumonia. Then, he was admitted to the ER -- which, unlike the triage area -- was completely full, he said.

"My heart rate wasn't good and my oxygen was low.," Saracino said. "My doctor was on the phone with the doctors and went through all my symptoms. He said 'You cannot let him out.'"

Saracino got his own room and was hooked up to an IV with Zithromax.

"The two medications that show the most promise for outpatients are Zithromax and Hydroxychloriquine together," Bock said.


"Studies show that Hydroxychloroquine with Zithromax is better than Hydroxychloroquine alone."

Saracino spent three nights in the hospital: Saturday, March 21 through Monday, March 23. He had chills, body aches and a terrible migraine. He would spent two hours sleeping, and then another two awake.

But then, exactly 48 hours after taking the initial dose of Hydroxychloroquine, Saracino says he started to feel better.

"I was sweating, I had to change clothes," Saracino said. "Then I started walking around a little bit."


"It’s no question," Bock said. "I think Hydroxychloroquine really helped him through this."

Every patient that Bock put Hydroxychloroquine on recovered except for one, whose condition worsened rapidly over the course of several hours, before the medication had time to work, the doctor said.

He's also had to take some patients off of it because of the side effects, Bock said.

There isn't enough research yet to understand why the drug works, according to Bock.

"They're thinking that Hydroxychloriquine in part is limiting the body’s inflammatory response in the lungs," he said.

After an agonizing three weeks, Saracino is on the mend and feels responsible to let the world know that Hydroxychloroquine helped him, and -- with physician's supervision and guidance -- could help others, too.


"Without my wife identifying the drug, Dr. Bock prescribing it to me or me being admitted to HUMC to continue treatment with the IV of Zithromax," said Saracino, "I don't think I'd be here speaking to you today."

"I am relatively healthy and people should take caution because this virus can hit anyone of any age at any time," Saracino said. "I look at this illness from a different angle than people who have not been through it."

Bock also urged the public to stay home in an effort to stop the spread.

"Half the people that are positive have no symptoms," he said.

"We’re completely at risk by going out and not observing social distance and not being smart. If you have to go out, wear the mask, wash your hands don’t touch your face.


"If you get [coronavirus], don't panic," he added. "Contact your doctor about symptoms and keep in mind the death rate is probably .6 percent, maybe less. It's not a cause for panic.

"Chances are, even if you're old, you’re not going to die from it. If you have symptoms, we can treat them."

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Old 04-09-2020, 10:19 PM   #1053
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Old 04-10-2020, 06:29 AM   #1054
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https://www.nationalreview.com/corne...utm_term=first


To describe as stunning the collapse of a key model the government has used to alarm the nation about the catastrophic threat of the coronavirus would not do this development justice.

In a space of just six days starting April 2, two revisions (on April 5 and 8) have utterly discredited the model produced by the University of Washington’s Institute for Health Metrics and Evaluation. I wrote about the IHME’s modeling at National Review on Monday, the day after the first revision — which was dramatic, but pales in comparison to Wednesday’s reassessment. This was not immediately apparent because the latest revision (April 8) did not include a side-by-side comparison, as did the April 5 revision. Perusal of the new data, however, is staggering, as is what it says about government predictions we were hearing just days ago about the likelihood of 100,000 deaths, with as many as 240,000 a real possibility.

As I noted in my last post on this subject, by April 5, the projection of likely deaths had plunged 12 percent in just three days, 93,531 to 81,766. Understand, this projection is drawn from a range; on April 2, IHME was telling us cumulative COVID-19 deaths could reach as high as approximately 178,000. The upper range was also reduced on April 5 to about 136,000.

On April 8, the projected cumulative deaths were slashed to 60,145 (with the upper range again cut, to about 126,000). That is, in less than a week, the model proved to be off by more than 33 percent.

My use of the term “off” is intentional. There is no shortage of government spin, regurgitated by media commentators, assuring us that the drastic reductions in the projections over just a few days powerfully illustrate how well social distancing and the substantial shuttering of the economy is working. Nonsense. As Alex Berenson points out on Twitter, with an accompanying screenshot data updated by IHME on April 1, the original April 2 model explicitly “assum[ed] full social distancing through May 2020.”

The model on which the government is relying is simply unreliable. It is not that social distancing has changed the equation; it is that the equation’s fundamental assumptions are so dead wrong, they cannot remain reasonably stable for just 72 hours.

