The Corona Virus

[Bartmanhomer]

This evidence points to one of two things: either the disease is really good at killing people, or the lock-downs didn't do anything. Without proper scientific studies, I doubt we will ever know which is the truth.

Well, it's official. This is definitely the end of the world.

[Joran]

This evidence points to one of two things: either the disease is really good at killing people, or the lock-downs didn't do anything. Without the proper scientific studies I doubt we will ever know which is the truth.

It doesn't point to either of those two things.

1) Coronavirus is extremely good at spreading. Serology tests seem to indicate that there's a lot more people who were infected than are tested. The low end estimate of the lethal range is still 2-4 times higher than the flu, but below other diseases like Ebola, SARS, or MERS. The lethality numbers and number of infected are still under research and really depends a lot on location.

2) Lockdown slows down the spread, but does not stop it. People still need to travel to get supplies or go to essential work. Sick people still come in contact with others.

What lockdown is supposed to do is flatten the curve; reduce the spread so it doesn't spread exponentially and allow the medical system and the rest of the infrastructure to catch up. What ideally should happen is that testing ramps up, supplies of PPE, drugs, and ventilators increase, so when the lockdown ends, the next outbreak won't overburden the health system.

The curve has been flattened successfully. Here in the Washington, D.C. region, our hospital systems haven't been overwhelmed. If left unchecked and without the physical distancing, it could have easily done so.

A hopeful outcome is if testing is strong enough that instead of having to do a general lockdown, there can be targeted testing/contact tracing so only people who've been exposed can be quarantined for the next outbreak. Some countries have developed phone apps to do this contract tracing automatically, but that leads to obvious privacy concerns.

Given the ease of spread, long incubation time, and lack of obvious symptoms in a lot of people, I'm not confident that targeted testing/contact tracing can be done. SARS had the benefit of having an obvious symptom (fever) and not being contagious before then. I am hopeful that due to physical distancing restrictions and lots of vigilance, that the spread can be reduced so we don't have unchecked exponential growth like what happened in March.

In the end, the final goal of everything is to try to reduce the number of people who die before a vaccine is produced (or viable treatment, I think). The timeline for that is a year or two off. Until that happens, expect physical distancing to stay with us.

Non-essential businesses will be open, but I'm guessing my tickets for Hamilton in July aren't going to be used. XD

Edit: Really good explainer article on antibody studies (including a good explanation about why this is worse than the flu): https://www.propublica.org/article/w...what-they-cant

Also, a link to an article about the Diamond Princess: https://www.eurosurveillance.org/con....25.12.2000256

[Strigon]

This evidence points to one of two things: either the disease is really good at killing people, or the lock-downs didn't do anything. Without the proper scientific studies I doubt we will ever know which is the truth.

It points to neither of those things. The disease has a long incubation period and a fairly long progression to death. As a result, any reactionary lockdown is going to be well behind the curve.
Data from all around the world suggests that the average death rate is roughly 3%, with a fair bit of wiggle room, and that the growth is slowing dramatically. So, unless you consider 3% mortality to be "really good at killing people," (In which case, what do you call Ebola? MERS? Rabies?) or you think the disease would naturally be peaking right now, you really can't make a claim like that.

[Kaptin Keen]

Anyone claiming that this is not a massive, massive problem that did, in fact, need a massive solution is just flat-out wrong.

What Joran just said - plus ... look, out of those 212.000, how many got the optimal care required? Do you have that number?

Because my claim is that most of those died because there wasn't an ICU available to treat them. And that outside of health sector bottlenecks, this virus is not particularly dangerous. The numbers I've seen do suggest it's really quite bad if you're over the age of 80. But so is any other flu. I haven't actually seen a comparison for leathality between covid-19, and any other flu, for patients 80+.

[snowblizz]

I'm not particularly interested in the numbers fight, just too many unknowns and different context really.


But something that stuck with me is when they interviewd a medical profesional of somekind and they kinda casually noted "intensive care" is more "intensive" than "care" really. Basically the frailer (correlating a lot with older) you are the worse it'll be to actually get the care itself as it stresses the body, never mind the disease. That's not something that came to me intuitively, one sort of thinks that once you are getting treatment you got a good chance.

[Bobb]

What Joran just said - plus ... look, out of those 212.000, how many got the optimal care required? Do you have that number?

Because my claim is that most of those died because there wasn't an ICU available to treat them. And that outside of health sector bottlenecks, this virus is not particularly dangerous. The numbers I've seen do suggest it's really quite bad if you're over the age of 80. But so is any other flu. I haven't actually seen a comparison for leathality between covid-19, and any other flu, for patients 80+.

