wuhan - coronavirus

[Arcadia]

🙂 🇬🇧 

https://www.bbc.com/sport/formula1/52189430

“Mercedes has made the design of a new breathing-aid device it helped develop freely available to help fight the coronavirus crisis.

The device helps patients with lung infections breathe more easily when an oxygen mask alone is insufficient.

The device was designed in conjunction with University College London.

UCL Hospital consultant Professor Mervyn Singer said: "These devices help save lives by ensuring ventilators are used only for the most severely ill."
 

The new 'continuous positive airway pressure' device was reverse-engineered from a previous model in less than 100 hours and received regulatory approval last week.

The revised design consumes 70% less oxygen than the earlier model.

The designs released by Mercedes for public use include specifications of materials, tools and kit used in the rapid-prototyping process.

The UK government has ordered 10,000 of the devices which are being produced "at a rate of up to 1,000 a day", Mercedes say, at their engine-design base in Brixworth, Northamptonshire.

Professor Rebecca Shipley, Director of UCL Institute of Healthcare Engineering, said: "These life-saving devices are relatively simple to manufacture and can be produced quickly. We hope that, by making the blueprints publicly available, they can be used to improve the resilience of healthcare systems preparing for the Covid-19 pandemic globally."

The Mercedes effort is part of a wider scheme undertaken by all seven UK-based F1 teams, featuring three different work streams, aimed at boosting the supply of critical-care equipment in hospitals across the country.”

[Corraleno]

1 hour ago, Pen said:

But I think now that there are some strong differences in USA regional attitudes toward CV19. 

I don't think you can extrapolate patterns like that based on a small number of random emails sent to one person.

I think being concerned about planning and wanting to see some decent data modeling is much more a function of individual personality and circumstances. Some people are planners and some are more go-with-the-flow. People who have/had important plans and activities that have been postponed are going to be more anxious about knowing when those things can resume than those whose plans are more flexible or easy to reschedule. For me, personally, it doesn't much matter whether restrictions lift in two weeks or 6 months, but that difference would literally be life-altering for DS, and having a "best estimate based on what we know now" is far less anxiety-inducing than "we have no idea."

There is also a lot of frustration not with the lack of exact numbers (peak deaths, or vent use, or whatever) but with the incredible discrepancies between different models that use different data and assumptions. I was shocked to discover that the IHME predictions were based entirely on data from Wuhan. That just seems so crazy and counter-productive to be making predictions — predictions that may be driving real policy decisions — based on data we know is absolute garbage. I would really like to see some of the other models and know what those are based on, in conjunction with qualitative "best guesses" from experts.

[Pen]

52 minutes ago, mathnerd said:

The bad news is that the dumping of milk has started already in california and wisconsin. All the school cafeterias, workplaces, restaurants have stopped ordering. Apparently the big restaurants now use ultra pasteurized shelf stable milk and no longer buy fresh milk. All the farmers who had contracts for supplying fresh milk to these places are dumping. That makes me so sad because I cannot buy as much milk as I want in my area because there is a limit of 1 per customer and forget about milk powder - I have been looking for it for a month now and can only get goat milk powder online. If I find the article about milk dumping, I will post a link to it later on.

 

Might not be the link you were thinking of but here is one

https://www.reuters.com/article/us-health-coronavirus-dairy-insight/u-s-dairy-farmers-dump-milk-as-pandemic-upends-food-markets-idUSKBN21L1DW

 

There’s obviously a mismatch between demand for milk that individuals want and milk dumping.

The article said milk can’t be frozen or stored in silos...

But powdered can be stored relatively well.

And maybe some company should make ice cream that’s to preserve the milk, not to make it into a dessert.  So for example no sugar form and it could last longer frozen and go in coffee.

Hey.  I have a home ice cream maker.  Next time I am out if I can get milk enough, if there aren’t severe restrictions on number of quarts allowed, I am getting some extra and seeing if I can do that.

And  what a bummer that I only just now thought of it! 

[TCB]

I saw something interesting on a healthcare FB Covid site - no source, couldn’t get the link to open also so am just going to copy and paste.

Below is a quote - not written by me!

 

 

“A friend sent this to me and it makes SO MUCH SENSE!!  Hypothesizing that covid-19 is a primary hematologic infection rather than respiratory.  This is an analysis done on a computer to study the virus.  A lengthy read but it is what we are seeing in these patients.

"Might not even be a respiratory illness after all and that's just a byproduct of the wreckage it makes in blood haemoglobin (thus making ARDS a symptom not a cause).