And mind you, when we observe that the government is relying on the models, we mean reliance for the purpose of making policy, including the policy of completely closing down American businesses and attempting to confine people to their homes because, it is said, no lesser measures will do. That seems worth stressing in light of this morning’s announcement that unemployment claims spiked another 6.6 million (now well over 16 million in just the past couple of weeks), to say nothing of the fact that, while the nation reels, the Senate has now chosen to go on recess, having failed, thanks to Democratic obstinacy, to enact legislation to give more relief to our fast-shrinking small-business sector.

As I detailed in the last post, the revised April 5 model was grossly wrong even in predicting conditions that would obtain on April 5 itself. It had predicted that on that day, New York, the epicenter of the crisis, would need about 24,000 hospital beds, including 6,000 ICU beds. In fact, the model was off by a third — New York had 16,479 hospitalized COVID patients, 4,376 that were in ICU.

On April 8, IHME reduced the total number of hospital beds it had predicted would be needed nationally by a remarkable 166,890 — down to 95,202 from the 262,092 it had predicted less than a week earlier (i.e., it was nearly two-thirds off). The ICU projection over that same week was cut in half: to 19,816 on April 8, down from 39,727 on April 2. The projected need for ventilators also fell by nearly half, to 16,845 from 31,782.

Because of the way the media report on skepticism about models and a desire to get reliable facts (which used to be the media’s job), I pause to stress that I am not belittling the threat of the virus, particularly to people who are especially vulnerable — the elderly and those with underlying health problems, especially respiratory problems. The question is one of balance. American lives are being shattered by the restrictions that have been put in place. The decision to do that was based on models. Those models have no credibility. They now tell us that about 61,000 may die of coronavirus this year — although, if the last few days are any indication, that number could be revised downward soon, perhaps substantially.

To compare, the CDC estimates that 61,000 people died from the flu in the extraordinarily bad 2017–2018 period. It has become fashionable to ridicule flu comparisons, but they are surely relevant, even if it is true that coronavirus is more readily transmissible and has a higher fatality rate. For this year, the CDC projects that flu deaths will range between 24,000 and 63,000, and that hospitalizations could surge as high as 730,000 (out of the 18 to 26 million people who are treated for flu, out of as many as 55 million Americans who experience flu-related illnesses). We don’t shut the country down for that.

The question of when government officials will reopen the country they have shut down for coronavirus presses, as does the question of whether some less-draconian measures than the ones in place could suffice. Hopefully, officials will have a better answer than, “Well, our models say …”
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Old 04-10-2020, 08:04 AM   #1055
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Originally Posted by patswin View Post
https://www.nationalreview.com/corne...utm_term=first


To describe as stunning the collapse of a key model the government has used to alarm the nation about the catastrophic threat of the coronavirus would not do this development justice.

In a space of just six days starting April 2, two revisions (on April 5 and 8) have utterly discredited the model produced by the University of Washington’s Institute for Health Metrics and Evaluation. I wrote about the IHME’s modeling at National Review on Monday, the day after the first revision — which was dramatic, but pales in comparison to Wednesday’s reassessment. This was not immediately apparent because the latest revision (April 8) did not include a side-by-side comparison, as did the April 5 revision. Perusal of the new data, however, is staggering, as is what it says about government predictions we were hearing just days ago about the likelihood of 100,000 deaths, with as many as 240,000 a real possibility.

As I noted in my last post on this subject, by April 5, the projection of likely deaths had plunged 12 percent in just three days, 93,531 to 81,766. Understand, this projection is drawn from a range; on April 2, IHME was telling us cumulative COVID-19 deaths could reach as high as approximately 178,000. The upper range was also reduced on April 5 to about 136,000.

On April 8, the projected cumulative deaths were slashed to 60,145 (with the upper range again cut, to about 126,000). That is, in less than a week, the model proved to be off by more than 33 percent.

My use of the term “off” is intentional. There is no shortage of government spin, regurgitated by media commentators, assuring us that the drastic reductions in the projections over just a few days powerfully illustrate how well social distancing and the substantial shuttering of the economy is working. Nonsense. As Alex Berenson points out on Twitter, with an accompanying screenshot data updated by IHME on April 1, the original April 2 model explicitly “assum[ed] full social distancing through May 2020.”

The model on which the government is relying is simply unreliable. It is not that social distancing has changed the equation; it is that the equation’s fundamental assumptions are so dead wrong, they cannot remain reasonably stable for just 72 hours.

And mind you, when we observe that the government is relying on the models, we mean reliance for the purpose of making policy, including the policy of completely closing down American businesses and attempting to confine people to their homes because, it is said, no lesser measures will do. That seems worth stressing in light of this morning’s announcement that unemployment claims spiked another 6.6 million (now well over 16 million in just the past couple of weeks), to say nothing of the fact that, while the nation reels, the Senate has now chosen to go on recess, having failed, thanks to Democratic obstinacy, to enact legislation to give more relief to our fast-shrinking small-business sector.

