Covid-19 – Testing delays cost lives

The numbers are becoming real familiar and really frightening. These are people not statistics.  I trust the professionals and their advice. All of it.

When someone is tested positive, it means that that person has been ill and potentially transmitting the disease, for days before the onset of symptoms.   This is the time lag, is the sum of the days in which the infected person had no symptoms, days with minor symptoms, days until the  patient can see a doctor and confirm that the symptoms are sufficiently  similar to Covid-19 (frequently a requirement for a test),  days until a test was performed, and days until the results were known and treatment begun.

Days + Days + Days + Days + Days = total time lag.   Surviving Covid-19 depends on early detection.   The last 3 lags occur from  the point of “flu like symptoms”  to  confirmed positives, and have to be shortened.   When I heard that in Miami, it takes 5 to 7 days from when a person is swabbed to a confirmed positive or negative, I was shocked, because this rules out early intervention.  These antiviral drugs are not working for late stage patients.  They may slow down the disease progression but not prevent death.    Testing areas in Miami and everywhere else are overrun.  Home swabbing has run into some real obstacles.   All this delay costs lives.

This also means that the new positives data, which show an exponential curve  are based on  old data.   The first light at the end of the tunnel is a decline in new positives.  Get ready for false lights, because a solid trend in the decline must be established.  Where some communities might be turning the corner, others will still be solidly on the all frightening exponential curve.  Early lifting of containment efforts can easily destroy the progress made.

Stay tuned,

Dave

 

 

Covid-19 Drive Thru testing in South Florida

The link below provides basic information on drive through testing in Miami, Broward and the Keys.

Drive Thru Testing in Miami

C.B. Smith Park site was closed after enormous lines.  A hotline for scheduling appointments has been activated.

CB Smith Park testing site closed for the day after long lines

It is  truly heart wrenching to know so many are in need of tests, and the delays in getting results can be a week or more.   There are faster ways to process the swabs,  but it takes time to get the equipment.

Start up home swabbing companies have stopped sending kits.   There are concerns of false negatives from home swabbing.

Things look bad.

Dave

Coronavirus drive thru testing

I am very focused on the drive thru testing.  How is it working?  Who qualifies and who doesn’t? How long does it takes to get the results?

I am focused on four counties in South Florida, with a combined population of 6.4 million people.   I will dispense with any political commentary.

A lot is going wrong.  Some things are going right.  Those working in the hospitals, clinics, and testing centers, thank you so much.

I just want facts.

Stay tuned,

Dave

 

Drive thru’s testing Covid-19

As a public service, I will attempt to list the names, addresses and phone numbers of any drive through Covid-19 facility, which is accepting new patients, which has recently opened in 4 Florida counties: Broward, Palm Beach, Miami-Dade  and Monroe Counties.    I will start with Miami, Florida where I have better access to information.  It is likely to be a daunting task, because drive thru’s open, get mobbed and then close.   They set up telephone numbers to screen out people.

Anyone who wants to get tested, may not qualify.    Community Health of South Florida says it will begin testing patients Wednesday at its Doris Ison Health Center, 10300 SW 216th St, in Miami, FL.  Their phone number is 305-252-4820.   This is the only drive-thru testing facility in Miami-Dade County.   A link from WSVN is provided below.   Testing will be done from 9:00 am to 12:00 noon.   Do not call just to find out how testing is going, wait times or who qualifies or not.  

Testing will be done only for regular clients who have called ahead to make sure they meet certain criteria.  To be eligible for the test, patients must have recently traveled to any of the affected countries or have been in contact with someone who has the novel coronavirus. They must also be experiencing symptoms such as fever, cough or shortness of breath. The nonprofit is asking those with severe symptoms to visit a hospital ER instead.

I assume this “regular clients” qualifier means a lot of people will not qualify.

Stay tuned,

Dave

Local News Link:

Community Health of South Florida begins drive-thru COVID-19 testing in SWMD

Coronavirus vaccine

Experts estimate it will take 12 to 18 months for a vaccine to be developed and deployed. There may be setbacks or unexpected successes, changing this estimate.   Please disregard any political noise on this issue.    Any vaccine will need animal testing trials.