I wish this would get more traction because if this computational analysis is correct, this could completely change the way we approach COVID, globally.

I will copy some summaries that explain this paper in layman's terms:

- Using computational analysis (modeling the behavior of a molecule in a computer), they've worked out the probable mechanism by which SARS-nCov-2 wreaks havoc on patients, as well as why chloroquine and favipiravir seem to work.

- Inside our red blood cells, there is a molecule called hemoglobin, which contains heme groups. Each heme group is a molecular "ring" (called a porphyrin) that can hold an iron (Fe) ion inside. Having an iron ion inside is what allows this heme to carry O2 (and CO2) in our blood. This is how our bodies move O2 to our tissues and remove CO2 waste products.

- The paper modeled these and found that the proteins produced when COVID replicates "collaborate" to knock iron ions out of heme groups (HBB) and replace them with one of the proteins. This makes the red blood cell unable to transport O2 and CO2!

- If the computer modeling is right, it shows that the virus hijacks our [red] blood [cells] and makes it unable to carry O2 to a patient's tissues/organs, and likewise unable to carry CO2 out of them. This would lead to organ and tissue death, roughly in the same way as if a patient were being suffocated. Even when a patient can breath (fill lungs with air), the oxygen isn't getting to the cells in their body.

- The inflammation in the lungs results from the lungs not being able to perform the oxygen/CO2 exchange, and would therefore appear to be a SECONDARY result of the hijacking of the blood. The lungs not working is a result of lack of O2 in blood, not the cause of it. Hence the "ground glass opacities".

- The paper models the behavior of chloroquine and faviparavir as well, which appear to bind to the non-structural viral proteins that hijack the heme groups, thus inhibiting them from knocking out the iron and wrecking the O2-carrying ability of the red blood cells.

- This also explains the observation made by various ER docs (incl this one in New Orleans) that patients tend to have elevated ferritin: ferritin is used to store excess iron. If a lot of iron is knocked out of heme groups and floating around, the body produces more ferritin

If true, this may mean a few things:

1. Starting drug treatment while symptoms are mild keeps virus from hijacking too much blood, enabling a still-healthy body to mount an immune response. Explains why early drug treatment (first week of symptoms) is often successful.

2. Drug treatment and intubation once patient is critical will rarely work because tissues/organs are already damaged, blood can't carry O2, and the body is too weak to produce new red blood cells able to carry Fe (and thus oxygen/CO2) even if drugs inhibit more hijacking.

3. Thus: start severe patients on drug treatment upon hospital intake to suppress further hijacking of blood by the virus, then give them a blood transfusion of new red blood cells immediately that are unhijacked. If all this is true, we would see rapid patient improvement.

---

The problem is we have not yet had studies testing whether patients will respond well to blood transfusions from people who have not had COVID-19. Right now medical attention is focused on blood transfusions from those who have beat COVID and have antibodies. This needs to be looked at

This research ties in to the fact that weight/age/high blood pressure are such risk factor and why certain blood types are less afflicted than other

NonAfrican malaria risk zones have a population with genetic thalassemia, which would explain the discrepancies in the population affected by CV, this is noted in Italy:" “

Edited April 7, 2020 by TCB

[lewelma]

13 hours ago, Matryoshka said:

Can someone tell me how the *same* model took those numbers and trends and decided that we'd end up needing 10x more beds and ventilators than Louisiana? 

Just catching up on the thread this morning.  The word "same" in modelling, does not mean the same *numbers* are put into coefficients. "Same" means the same *type* of model (there are many many kinds). So the models can be considered the same, while having different rates, relationships, and time lags put between variables to link them.  Small changes to these numbers can make massive massive differences to forecasts.  

Edited April 7, 2020 by lewelma

[Matryoshka]

4 minutes ago, TCB said:

I saw something interesting on a healthcare FB Covid site - no source, couldn’t get the link to open also so am just going to copy and paste.

 

“A friend sent this to me and it makes SO MUCH SENSE!!  Hypothesizing that covid-19 is a primary hematologic infection rather than respiratory.  This is an analysis done on a computer to study the virus.  A lengthy read but it is what we are seeing in these patients.

"Might not even be a respiratory illness after all and that's just a byproduct of the wreckage it makes in blood haemoglobin (thus making ARDS a symptom not a cause).

I wish this would get more traction because if this computational analysis is correct, this could completely change the way we approach COVID, globally.

I will copy some summaries that explain this paper in layman's terms:

- Using computational analysis (modeling the behavior of a molecule in a computer), they've worked out the probable mechanism by which SARS-nCov-2 wreaks havoc on patients, as well as why chloroquine and favipiravir seem to work.