As I detailed in the last post, the revised April 5 model was grossly wrong even in predicting conditions that would obtain on April 5 itself. It had predicted that on that day, New York, the epicenter of the crisis, would need about 24,000 hospital beds, including 6,000 ICU beds. In fact, the model was off by a third — New York had 16,479 hospitalized COVID patients, 4,376 that were in ICU.

On April 8, IHME reduced the total number of hospital beds it had predicted would be needed nationally by a remarkable 166,890 — down to 95,202 from the 262,092 it had predicted less than a week earlier (i.e., it was nearly two-thirds off). The ICU projection over that same week was cut in half: to 19,816 on April 8, down from 39,727 on April 2. The projected need for ventilators also fell by nearly half, to 16,845 from 31,782.

Because of the way the media report on skepticism about models and a desire to get reliable facts (which used to be the media’s job), I pause to stress that I am not belittling the threat of the virus, particularly to people who are especially vulnerable — the elderly and those with underlying health problems, especially respiratory problems. The question is one of balance. American lives are being shattered by the restrictions that have been put in place. The decision to do that was based on models. Those models have no credibility. They now tell us that about 61,000 may die of coronavirus this year — although, if the last few days are any indication, that number could be revised downward soon, perhaps substantially.

To compare, the CDC estimates that 61,000 people died from the flu in the extraordinarily bad 2017–2018 period. It has become fashionable to ridicule flu comparisons, but they are surely relevant, even if it is true that coronavirus is more readily transmissible and has a higher fatality rate. For this year, the CDC projects that flu deaths will range between 24,000 and 63,000, and that hospitalizations could surge as high as 730,000 (out of the 18 to 26 million people who are treated for flu, out of as many as 55 million Americans who experience flu-related illnesses). We don’t shut the country down for that.

The question of when government officials will reopen the country they have shut down for coronavirus presses, as does the question of whether some less-draconian measures than the ones in place could suffice. Hopefully, officials will have a better answer than, “Well, our models say …”

Great article.

To the bold, how do we know? I can’t stand these bold proclamations. Think how much the mortality rate shifts if 500K are asymptomatic. 1 mil. 10 mil. 100 mil.

Until antibodies screening is underway and better data comes in its a pure assumption.
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Old 04-10-2020, 08:21 AM   #1056
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Great article.

To the bold, how do we know? I can’t stand these bold proclamations. Think how much the mortality rate shifts if 500K are asymptomatic. 1 mil. 10 mil. 100 mil.

Until antibodies screening is underway and better data comes in its a pure assumption.
We don't know! That doesn't stop people who haven't a clue what they are talking about staring at a camera and bullshitting people that all of this was necessary.
The key of that whole article is that everything we've been subjected to was based on these BS numbers, and now that they've been proved wrong, or I should say proved themselves wrong, people are not going to stand for it. Give it a week. Max. That Dr Fauci will go from hero to zero faster than anyone can imagine.
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Old 04-10-2020, 08:24 AM   #1057
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We don't know! That doesn't stop people who haven't a clue what they are talking about staring at a camera and bullshitting people that all of this was necessary.
The key of that whole article is that everything we've been subjected to was based on these BS numbers, and now that they've been proved wrong, or I should say proved themselves wrong, people are not going to stand for it. Give it a week. Max. That Dr Fauci will go from hero to zero faster than anyone can imagine.
Agree.

It was already uncomfortable watching them try and deflect on any and all questions. “Well, the models....”
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Old 04-10-2020, 08:25 AM   #1058
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One thing I have learned over the last 20-30 years is that computer models are worthless.

Computer models only amplify the biases of the people that develop them and use them....and so they tend to deliver apocalyptic predictions that vastly overstate and overestimate the problem.

It doesn't matter whether it's Covid-19, or Global Warming...the old adage still applies...garbage in, garbage out.

That's not to say all models are to be totally discounted, in all cases....hurricane models and things like that are a little better.

But, generally speaking....all computer modelling should be given credibility on par with any other conspiracy theory, you have to judge the motives and biases of the people who develop and use them.

If I am a climate scientist who thinks the world is coming to an end in fire, my models will show fiery destruction for the planet as a prediction.

If I am a climate scientist who thinks the next ice age is coming, my models will show the inevitable and inexorable burying of North America in ice.

If I am a pandemic medical specialist of some kind, my models will show the zombie apocalypse is upon us.