Latest I heard there isn't really any treatment. Even the ventilators are more of a going through the motions thing rather than an effective treatment.

That's part of the deal why it's scary. No means of mitigating damage we yet know of.

[Brother Oni]

Latest I heard there isn't really any treatment. Even the ventilators are more of a going through the motions thing rather than an effective treatment.

That's part of the deal why it's scary. No means of mitigating damage we yet know of.

Ventilators are a treatment, it's just not as effective as we'd like. Ventilators help keep the patient from drowning/suffocating until the immune system can configure a defence against the virus and the patient can breathe on their own without assistance - that's far from going through the motions.

Plasma donations from recovered people are also being looked into as a means of giving the patient's immune system a head start.

All of this is far from the gold standard treatment for a viral infection - a safe and efficacious vaccine that can be mass produced in sufficient quantities, distributed and administered effectively, all at a reasonable price.

We're still at the development of the 'safe and efficacious' stage.

[NichG]

What Joran just said - plus ... look, out of those 212.000, how many got the optimal care required? Do you have that number?

Because my claim is that most of those died because there wasn't an ICU available to treat them. And that outside of health sector bottlenecks, this virus is not particularly dangerous. The numbers I've seen do suggest it's really quite bad if you're over the age of 80. But so is any other flu. I haven't actually seen a comparison for leathality between covid-19, and any other flu, for patients 80+.

In the US at least, it looks like the bed shortage is something like 20-30% of the total bed demand (based on IHME report). So if we're generous about that and assume 100% effectiveness of medical intervention, it'd still be about 150k dead if everyone got beds.

In terms of mortality by age, flu scales by about a factor of 10 mortality per 15 years of age (https://bmcmedicine.biomedcentral.co...41-7015-10-162). So a 50 year old has a 1/100 chance of dying from it compared to an 80 year old. Covid fatalities seem to be a bit flatter with respect to age - 0.4% CFR for 40-49 year old bracket, versus 3.6% CFR for the 60-69 year old bracket - so about a factor of 10 per 20 years of age in that range. However, the 80+ bracket is listed as 14.8% which is half of what you'd get if you continued the scaling (whereas the flu scaling does seem to hold into those age ranges).

Or in other words, Covid actually kills proportionally more young people than flu does.

I'm using https://www.worldometers.info/corona...-demographics/ for the Covid data here.

I'm not particularly interested in the numbers fight, just too many unknowns and different context really.

But something that stuck with me is when they interviewd a medical profesional of somekind and they kinda casually noted "intensive care" is more "intensive" than "care" really. Basically the frailer (correlating a lot with older) you are the worse it'll be to actually get the care itself as it stresses the body, never mind the disease. That's not something that came to me intuitively, one sort of thinks that once you are getting treatment you got a good chance.

I think there's a perception that the very extreme successes of a couple aspects of modern medicine should apply uniformly across basically everything that could go wrong with you. We see that something like antibiotics can turn what would otherwise be a death sentence infection into something you can basically survive, that there are procedures like blood transfusions that turn 'you will definitely die from this' to 'you will probably survive', surgical corrections to things that would be death sentences a few hundred years ago, etc.

So then there's an impression that that should also be true for a viral infection, or in the case where your lungs just don't work, or things like that.

But I guess modern medicine is actually really patchy. Some things absolutely require treatment but we know how to treat them. Some things, we know what's going wrong but there's almost nothing that can be done about it no matter how much money you spend or resources you dedicate. There's no question to the effectiveness of antibiotics, vaccines have wiped out some diseases from the face of the world, but for antivirals it seems that the effect sizes are small enough that you actually have to be quite careful in how you construct the trials to see whether they're having an effect beyond placebo levels.

[Iruka]

What Joran just said - plus ... look, out of those 212.000, how many got the optimal care required? Do you have that number?

Because my claim is that most of those died because there wasn't an ICU available to treat them. And that outside of health sector bottlenecks, this virus is not particularly dangerous. The numbers I've seen do suggest it's really quite bad if you're over the age of 80. But so is any other flu. I haven't actually seen a comparison for leathality between covid-19, and any other flu, for patients 80+.

Those ~200k dead are confirmed Covid-19 cases, so I would assume the majority got optimal care (within the standard spectrum of the health systems).
From what I gathered the health system was only completely overwhelmed in northern Italy and New York. There they had to decide who to turn away as a hopeless case. There they had to call in the army to transport the bodies and start digging mass graves.
Those who did not receive care because they were not diagnosed in the first place are probably the additional ~100k who show up in the statistics of excess mortality.