- Inside our red blood cells, there is a molecule called hemoglobin, which contains heme groups. Each heme group is a molecular "ring" (called a porphyrin) that can hold an iron (Fe) ion inside. Having an iron ion inside is what allows this heme to carry O2 (and CO2) in our blood. This is how our bodies move O2 to our tissues and remove CO2 waste products.

- The paper modeled these and found that the proteins produced when COVID replicates "collaborate" to knock iron ions out of heme groups (HBB) and replace them with one of the proteins. This makes the red blood cell unable to transport O2 and CO2!

- If the computer modeling is right, it shows that the virus hijacks our [red] blood [cells] and makes it unable to carry O2 to a patient's tissues/organs, and likewise unable to carry CO2 out of them. This would lead to organ and tissue death, roughly in the same way as if a patient were being suffocated. Even when a patient can breath (fill lungs with air), the oxygen isn't getting to the cells in their body.

- The inflammation in the lungs results from the lungs not being able to perform the oxygen/CO2 exchange, and would therefore appear to be a SECONDARY result of the hijacking of the blood. The lungs not working is a result of lack of O2 in blood, not the cause of it. Hence the "ground glass opacities".

- The paper models the behavior of chloroquine and faviparavir as well, which appear to bind to the non-structural viral proteins that hijack the heme groups, thus inhibiting them from knocking out the iron and wrecking the O2-carrying ability of the red blood cells.

- This also explains the observation made by various ER docs (incl this one in New Orleans) that patients tend to have elevated ferritin: ferritin is used to store excess iron. If a lot of iron is knocked out of heme groups and floating around, the body produces more ferritin

If true, this may mean a few things:

1. Starting drug treatment while symptoms are mild keeps virus from hijacking too much blood, enabling a still-healthy body to mount an immune response. Explains why early drug treatment (first week of symptoms) is often successful.

2. Drug treatment and intubation once patient is critical will rarely work because tissues/organs are already damaged, blood can't carry O2, and the body is too weak to produce new red blood cells able to carry Fe (and thus oxygen/CO2) even if drugs inhibit more hijacking.

3. Thus: start severe patients on drug treatment upon hospital intake to suppress further hijacking of blood by the virus, then give them a blood transfusion of new red blood cells immediately that are unhijacked. If all this is true, we would see rapid patient improvement.

---

The problem is we have not yet had studies testing whether patients will respond well to blood transfusions from people who have not had COVID-19. Right now medical attention is focused on blood transfusions from those who have beat COVID and have antibodies. This needs to be looked at

This research ties in to the fact that weight/age/high blood pressure are such risk factor and why certain blood types are less afflicted than other

NonAfrican malaria risk zones have a population with genetic thalassemia, which would explain the discrepancies in the population affected by CV, this is noted in Italy:" “

That is very interesting!  I had to look up thalassemia and who's in the higher risk group genetically, and came up with Thalassemia occurs most often in African Americans and in people of Mediterranean and Southeast Asian descent.  Is this a US-centric look?  Why African-Americans and not Africans?  Could explain the unusually high death rates in the European Mediterranean countries?  But Southeast Asia seems to be doing relatively well, at least so far??

[Pen]

Okay — sent messages to my state Dairy Council and to a local area creamery.

Will contact OV too.  

[lewelma]

Also, I'm not sure that anyone has mentioned this yet, but given the number of models being made and the standard significance level of 5% to be considered statistically significant, they are doing way too many tests.  Each model's coefficients for each variable will have its own significance level, so more like 10 per model.  So unless they have dropped their significance level *way* down, they are coming up with a large number of spurious results. And given that I believe they are using daily data (not hourly), they don't have enough data to actually drop the significance level down and still find anything significant.

That means that they could think that a certain relationship is important when there is actually NO evidence to support it.  This could lead them to forecast the future with models that are completely unsupported. 

[RootAnn]

10 minutes ago, TCB said:

NonAfrican malaria risk zones have a population with genetic thalassemia, which would explain the discrepancies in the population affected by CV, this is noted in Italy:" “

I was following this well enough until this. I looked up genetic thalassemia but got lost pretty fast (like immediately). Can you explain if this is good or bad? I assume some populations have blood cells that are harder to hijack?

Besides the drugs listed, what would be a treatment  (or preventative) to catch this early on if this is true? Ideas?

[Pen]

 

@CuriousMomof3 I deleted ref to you from my post. You are on my “ignore list” but somehow it seems to fail and sometimes your messages come through to me.

Believe you me, I don’t want them to! 