Keep this in mind whenever you hear scientist and experts quoting computer model predictions....they are almost always wrong, and almost always vastly exaggerated predictions.
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Old 04-10-2020, 08:45 AM   #1059
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Originally Posted by Baron Samedi View Post
One thing I have learned over the last 20-30 years is that computer models are worthless.

Computer models only amplify the biases of the people that develop them and use them....and so they tend to deliver apocalyptic predictions that vastly overstate and overestimate the problem.

It doesn't matter whether it's Covid-19, or Global Warming...the old adage still applies...garbage in, garbage out.

That's not to say all models are to be totally discounted, in all cases....hurricane models and things like that are a little better.

But, generally speaking....all computer modelling should be given credibility on par with any other conspiracy theory, you have to judge the motives and biases of the people who develop and use them.

If I am a climate scientist who thinks the world is coming to an end in fire, my models will show fiery destruction for the planet as a prediction.

If I am a climate scientist who thinks the next ice age is coming, my models will show the inevitable and inexorable burying of North America in ice.

If I am a pandemic medical specialist of some kind, my models will show the zombie apocalypse is upon us.

Keep this in mind whenever you hear scientist and experts quoting computer model predictions....they are almost always wrong, and almost always vastly exaggerated predictions.
Very true.

And hurricane/any weather models have pinpoint accurate past data to base off of, instead of assumptions.
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Old 04-10-2020, 09:14 AM   #1060
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Know who else uses computer models and isn’t right or models change almost hourly? The weather forecasters. That is why ever since I heard how numbers were being predicted, I didn’t fully believe them. I work at a tv station and know even two days out that they could be wrong.

---------- Post added at 10:14 AM ---------- Previous post was at 10:13 AM ----------

Know who else uses computer models and isn’t right or models change almost hourly? The weather forecasters. That is why ever since I heard how numbers were being predicted, I didn’t fully believe them. I work at a tv station and know even two days out that they could be wrong.
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Old 04-10-2020, 09:23 AM   #1061
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Old 04-10-2020, 09:35 AM   #1062
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Know who else uses computer models and isn’t right or models change almost hourly? The weather forecasters. That is why ever since I heard how numbers were being predicted, I didn’t fully believe them. I work at a tv station and know even two days out that they could be wrong.[COLOR="Silver"]
I give weather forecasters a pass for a couple of reasons. The first being that they are orders of magnitude more accurate than AGW predictions...I would say they have an accuracy of well over 50%....whereas AGW models...all 1100 of them, have an accuracy of 0%, and they are universally inaccurate on the apocalypse side, all 1100 of them have grossly overestimated the temperature in their predictions by very wide margins, and that's even using the massaged and faked numbers.

The second reason I give weather forecasters a pass is, aside from at least having a record of being right most of the time, they aren't actually modelling their biases....they don't have any....they don't have a vest interested in the weather being warmer in the coming week, or colder in the coming week, so there is nothing fro the model to amplify.

---------- Post added at 10:35 AM ---------- Previous post was at 10:33 AM ----------

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Very true.

And hurricane/any weather models have pinpoint accurate past data to base off of, instead of assumptions.
Yeah, at least the hurricane models can accurately reproduce past hurricanes. That's an achievement the climate models have not been able to accomplish for over 30 years.
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Old 04-10-2020, 09:37 AM   #1063
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MAINSTREAM MEDIA IGNORED FAUCI DOWNPLAYING CORONAVIRUS
Recent Fauci report compared COVID-19 to a bad flu season
Daniel Taylor | Old-Thinker News - APRIL 6, 2020 20 Comments
Mainstream Media Ignored Fauci Downplaying Coronavirus
IMAGE CREDITS: SARAH SILBIGER / STRINGER / GETTY.

While the mainstream media was busily attacking President Trump for initially claiming that COVID-19 was “like the flu”, a late February report authored by Dr. Anthony Fauci claimed just that.

The report was published on March 26, 2020 in the New England Journal of Medicine.


In the report (initially published on February 28, 2020), Fauci and his co-authors wrote:

“If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”

Mainstream media failed to report on Dr. Fauci’s report comparing Coronavirus to a bad flu season, instead choosing to attack Trump, who was likely following guidance from Fauci saying the same thing.

---------- Post added at 03:37 AM ---------- Previous post was at 03:36 AM ----------

and here is the NEJM article:

Covid-19 — Navigating the Uncharted
List of authors.
Anthony S. Fauci, M.D., H. Clifford Lane, M.D., and Robert R. Redfield, M.D.
Article
Metrics

12 References
20 Citing Articles
The latest threat to global health is the ongoing outbreak of the respiratory disease that was recently given the name Coronavirus Disease 2019 (Covid-19). Covid-19 was recognized in December 2019.1 It was rapidly shown to be caused by a novel coronavirus that is structurally related to the virus that causes severe acute respiratory syndrome (SARS). As in two preceding instances of emergence of coronavirus disease in the past 18 years2 — SARS (2002 and 2003) and Middle East respiratory syndrome (MERS) (2012 to the present) — the Covid-19 outbreak has posed critical challenges for the public health, research, and medical communities.