[halfeye]

But so is any other flu.

It's not a flu. It's much more closely related to the colds, which are much milder than the flu.

[Joran]

Those ~200k dead are confirmed Covid-19 cases, so I would assume the majority got optimal care (within the standard spectrum of the health systems).
From what I gathered the health system was only completely overwhelmed in northern Italy and New York. There they had to decide who to turn away as a hopeless case. There they had to call in the army to transport the bodies and start digging mass graves.
Those who did not receive care because they were not diagnosed in the first place are probably the additional ~100k who show up in the statistics of excess mortality.

Yeah, optimal care isn't much it seems. It's putting people on oxygen and then ventilators and hoping the body's immune system fights off the infection.

Ventilators aren't great either. It's seems like 40-50% of people put on ventilators still die; 80% in NYC.

It's not a flu. It's much more closely related to the colds, which are much milder than the flu.

SARS and MERS are also coronaviruses and substantially more lethal than the cold.

[Lvl 2 Expert]

Yeah, optimal care isn't much it seems. It's putting people on oxygen and then ventilators and hoping the body's immune system fights off the infection.

Ventilators aren't great either. It's seems like 40-50% of people put on ventilators still die; 80% in NYC.

Apparently being put on a ventilator itself is quite tough on the body. So these people have to be put on ventilation or they'll suffocate, but as you hook up the ventilator you basically condemn them to at least one or two more days of their condition worsening because the shock of being put on ventilation hampers the immune system's response to the virus in that time. It's not pretty.

You could suggest trying to put people on ventilation earlier in the disease's progression so this shock comes at a slightly less inopportune time, but that will take up more ventilators and worsen the condition of people who might have been able to skate by without ventilation had you not have put them on it anyway. A more common choice seems to be to try and do it as late as humanly possible, give the patients the best chance they can get without ventilation before switching the approach over.

[Rockphed]

Latest I heard there isn't really any treatment. Even the ventilators are more of a going through the motions thing rather than an effective treatment.

That's part of the deal why it's scary. No means of mitigating damage we yet know of.

In addition to the other treatments mentioned, there is also the possibility of antimalarial drugs.

[HandofShadows]

In addition to the other treatments mentioned, there is also the possibility of antimalarial drugs.

Old news unfortunately. Hydroxychloroquine linked to more COVID-19 deaths. Not only didn't it help, it seems to have had a negative affect. (The SciShow vid came out before the study was published.) There are some studies being started to see if BCG (the vaccine for tuberculosis) might help (not cure, just help!) with COVID-19. Could BCG be used to protect against COVID-19?

[Tvtyrant]

A weird thing to me is that we oxygenate blood using the lungs at all. How have we not invented an artificial gill/blood oxygenating system that bypasses the lungs yet?

[Peelee]

A weird thing to me is that we oxygenate blood using the lungs at all. How have we not invented an artificial gill/blood oxygenating system that bypasses the lungs yet?

You're more than welcome to evolve it.

...well, your future children are, I should say.

[Iruka]

A weird thing to me is that we oxygenate blood using the lungs at all. How have we not invented an artificial gill/blood oxygenating system that bypasses the lungs yet?

It exists, apparently since the 1950s, and is used for Covid-19 cases. I would however assume the equipment to be in even shorter supply than ventilators.

[Tvtyrant]

It exists, apparently since the 1950s, and is used for Covid-19 cases. I would however assume the equipment to be in even shorter supply than ventilators.

Interesting. Seems like there should be a lot more of them considering how many deaths stem from lungs failing (my best friend had his lungs pressure collapse for instance.) Even without the issue of Covid lungs failing from pneumonia and gunshot wounds is pretty common, seems like this should be more utilized than it is. Another example personally was my grandmother having to be ventilated and puking into the tubes.

[halfeye]

A weird thing to me is that we oxygenate blood using the lungs at all. How have we not invented an artificial gill/blood oxygenating system that bypasses the lungs yet?

They are very effective. The surface area inside the lungs is vast.

[Brother Oni]

Interesting. Seems like there should be a lot more of them considering how many deaths stem from lungs failing (my best friend had his lungs pressure collapse for instance.) Even without the issue of Covid lungs failing from pneumonia and gunshot wounds is pretty common, seems like this should be more utilized than it is. Another example personally was my grandmother having to be ventilated and puking into the tubes.