I found the following link very interesting as why it takes so long:

From ferrets to mice and marmosets, labs scramble to find right animals for coronavirus studies

Here are the opening lines:

One lab is digging into its freezer to thaw out the archived sperm of SARS-susceptible mice. Another is anesthetizing ferrets so they don’t sneeze when the new coronavirus is squirted into their nostrils. Yet others are racing to infect macaques, marmosets, and African green monkeys.

One of the main points is that coronaviruses are not new to scientists. The SAR’s virus is a coronavirus.  But Covid-19 is a different one, coming with new complications.   Apparently,  the good guys in our body’s defense (the immune system) might end up making things worse as it can result in “a violent inflammatory response to a viral intruder.”  Scientists refer to this as the host immune response.  The critters used in experiments need a response as similar as possible to the ones in humans.

Science is supposed to build on prior knowledge, but can only do so if the past viruses are similar in their attack and host response.  In novel coronavirus, it looks like nature has thrown a curve ball.  For SARS –  the golden Syrian hamster “an excellent model” according to the above article.

Now we get to the crazy part.  Testing may be most effective using genetically altered mice.  “Give the rodents [mice]  human receptors, either inserting the molecules locally in the respiratory tract or breeding mice that have virus-susceptibility wired into the entire body’s DNA.”

These  special mice used for testing will likely come from two sources:  Jackson Laboratories in Bar Harbor, Maine (see link below) and University of North Carolina.    The best line of the article is:

Now, researchers are rushing to figure out which creatures work best, a task that could take months. “We’re at the ‘Uh oh, it’s complicated’ stage,” said Lisa Gralinski, a microbiologist and assistant professor of epidemiology who studies coronaviruses at the University of North Carolina at Chapel Hill.

It’s absolutely complicated and really all the stuff about receptors and the virus sneaking inside a cell is beyond my high school level of biology.  But I immensely appreciate the author’s help in breaking down these concepts.

I also know of Jackson Labs, one of the great non-profit organizations.  It recently celebrated its 90th anniversary.  They will likely not be discovering the right vaccine, but they will be providing one critical element – the transgenic mice to research groups around the world.

My impression is we’ve got excellent research organizations and laboratories who are working around the clock on coronavirus.  There is an immense knowledge sharing worldwide.

Unfortunately bottom line is testing  of the many possible vaccines is challenging.  Finding the right test animals and creating a sufficient stock is one of the challenges.

Stay tuned,

Dave

Links:

Jackson Labs – Coronavirus

Notice from Jackson Labs:  We are now accepting pre-orders for the K18-hACE2 transgenic mouse model for coronavirus research.

An air-locked lab at UNC is leading research on cures for the coronavirus

Coronavirus, the flu shot, etc.

I got my shot in September of last year.  It was given free at CVS.  I’ve read enough on legitimate websites to convince me to get the shot.  Every year a lot of people will get the flu and some will show up at hospitals and doctor offices wanting to be tested for Covid-19.   I don’t want to be in that group if I can help it.   The flu shot doesn’t help your resistance to Covid-19.   Fewer folks with the flu this year means more effective Covid-19 testing.

I will also not buy a mask.  The surgeon general says it doesn’t help keep you from getting Covid-19.  Sure, doctors, nurses and dentist use them.    But they are in intimate contact with a lot of ill people.

I will travel outside the US.  Travel to me is one of life’s pleasures.  Fortunately, cruises have never been a part of my plan.

Stay tuned,

Dave

 

 

Political rhetoric on Coronavirus

First, any spread of misinformation for political gain, from either party is really reprehensible.   Also, we will report on any politician who spreads misinformation, regardless of their political affiliation.    The worst offenders are the social media posts, particularly Facebook right now.

(1) Testing Confusion (Trump announcement, March 4):

“The Obama administration made a decision on testing that turned out to be very detrimental to what we’re doing, and we undid that decision a few days ago so that the testing can take place at a much more accurate and rapid fashion,” Trump stated. “That was a decision we disagreed with. I don’t think we would have made it, but for some reason it was made. But we’ve undone that decision.”