In their Journal article, Li and colleagues3 provide a detailed clinical and epidemiologic description of the first 425 cases reported in the epicenter of the outbreak: the city of Wuhan in Hubei province, China. Although this information is critical in informing the appropriate response to this outbreak, as the authors point out, the study faces the limitation associated with reporting in real time the evolution of an emerging pathogen in its earliest stages. Nonetheless, a degree of clarity is emerging from this report. The median age of the patients was 59 years, with higher morbidity and mortality among the elderly and among those with coexisting conditions (similar to the situation with influenza); 56% of the patients were male. Of note, there were no cases in children younger than 15 years of age. Either children are less likely to become infected, which would have important epidemiologic implications, or their symptoms were so mild that their infection escaped detection, which has implications for the size of the denominator of total community infections.

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On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%.4 In another article in the Journal, Guan et al.5 report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.2

The efficiency of transmission for any respiratory virus has important implications for containment and mitigation strategies. The current study indicates an estimated basic reproduction number (R0) of 2.2, which means that, on average, each infected person spreads the infection to an additional two persons. As the authors note, until this number falls below 1.0, it is likely that the outbreak will continue to spread. Recent reports of high titers of virus in the oropharynx early in the course of disease arouse concern about increased infectivity during the period of minimal symptoms.6,7

China, the United States, and several other countries have instituted temporary restrictions on travel with an eye toward slowing the spread of this new disease within China and throughout the rest of the world. The United States has seen a dramatic reduction in the number of travelers from China, especially from Hubei province. At least on a temporary basis, such restrictions may have helped slow the spread of the virus: whereas 78,191 laboratory-confirmed cases had been identified in China as of February 26, 2020, a total of 2918 cases had been confirmed in 37 other countries or territories.4 As of February 26, 2020, there had been 14 cases detected in the United States involving travel to China or close contacts with travelers, 3 cases among U.S. citizens repatriated from China, and 42 cases among U.S. passengers repatriated from a cruise ship where the infection had spread.8 However, given the efficiency of transmission as indicated in the current report, we should be prepared for Covid-19 to gain a foothold throughout the world, including in the United States. Community spread in the United States could require a shift from containment to mitigation strategies such as social distancing in order to reduce transmission. Such strategies could include isolating ill persons (including voluntary isolation at home), school closures, and telecommuting where possible.9

A robust research effort is currently under way to develop a vaccine against Covid-19.10 We anticipate that the first candidates will enter phase 1 trials by early spring. Therapy currently consists of supportive care while a variety of investigational approaches are being explored.11 Among these are the antiviral medication lopinavir–ritonavir, interferon-1β, the RNA polymerase inhibitor remdesivir, chloroquine, and a variety of traditional Chinese medicine products.11 Once available, intravenous hyperimmune globulin from recovered persons and monoclonal antibodies may be attractive candidates to study in early intervention. Critical to moving the field forward, even in the context of an outbreak, is ensuring that investigational products are evaluated in scientifically and ethically sound studies.12

Every outbreak provides an opportunity to gain important information, some of which is associated with a limited window of opportunity. For example, Li et al. report a mean interval of 9.1 to 12.5 days between the onset of illness and hospitalization. This finding of a delay in the progression to serious disease may be telling us something important about the pathogenesis of this new virus and may provide a unique window of opportunity for intervention. Achieving a better understanding of the pathogenesis of this disease will be invaluable in navigating our responses in this uncharted arena. Furthermore, genomic studies could delineate host factors that predispose persons to acquisition of infection and disease progression.

The Covid-19 outbreak is a stark reminder of the ongoing challenge of emerging and reemerging infectious pathogens and the need for constant surveillance, prompt diagnosis, and robust research to understand the basic biology of new organisms and our susceptibilities to them, as well as to develop effective countermeasures.

Disclosure forms provided by the authors are available with the full text of this editorial at NEJM.org.

This editorial was published on February 28, 2020, at NEJM.org.
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Old 04-10-2020, 09:46 AM   #1064
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Old 04-10-2020, 09:56 AM   #1065
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Gears grinding to a halt in fools heads?

Funny, yet entirely consistent, that the loudest yammerers will go dark the minute facts and examples are injected.
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