Maybe the Ignore failure is started by you replying to some of my posts and maybe that knocks you out of “Ignore”? 

Or maybe it is just a sight glitch like how sometimes I can and sometimes can’t do multi quote or even single quote, and some times can and sometimes cannot do links.  Maybe it is just a site glitch that sometimes “Ignore” feature fails.

Though it does seem to fail at times, I urge you to put me on your “Ignore” as I put you on mine, not to quote my posts, and I think we will both be happier. 😊

Edited April 7, 2020 by Pen

[Matryoshka]

Just now, lewelma said:

Just catching up on the thread this morning.  The word "same" in modelling, does not mean the same *numbers* are put into coefficients. "Same" means the same *type* of model (there are many many kinds). So the models can be considered the same, while having different rates, relationships, and time lags put between variables to link them.  Small changes to these numbers can make massive massive differences to forecasts.  

Thanks.  But that if whatever coefficients they're using in their equation causes that stark a discord between both basic common sense (I don't need any kind of model to know that Louisiana was not past peak in any way, shape, or form) and actually ends up predicting outcomes in both directions that are in complete opposition to what happens, then I kinda think their model stinks, and I have a really hard time looking at any other data it's spewed out and thinking that it's anything but dartboard territory.

My dh said in his engineering classes, he had a prof that would harp on when doing any kind of math, especially as it applies to real-life problems, look at the answer and say "does that make sense" to see if you've, say, misplaced a decimal or mixed up your dimensional analysis (ending up with mm instead of meters, or mixing metric with US measurements, or any number of other gaffes).  The output here, flatly, makes no sense.  

[TCB]

2 minutes ago, Seasider too said:

 

Wow that is fascinating! Thanks for the layman’s translation. This does seem to tie together some of the random observations gathered as we’ve learned more about this virus along the way. 

I can’t take any credit for it at all. I simply copied and pasted. The only thing I wrote is the very first paragraph. Couldn’t figure out how to make that more clear.

[TracyP]

2 hours ago, BeachGal said:

Regarding the plasma antibody treatment, I think Mayo is coordinating and overseeing the places that will be using it, but the identification of the antibodies that work on Covid, I believe, is the result of Regeneron’s work. It’s no small feat what Regeneron has done.

https://www.fiercepharma.com/pharma/regeneron-s-r-d-war-room-sleepless-nights-and-esprit-de-corps-hunt-for-covid-19-therapy

It will be interesting to see how well this works because antibodies have trouble “sticking” to this virus. It’s a sneaky virus for sure.

I don't think this project is related to what Mayo is doing. The Mayo trial will be giving transfusions using the blood of someone recovered from COVID. A couple (very small) Chinese studies showed success with this treatment. The Regeneron project sounds like it will be much more targeted since it is looking at which specific antibodies will be most effective and creating them in the lab. It's exciting to see this being worked on from so many different fronts.

[Matryoshka]

9 minutes ago, RootAnn said:

I was following this well enough until this. I looked up genetic thalassemia but got lost pretty fast (like immediately). Can you explain if this is good or bad? I assume some populations have blood cells that are harder to hijack?

My google came up with a site that simplified the description enough that I think I've got the gist... Thalassemia (thal-uh-SEE-me-uh) is an inherited blood disorder that causes your body to have less hemoglobin than normal. Hemoglobin enables red blood cells to carry oxygen. Thalassemia can cause anemia, leaving you fatigued.

So, what I'm getting from this is that if you have it, your blood already has trouble with your red blood cells transporting oxygen (to varying extents).  So a disease that impacted that would be worse for those people.

Edited April 7, 2020 by Matryoshka

[TCB]

4 minutes ago, RootAnn said:

I was following this well enough until this. I looked up genetic thalassemia but got lost pretty fast (like immediately). Can you explain if this is good or bad? I assume some populations have blood cells that are harder to hijack?

Besides the drugs listed, what would be a treatment  (or preventative) to catch this early on if this is true? Ideas?

I think having Thalassemia would be a negative thing. I’m pretty sure there is a prevalence of it in Italy and other Mediterranean countries which may explain the worse outcomes.

I have heard at work that the hydroxychloraquine does not work as well later on in the disease course. If we could figure out those at more risk, find them early in their disease course and treat them with this drug it may prevent them getting worse.

I have been hearing a few people questioning the mechanism of the disease so thought this was very interesting. 

[Arcadia]

20 minutes ago, TCB said:

I saw something interesting on a healthcare FB Covid site - no source, couldn’t get the link to open also so am just going to copy and paste.

Below is a quote - not written by me!