The website, “Red State Poll” concluded: “An example of the unanticipated effects of over regulation, one of the many from the Obama administration.”  Commentators followed by noting that many lives could have been saved it Obama hadn’t decided to over regulate the drug industry, with unnecessary regulations.

Problem with Trump’s claim and all the subsequent comments, is that the claim is false.  Yes,  the Obama administration was proposing ways that state testing could be better standardized, but this regulation was never passed  as a rule.   Trump did not “undo” anything passed by the Obama administration.  Laboratory determined tests (LDT)  at variance with FDA approved testing is permitted under FDA regulations, without pre-approval in emergency situations.   See links from factcheck.org and politifact,com

Politifact:  Trump’s claim is FALSE.

Factcheck: Experts, however, told us no such formal regulation was ever implemented under the previous administration.

(2) “Bad”  Covid-19 Test Kits were distributed to health departments causing inconclusive results 

This  is true, according to the CDC website.  It has been called a glitch or snag in the testing.   The CDC confirmed this testing problem as follows:

After distribution of a CDC rRT-PCR test to diagnose COVID-19 to state and local public health labs started, performance issues were identified related to a problem in the manufacturing of one of the reagents. Laboratories were not able to verify the test performance.

There are two possible errors that can be made in testing, which are a false negative, when a patient is diagnosed as not having Covid-19 when in fact they do and a false positive, when a patient is diagnosed as having Covid-19 when they do not.  If the tests were inconclusive, then the health departments may have erroneously interpreted this as the patient was suffering from the flu or other illnesses.

Apparently, the problem was in the manufacturing of one of the reagents in the test kits.  The CDC website indicates that the faulty kits can still be used but with a new testing protocol.   Of course, they are trying to produce as many good test kits as possible.

(3) Trump’s “seasonality” tweet

“On Feb 7 following a conversation with China’s president about the outbreak, President Donald Trump tweeted that as the weather becomes warmer the virus will become weaker and die out.”

The claim is FALSE

When asked about Trump’s tweet, Messonnier said most respiratory viruses are indeed seasonal, but COVID-19 is a new disease that health officials have been observing for only 6 weeks, so it’s premature to make assumptions on whether it will continue to circulate into the spring and summer.  She added that the CDC, in its outbreak planning, isn’t counting on a drop in virus activity as the weather warms. [Note: Dr.  Nancy Messonnier  directs the CDC’s National Center for Immunization and Respiratory Diseases].

(4) The Obama administration “didn’t do anything about” swine flu. (Trump’s interview with Sean Hannity, March 4)

The claim is FALSE according to Politifact. Obama’s acting director of health and human services declared H1N1 a public health emergency on April 26, 2009. That was when the United States had only 20 confirmed cases of H1N1 and no deaths.

Trump said: “There were 60 million cases of swine flu” during the Obama administration “and they didn’t do anything about it.” His assessment on the nation’s response is incorrect. The Obama administration issued two emergency declarations, triggering billions of dollars in spending toward vaccines and other public health response measures. The statement is False.

(5) Mike Bloomberg  said  of President Donald Trump’s actions on the coronavirus: “No. 1, he fired the pandemic team two years ago. No. 2, he’s been defunding the Centers for Disease Control.”

Politifact rates this claim as HALF TRUE.

According to Politifact:   “Bloomberg had a point that the Trump administration ousted some of its officials dealing with global pandemics, but “defunding” the CDC is more complicated than he let on… It’s not accurate to say that Trump has been “defunding” the CDC, but he has tried to make cuts in key programs. It’s just that Congress didn’t listen.”

A graph on the Politifact website  shows that through the Obama and Trump administrations, Congress has appropriated consistently increased annual funding for emerging and zoonotic infectious diseases at the Centers for Disease Control and Prevention.

I would probably have labeled Bloomberg’s claims as false, because Trump did not fire his “pandemic team” nor were the important areas of the CDC budget cut.

(6) Mike Pence: “With regard to the cost, let me be very clear: HHS has designated the coronavirus test as an essential health benefit. That means, by definition, it’s covered in the private health insurance of every American, as well as covered by Medicare and Medicaid.”

