SARS-CoV-2 Coronavirus (COVID-19)

I prefer to follow Johns Hopkins:

When I wander through the individual states, the middle and most anti-mask and non-shutdown states look really grim. They have case trends headed the wrong way.

Bob Wilson

 

Would be awesome for therapeutics to be our salvation, but the contributions of things like Remdesivir and antibody treatment are less than modest when it comes to reducing morbidity and mortality. Like oseltamivir (Tamiflu) which slightly decreases the duration and intensity of influenza, there is nothing remotely like a cure on the radar.

Nearly all of the decrease in morbidity and mortality/CFR from COVID-19 instead comes from some (not real and real decrease) things such as:
1) selection bias: initially the virus spread through populations with little or no understanding of the infiltration in their midst; broad cohorts widely did not practice physical distancing with the poorly known enemy and the infected elderly and infirm died at a significant rate; later the elderly and infirm became wiser to the enemy and continue to hide, the younger and others with much lower risks - much less so; in the beginning, only the sickest were measured/detected (<10% infected), and although we are nowhere near capturing 100%, we are multiples better

2) reduced viral loads: physical distancing and masks, imperfectly practiced as they remain, means that infections start with fewer virions; given the nature of half-life replication speed, this allows the immune system much more time to ascertain the invaders and mount a proportionate and less self lethal response

Moral of the story: don't thank your doctor, thank your public health official (well ok, the latter is often to former too). Oh, and please listen to your public health officials.

 

U.S. government officials are putting an early end to a study testing an Eli Lilly antibody drug for people hospitalized with COVID-19 because it doesn't seem to be helping them.​

Lilly antibody drug fails in a COVID-19 study; others go on

 

ma is on an increasing trend i am not happy about

 

Majority of current infections stated wore masks often or all the time...

 

Incorrect. I have taken care of plenty of hospitalized COVID patients and poor physical distancing and poor mask utilization has an extremely high correlation with infection.

 

Longitudinal observation and decline of neutralizing antibody responses in the three months following SARS-CoV-2 infection in humans
Nature Microbiology (2020)

Simply put, those who have had severe symptoms had a stronger immune response, but patients with milder symptoms had a lesser degree of immune response that declined to the baseline level quickly. This is very similar to immune responses to other human coronaviruses which last for as little as 12 weeks. This means that even if an effective vaccine for SARS-CoV-2 can be successfully developed, we may need a booster shot every 12 weeks...

 

how many times must it be said: wearing a mask protects 'others'

it may or may not provide you with some protection, depending on the situation. and it depends on the mask.

by now, the government should have been supplying n95 masks free of charge to all citizens.

 

Where I grew up in the Far East, the attitude to mask wearing was that they were worn as ‘a gift to others’.

So when the pandemic arrived, I guess it wasn’t too much to ask over there.

Now as a medic working in the West, I am puzzled by the anti-mask sentiment minority views. Before the pandemic, what would they think of a surgeon who refused to wear a mask when operating on them because of his/her right to breathe?!

Mask wearing has always been to show respect and care for others - yes, even those you don’t know.

 

While it is right to have raised a concern, remember that these antibodies only reflect one domain of our immunity, that is the so-called B-cell or humoral immunity.

The ‘memory’ of our past infections is also held with our T-cells. The studies of this domain are harder and more limited in number so it remains an open question to what degree and how often we might need to re-vaccinate (at this time).

 

At the beginning of the outbreak our Archbishop issued a statement saying that wearing masks and reducing the size of our gatherings is "out of love for our brothers and sisters."

 

Some have confused the liberty/mask wearing issue. The one not wearing a mask takes away the liberty of others.

A similar situation would an individual burning trash in his backyard. Saves him a few bucks than paying for proper disposal that might be more convenient for the trash burner, but takes away the liberty of his neighbors to breath clean air.

These situations would be better described as anarchy.