If you read down a bit on the Wikipedia article, there's a number of quite severe side effects. Another factor would be the comparative cost versus ventilators; I suspect the equipment, operational and training costs of an ECMO procedure would be much higher than that for a ventilator.

[factotum]

Even without the issue of Covid lungs failing from pneumonia and gunshot wounds is pretty common, seems like this should be more utilized than it is.

The problem is, that looks to be (a) pretty invasive (because you have to withdraw and put the blood back into the patient) and (b) in no way a long term solution to anything--if a patient has pneumonia and you start bypassing their lungs with the blood supply, how is the body supposed to fight the infection? The things it uses to do that are in the blood! Seems to me you'd run a real risk of the lungs just undergoing organ death and leaving the patient requiring a full lung transplant if they're going to survive at all. Of course, I'm not a medical professional and nor do I play one on TV, that's just my thoughts on it.

[Tvtyrant]

If you read down a bit on the Wikipedia article, there's a number of quite severe side effects. Another factor would be the comparative cost versus ventilators; I suspect the equipment, operational and training costs of an ECMO procedure would be much higher than that for a ventilator.

True enough. I was going to object by saying that dialysis is practically the same process in reverse but that takes up a huge amount of money and has a shockingly bad mortality rate for the same reasons (especially in the US.) Sounds like we need better machines for this.

The problem is, that looks to be (a) pretty invasive (because you have to withdraw and put the blood back into the patient) and (b) in no way a long term solution to anything--if a patient has pneumonia and you start bypassing their lungs with the blood supply, how is the body supposed to fight the infection? The things it uses to do that are in the blood! Seems to me you'd run a real risk of the lungs just undergoing organ death and leaving the patient requiring a full lung transplant if they're going to survive at all. Of course, I'm not a medical professional and nor do I play one on TV, that's just my thoughts on it.

Presumably that means you have a big chest cavity area for cybernetic use :P We just need to get the machine small enough it can fit inside the ribcage.

[DavidSh]

The side effects seem to primarily be due to the problem of blood clotting. If you don't use anticoagulants, blood will tend to clot in the device. If you do, you risk bleeding inside the patient's body, such as in the brain. I don't see a solution until we can construct a lung out of actual human tissue. And we'd have to be able to construct one in relatively short order, as opposed to the time it takes for natural ones to grow.

[Tvtyrant]

The side effects seem to primarily be due to the problem of blood clotting. If you don't use anticoagulants, blood will tend to clot in the device. If you do, you risk bleeding inside the patient's body, such as in the brain. I don't see a solution until we can construct a lung out of actual human tissue. And we'd have to be able to construct one in relatively short order, as opposed to the time it takes for natural ones to grow.

In the world of the very wildly evil/unethical we could make immunity system free mindless clones and run the blood through those to get oxygen?

[Forum Explorer]

In the world of the very wildly evil/unethical we could make immunity system free mindless clones and run the blood through those to get oxygen?

Not really. Cloning isn't on that level yet. Also, if it was we'd just create the mindless clone, harvest it's healthy lungs, and put that into the patient.

[HandofShadows]

Not really. Cloning isn't on that level yet. Also, if it was we'd just create the mindless clone, harvest it's healthy lungs, and put that into the patient.

It would be a lot easier just to make/grow a new pair of lungs to implant rather than a whole person. And they can already transplant artificial lungs into pigs right now.

[Grey_Wolf_c]

It would be a lot easier just to make/grow a new pair of lungs to implant rather than a whole person. And they can already transplant artificial lungs into pigs right now.

Sure, but if you grow the whole person, you just transplant the brain, and not only remove the virus, but have given them a brand new younger body!

You know, if it was at all plausible and we had no moral or economic constraints.

Grey Wolf

[Forum Explorer]

It would be a lot easier just to make/grow a new pair of lungs to implant rather than a whole person. And they can already transplant artificial lungs into pigs right now.

I'm not super in the loop for biotechnology. Namely, I don't know how you clone just the lungs.

[Eldan]

Definitely working on that. I know that a few years ago, they cloned someone a new esophagus. Skin is pretty regularly replicated in vitro for burn victims or people with significant infections. People are working on the liver next, since that's a comparatively simple organ. Lungs are probably going to take a while.

But yeah, makign a functioning lung system that's not much, much bigger than a lung is a while away. Lungs are fantastically complex.

[georgie_leech]

I'm not super in the loop for biotechnology. Namely, I don't know how you clone just the lungs.

To over simplify, start the cloning process, grab those tasty stem cells and put them in a proper biologic scaffolding. All of the lungs with none of the pesky rest-of-the-clone to clean up.