Date format is day.month.year
https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173
“

COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism

Version 5

 

Preprint revised on 27.03.2020, 17:33 and posted on 30.03.2020, 01:53 by liu wenzhong Li hualan

The novel coronavirus pneumonia (COVID-19) is an infectious acute respiratory infection caused by the novel coronavirus. The virus is a positive-strand RNA virus with high homology to bat coronavirus. In this study, conserved domain analysis, homology modeling, and molecular docking were used to compare the biological roles of certain proteins of the novel coronavirus. The results showed the ORF8 and surface glycoprotein could bind to the porphyrin, respectively. At the same time, orf1ab, ORF10, and ORF3a proteins could coordinate attack the heme on the 1-beta chain of hemoglobin to dissociate the iron to form the porphyrin. The attack will cause less and less hemoglobin that can carry oxygen and carbon dioxide. The lung cells have extremely intense poisoning and inflammatory due to the inability to exchange carbon dioxide and oxygen frequently, which eventually results in ground-glass-like lung images. The mechanism also interfered with the normal heme anabolic pathway of the human body, is expected to result in human disease. According to the validation analysis of these finds, chloroquine could prevent orf1ab, ORF3a, and ORF10 to attack the heme to form the porphyrin, and inhibit the binding of ORF8 and surface glycoproteins to porphyrins to a certain extent, effectively relieve the symptoms of respiratory distress. Favipiravir could inhibit the envelope protein and ORF7a protein bind to porphyrin, prevent the virus from entering host cells, and catching free porphyrins. Because the novel coronavirus is dependent on porphyrins, it may originate from an ancient virus. Therefore, this research is of high value to contemporary biological experiments, disease prevention, and clinical treatment.”

 

[lewelma]

20 minutes ago, Matryoshka said:

Thanks.  But that if whatever coefficients they're using in their equation causes that stark a discord between both basic common sense (I don't need any kind of model to know that Louisiana was not past peak in any way, shape, or form) and actually ends up predicting outcomes in both directions that are in complete opposition to what happens, then I kinda think their model stinks, and I have a really hard time looking at any other data it's spewed out and thinking that it's anything but dartboard territory.

My dh said in his engineering classes, he had a prof that would harp on when doing any kind of math, especially as it applies to real-life problems, look at the answer and say "does that make sense" to see if you've, say, misplaced a decimal or mixed up your dimensional analysis (ending up with mm instead of meters, or mixing metric with US measurements, or any number of other gaffes).  The output here, flatly, makes no sense.  

I complete agree.  I posted quite a bit about models yesterday on this thread. Have you seen my posts?  Basically, there are likely not enough *good* modellers for each area, and it is very *easy* to make a poor model and not know that it is poor because you either 1) don't have a lot of experience in modelling or 2) you are overconfident in you abilities, or 3) you just don't have the personality/intellect to model well. 

After I did 4 years of modelling for my PhD, my take away was that all my models were useless.  They were a complete fabrication based on trial and error and lots of guess, but then put in the guise of objective analysis with clinical numbers. I walked away from modelling and never looked back.  It is because of this experience that I have been completely ignoring the models once the interventions began.  They do not have enough data. The models after the interventions are not any good and that is why they make NO sense. 

Edited April 7, 2020 by lewelma

[Matryoshka]

1 minute ago, lewelma said:

I complete agree.  I posted quite a bit about models yesterday on this thread. Have you seen my posts?  Basically, there are likely not enough *good* modellers for each area, and it is very *easy* to make a poor model and not know that it is poor because you either 1) don't have a lot of experience in modelling or 2) you are overconfident in you abilities, or 3) you just don't have the personality/intellect to model well. 

After I did 4 years of modelling for my PhD, my take away was that all my models were useless.  They were a complete fabrication based on trial and error and lots of guess, but then put in the guise of objective analysis with clinical numbers. I walked away from modelling and never looked back.  It is because of this experience that I have been completely ignoring the models once the interventions began.  They do not have enough data. The models after the interventions are not ANY good and that is why they make NO sense. 

I did read your posts earlier, but was still hoping you'd weigh in on this one, as it just seemed SO bad.  Like they did 2+2=22, and just put it out there and hoped we wouldn't notice?  I'd think at the very least what you'd do with a necessarily imperfect model with too-limited data would be check what it spit out against basic reality and make sure it wasn't 180 degrees off...

Thanks for the additional info and the second paragraph made me LOL.  I shall just continue to ignore that model, then! 