 

Why You Shouldn’t Worry About Studies Showing Waning Coronavirus Antibodies

...Data from monkeys suggests that even low levels of antibodies can prevent serious illness from the virus, if not a re-infection. Even if circulating antibody levels are undetectable, the body retains the memory of the pathogen. If it crosses paths with the virus again, balloon-like cells that live in the bone marrow can mass-produce antibodies within hours.

A very small number of people may not make any antibodies. But even those people may have immune cells called T cells that can identify and destroy the virus. The vast majority of people infected with the coronavirus develop lasting cellular responses, according to several recent studies.

T cells are unlikely to prevent infection, but they may at least prevent serious illness by blunting the attack, Dr. Crotty said. Given all that, he said, interpreting low antibody levels to mean that immunity disappears, or that coronavirus vaccines will not be effective is “wrong.”

For example, the human papillomavirus “elicits a terrible immune response and lousy antibodies,” he said. “But the vaccine with a single immunization elicits fantastic antibodies that are 99 percent protective in people for 10-plus years, just a complete night-and-day difference.”...

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Why You Shouldn’t Worry About Studies Showing Waning Coronavirus Antibodies - The New York Times

“Many concerns have been expressed about immunity against COVID-19 not lasting. We used this study to investigate that question and found immunity is stable for at least five months.”​

UArizona Health Sciences Study Shows SARS-CoV-2 Antibodies Provide Lasting Immunity | The University of Arizona Health Sciences

 

Makes sense. I tire of the negative readings of Covid-19. We have to start seeing this from the biological and scientific side. 9 months into this, we now know that people die from this (which is horrible enough), and that it is still around rearing its ugly head. What we need to continue to learn is who has gotten it, survived it and why. We need to focus on this more and more. It is the positive and responsible thing we can do for those who are still alive and in honor of those who are not.

 

many americans have always thought that asian mask wearing was odd, and a sign of weakness, in that they were afraid of catching something.
i suppose that mentality lingers.

even mrs b, an rn from the 70's believes that she was taught that medical personnel wore masks to protect themselves from infectious diseases.

 

Study finds over 80% of COVID-19 patients have vitamin D deficiency

Not surprised in the least. Consider yourself forewarned.

 

This article is missing an extremely important element: a control group. What is the prevalence of vitamin D deficiency among a similar local population without Covid-19?

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The best I found in a very brief search, though not a good enough substitute:

Recommended vitamin D levels in the general population | Endocrinología, Diabetes y Nutrición (English ed.)

"Prevalence of vitamin D insufficiency/deficiency in Spain

Vitamin D insufficiency/deficiency represents an apparent worldwide epidemic. Thus, it has been reported that 88% of the population has plasma levels of 25OHD less than 30ng/mL, 37% levels less than 20ng/mL, and up to 7% mean levels under 10ng/mL.

The situation in Spain is very similar. In subjects over 65 years of age, 25OHD levels less than 20ng/mL have been reported in 80%–100% of cases, and 40% of those under 65 years have deficient values.This apparent paradox of low vitamin D levels in Spain has been explained by low dietary provision, protection from sun exposure in the summer months, and by the fact that the greatest part of Spain is above the 35°N parallel, where the possibility of synthesizing vitamin D is low in winter and spring."

 

If you read the original paper referenced in the article, the control group value is clearly stated.

Vitamin D Status in Hospitalized Patients With SARS-CoV-2 Infection | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic

Retrospective case-control study of 216 COVID-19 patients and 197 population-based controls. Serum 25OHD levels were measured in both groups.

Of the 216 patients, 19 were on vitamin D supplements and were analyzed separately. In COVID-19 patients, mean±SD 25OHD levels were 13.8±7.2 ng/ml, compared to 20.9±7.4 ng/ml in controls (p<0.0001). 25OHD values were lower in men than in women. Vitamin D deficiency was found in 82.2% of COVID-19 cases and 47.2% of population-based controls (p<0.0001).​

 

Hemoglobin is significantly reduced (anemia) in most patients hospitalized with infectious diseases such as COVID-19, other respiratory and non-respiratory illnesses, and more advanced states such as sepsis compared to well matched control groups.

What say ye to do here?