Politifact labels this claim as HALF TRUE.  

Politifact concludes that simply labeling the Covid-19 testing as an essential health benefit (EHB) does not mean it is automatically covered. The requirements (as an EHB)  don’t apply to many workplace plans (including those provided by large businesses and self-insured plans), even though most Americans ― about 157 million ― who have health insurance get it through their job.  Most of these plans, though, do cover a wide range of benefits, including laboratory services, but they are not required by law to do so.

I will add that it makes a lot of good common sense for insurance companies to gain the goodwill of their customers, to pay for testing.   His statement that insurance companies will pay for testing will prove to be true but not because of any action by HHS.

I’d say Trump is still the winner in the most egregious and politically motivated lie on the rescinding of Obama era regulations for Covid-19 testing.  It is certainly a good contender in the Lie of the Year for 2020.

As I have blogged previously, the absolutely worst place to get information is social media.   Politifact website list 14 comments qualifying as “Pants on Fire”, which includes baseless and very reckless comments from social media, primarily Facebook.   Hopefully, Facebook will take action to force bloggers to remove these posts.

Stay tuned,

Dave

Links:

Politifact on testing regulations: 

Glitch delays COVID-19 tests for states as first evacuees cleared

CDC website which acknowledges testing problems

Factcheck on testing problems: 

Politifact:  Insurance coverage for testing

Politifact:  Coronavirus fact checking

 

North Korea – Enormous Problems for the Hermit Kingdom

We don’t know how many people are infected with Covid-19 in North Korea.     But, in  South Korea there are over 7,000 cases reported.   The problem in North Korea is there is also a tuberculosis epidemic and the quarantines are stopping vital medications to treat TB.    TB is curable and preventable.  This is from the World Health Organization website:

A total of 1.5 million people died from TB in 2018 (including 251 000 people with HIV). Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent (above HIV/AIDS).
In 2018, an estimated 10 million people fell ill with tuberculosis(TB) worldwide. 5.7 million men, 3.2 million women and 1.1 million children. There were cases in all countries and age groups. But TB is curable and preventable.  In 2018, 1.1 million children fell ill with TB globally, and there were 205 000 child deaths due to TB (including among children with HIV). Child and adolescent TB is often overlooked by health providers and can be difficult to diagnose and treat.

There is a multiple drug resistant form, called MDR-TB which requires taking several drugs in combination.   See links below from Mayo Clinic.

I’ve said it before, that globalism v.  nationalism in many cases isn’t a choice, because global problems requires global solutions.    The old adage, “What goes around, comes around” is really true now.   The cases in the US are increasing, hitting a new high of 80 cases/day.

See links below.

Stay tuned,

Dave

Links:

Science Mag: Coronavirus disruptions could hurt North Korea’s efforts to treat tuberculosis

World Health Organization:  Tuberculosis

Mayo Clinic Tuberculosis

Good sources of information on the Coronavirus

There is a lot of bad information being circulated.

These are all very good websites.

CDC: 2019 Novel Coronavirus Situation Summary

Excellent up-to-date information on many aspects of the Coronavirus.

Food and Drug Administration:  Coronavirus

World Health Organization: Coronavirus

New York Times:  Tracking every Coronavirus case in the US

The New York Times has done an excellent public service by providing free interactive maps of the known cases of Covid-19 as obtained by the information provided by the CDC and other health officials.   New cases seem to be growing exponentially.  As of March 6, 306 people have Covid-19.    China has approximately 80,600 known cases.  The same link has a map with a world wide cases.   Italy, Iran and Korea have cases in the thousands.

What I found interesting was in 107 cases, or approximate 1/3 of the cases, the possible origins are unknown.   In only 15 cases, there was travel to China.

Dr.  Anthony Fauci,  is the director of the NIAID (National Institute for Allergies and Infection Diseases) said we are probably a year away from a vaccine against Covid-19.

Contagion Live 

China and the other hard hit countries will likely be the places where new vaccines are tested.  I hope that scientists will find an effective vaccine in less than a year.

Stay tuned,

Dave