[mathnerd]

53 minutes ago, Pen said:

 

Might not be the link you were thinking of but here is one

https://www.reuters.com/article/us-health-coronavirus-dairy-insight/u-s-dairy-farmers-dump-milk-as-pandemic-upends-food-markets-idUSKBN21L1DW

 

There’s obviously a mismatch between demand for milk that individuals want and milk dumping.

The article said milk can’t be frozen or stored in silos...

But powdered can be stored relatively well.

And maybe some company should make ice cream that’s to preserve the milk, not to make it into a dessert.  So for example no sugar form and it could last longer frozen and go in coffee.

Hey.  I have a home ice cream maker.  Next time I am out if I can get milk enough, if there aren’t severe restrictions on number of quarts allowed, I am getting some extra and seeing if I can do that.

And  what a bummer that I only just now thought of it! 

The problem is that it is not feasible for farmers under contracts with providers who cater to school cafeterias and such to turn around and send their inventory to a powdered milk maker or ice cream factory because businesses are not so agile as to suddenly divert their trucks to farms that have too much milk, send them over to factories that have fixed production capacities and manpower and make more of some things on-demand because there is a crisis. Some overseeing body has to take this issue up and co-ordinate this effort on a massive scale in order to make best use of dairy products. Who that is and how it will be done is what I am thinking about.

[hopeallgoeswell]

22 minutes ago, square_25 said:

The county tracker now has a "go back in time" button: 

https://infection2020.com/

I have a hard time with this. If the testing rates in the beginning are extremely low and even then are only testing symptomatic people who have tested negative for the flu then over time move to more testing of a greater range of people, the spread is naturally going to look bad, right?  A better graph might be started after testing is wide-spread and includes people who are both well and have not been traced to positive people.  That would give a better data set and not be so "doomsday"?  I think people who don't understand numbers are going to look at the map in the link and push for locking down permanently for over a year (like some media is repeating ad nauseam) to prevent further spread. 

[Frances]

1 hour ago, TCB said:

I saw something interesting on a healthcare FB Covid site - no source, couldn’t get the link to open also so am just going to copy and paste.

Below is a quote - not written by me!

 

 

“A friend sent this to me and it makes SO MUCH SENSE!!  Hypothesizing that covid-19 is a primary hematologic infection rather than respiratory.  This is an analysis done on a computer to study the virus.  A lengthy read but it is what we are seeing in these patients.

"Might not even be a respiratory illness after all and that's just a byproduct of the wreckage it makes in blood haemoglobin (thus making ARDS a symptom not a cause).

I wish this would get more traction because if this computational analysis is correct, this could completely change the way we approach COVID, globally.

I will copy some summaries that explain this paper in layman's terms:

- Using computational analysis (modeling the behavior of a molecule in a computer), they've worked out the probable mechanism by which SARS-nCov-2 wreaks havoc on patients, as well as why chloroquine and favipiravir seem to work.

- Inside our red blood cells, there is a molecule called hemoglobin, which contains heme groups. Each heme group is a molecular "ring" (called a porphyrin) that can hold an iron (Fe) ion inside. Having an iron ion inside is what allows this heme to carry O2 (and CO2) in our blood. This is how our bodies move O2 to our tissues and remove CO2 waste products.

- The paper modeled these and found that the proteins produced when COVID replicates "collaborate" to knock iron ions out of heme groups (HBB) and replace them with one of the proteins. This makes the red blood cell unable to transport O2 and CO2!

- If the computer modeling is right, it shows that the virus hijacks our [red] blood [cells] and makes it unable to carry O2 to a patient's tissues/organs, and likewise unable to carry CO2 out of them. This would lead to organ and tissue death, roughly in the same way as if a patient were being suffocated. Even when a patient can breath (fill lungs with air), the oxygen isn't getting to the cells in their body.

- The inflammation in the lungs results from the lungs not being able to perform the oxygen/CO2 exchange, and would therefore appear to be a SECONDARY result of the hijacking of the blood. The lungs not working is a result of lack of O2 in blood, not the cause of it. Hence the "ground glass opacities".

- The paper models the behavior of chloroquine and faviparavir as well, which appear to bind to the non-structural viral proteins that hijack the heme groups, thus inhibiting them from knocking out the iron and wrecking the O2-carrying ability of the red blood cells.

- This also explains the observation made by various ER docs (incl this one in New Orleans) that patients tend to have elevated ferritin: ferritin is used to store excess iron. If a lot of iron is knocked out of heme groups and floating around, the body produces more ferritin

If true, this may mean a few things:

1. Starting drug treatment while symptoms are mild keeps virus from hijacking too much blood, enabling a still-healthy body to mount an immune response. Explains why early drug treatment (first week of symptoms) is often successful.

2. Drug treatment and intubation once patient is critical will rarely work because tissues/organs are already damaged, blood can't carry O2, and the body is too weak to produce new red blood cells able to carry Fe (and thus oxygen/CO2) even if drugs inhibit more hijacking.

3. Thus: start severe patients on drug treatment upon hospital intake to suppress further hijacking of blood by the virus, then give them a blood transfusion of new red blood cells immediately that are unhijacked. If all this is true, we would see rapid patient improvement.

---

The problem is we have not yet had studies testing whether patients will respond well to blood transfusions from people who have not had COVID-19. Right now medical attention is focused on blood transfusions from those who have beat COVID and have antibodies. This needs to be looked at

This research ties in to the fact that weight/age/high blood pressure are such risk factor and why certain blood types are less afflicted than other

NonAfrican malaria risk zones have a population with genetic thalassemia, which would explain the discrepancies in the population affected by CV, this is noted in Italy:" “

In one of the articles I read about Germany’s low death rate, it said they had healthcare workers going into patient’s homes and checking on them, including doing blood work. Then even some that still felt ok would be admitted based on the results, so they could be treated early. I wonder what blood tests they were doing and what results caused hospitalization?

[TCB]

12 minutes ago, Frances said:

In one of the articles I read about Germany’s low death rate, it said they had healthcare workers going into patient’s homes and checking on them, including doing blood work. Then even some that still felt ok would be admitted based on the results, so they could be treated early. I wonder what blood tests they were doing and what results caused hospitalization?

I’m wondering if they may be checking arterial blood gases but not sure if there is a portable option for that. Maybe also some of the markers for worsening disease. I believe ferritin levels is one.

[Arcadia]

Vermont https://accd.vermont.gov/press-releases/agency-commerce-and-community-development-directs-“big-box”-retailers-cease-person

Montpelier, Vt. –  The Agency of Commerce and Community Development (ACCD) is directing large “big box” retailers, such as Walmart, Target and Costco, with in-store sales of food, beverage and pharmacy, as well as electronics, toys, clothing, and the like to cease in-person sales of non-essential items in order to reduce the number of people coming into the stores.

“Large ‘big box’ retailers generate significant shopping traffic by virtue of their size and the variety of goods offered in a single location,” said Agency of Commerce and Community Development Secretary Lindsay Kurrle.  “This volume of shopping traffic significantly increases the risk of further spread of this dangerous virus to Vermonters and the viability of Vermont’s health care system. We are directing these stores to put public health first and help us reduce the number of shoppers by requiring on-line ordering, delivery and curbside pickup whenever possible, and by stopping the sale of non-essential items.”

...

Large “big box” retailers must cease in-person sales of non-essential items not listed in the Executive Order, including, but not limited to: arts and crafts, beauty, carpet and flooring, clothing, consumer electronics, entertainment (books, music, movies), furniture, home and garden, jewelry, paint, photo services, sports equipment, toys and the like.

Large “big box” retailers must:

• Restrict access to non-essential goods. Stores must close aisles, close portions of the store, or remove items from the floor.
• Only offer non-essential items via online portals, telephone, delivery, or curbside pickup, to the extent possible.
• Except in the event of emergencies threatening the health and welfare of a customer, showrooms and garden sections of large home improvement centers should be closed.”

[kbutton]

3 hours ago, Pen said:

I would not want to “complain” so much as to suggest that there might be some way for the Wisconsin dairy farmers to have their milk get converted to powdered instead of dumping.

I presume in powdered form it could go where there is a shortage.  

 

1 hour ago, Pen said:

Okay — sent messages to my state Dairy Council and to a local area creamery.

Will contact OV too.  

Thank you! This is what I was getting at, but apparently not coming across quite right. We don't have shortages (yet) locally of regular milk or cheese, and I am not sure if we will. DH shops and isn't going to be browsing the canned/dried aisles, so I don't have anything to report. One of the articles I read asked people to contact their dairy authorities if they had shortages so that it could be acted upon. 

[math teacher]

Some of you have mentioned ferritin levels. That makes me think of my mother who has hemachromotosis. Her body stores too much iron, and she has a ferritin level check ever so often to determine if she needs phlebotomy or not. 

Does this make her more susceptible to the virus, or would she have a rougher time with it if she caught it?

[Corraleno]

8 hours ago, square_25 said:

I think Sweden's numbers are wonky, too. They aren't testing enough, if I remember correctly, so their already stark numbers are almost certainly serious underestimates. 

I was originally puzzled by Sweden's very low level of testing, given that the choice of response is generally either widespread lock down or aggressive testing and contact tracing while keeping businesses open — yet Sweden is not doing either of those things. After reading comments by the PM and health minister, it became apparent that the reason they aren't testing and contact tracing is because, in their view, widespread infection is actually a feature not a bug. They have taken a let's-get-it-over-with approach, on the assumption that if they just protect the over-70s and let everyone else get it, there won't be too many deaths and then they'll have herd immunity. Except that ignores two critical facts: a lot of people under the age of 70 are also going to die, and you really can't protect the elderly just by telling them to stay home while their families, neighbors, and caregivers continue to interact and get infected. The fact that the virus is already spreading rapidly through nursing homes in Stockholm is proof of that. One of the comments I read from a Swedish health professional basically asked why should Swedes be forced to participate, without their consent, in a risky experiment that no other country is willing to try?

Edited April 7, 2020 by Corraleno

[Jean in Newcastle]

6 minutes ago, Corraleno said:

I was originally puzzled by Sweden's very low level of testing, given that the choice of response is generally either widespread lock down or aggressive testing and contact tracing while keeping businesses open — yet Sweden is not doing either of those things. After reading comments by the PM and health minister, it became apparent that the reason they aren't testing and contact tracing is because, in their view, widespread infection is actually a feature not a bug. They have taken a let's-get-it-over-with approach, on the assumption that if they just protect the over-70s and let everyone else get it, there won't be too many deaths and then they'll have herd immunity. Except that ignores two critical facts: a lot of people under the age of 70 are also going to die, and you really can't protect the elderly just by telling them to stay home while their families, neighbors, and caregivers continue to interact and get infected. The fact that the virus is already spreading rapidly through nursing homes in Stockholm is proof of that. One of the comments I read from a Swedish health professional basically asked why should Swedes be forced to participate, without their consent, in a risky experiment that no other country is willing to try?

Couldn't the nursing homes etc. make their own isolation "stay in place" policies?  As well as individuals?  Not saying that I think that the government is making wise choices but I would do everything in my power to protect my family and patients (if I had patients). 

Edited April 7, 2020 by Jean in Newcastle

[Terabith]

1 hour ago, Jean in Newcastle said:

Couldn't the nursing homes etc. make their own isolation "stay in place" policies?  As well as individuals?  Not saying that I think that the government is making wise choices but I would do everything in my power to protect my family and patients (if I had patients). 

I think it would be hard, because it would require moving staff into the site, not allowing them to go home.  Which then...what about their children and families?  It would be tough to really isolate or lock it down without societal consent.

[Frances]

15 minutes ago, Terabith said:

I think it would be hard, because it would require moving staff into the site, not allowing them to go home.  Which then...what about their children and families?  It would be tough to really isolate or lock it down without societal consent.

I think they’ve done this in places in Germany.

[Terabith]

1 minute ago, Frances said:

I think they’ve done this in places in Germany.

Yeah.  It lets the nursing home be its own bubble.  But it's pretty disruptive to the lives of staff.

[Terabith]

Just now, square_25 said:

And Germany has other severe measures in place, right? 

I think so.  Certainly more measures than Sweden does.  

[itsheresomewhere]

All 4H activities, fair etc are cancelled here through the end of August.  Since our university is part of our 4H through the extension, it makes me wonder if they are not planning for in person fall classes. 

[Terabith]

3 minutes ago, square_25 said:

Also, frankly, it's not likely this only strikes the oldest people. Yes, they are the highest risk, but we have LOTS of people of ages 45 to 64 dying of COVID-19 here: 

https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-daily-data-summary-deaths-04072020-1.pdf

How are you supposed to quarantine everyone in their 50s and 60s? Lots of them have very responsible jobs. 

Yeah, that's the biggest issue.  Lots of folks in their 30s and 40s not doing well.

[Ausmumof3]

5 hours ago, TCB said:

I saw something interesting on a healthcare FB Covid site - no source, couldn’t get the link to open also so am just going to copy and paste.

Below is a quote - not written by me!

 

 

“A friend sent this to me and it makes SO MUCH SENSE!!  Hypothesizing that covid-19 is a primary hematologic infection rather than respiratory.  This is an analysis done on a computer to study the virus.  A lengthy read but it is what we are seeing in these patients.

"Might not even be a respiratory illness after all and that's just a byproduct of the wreckage it makes in blood haemoglobin (thus making ARDS a symptom not a cause).

I wish this would get more traction because if this computational analysis is correct, this could completely change the way we approach COVID, globally.

I will copy some summaries that explain this paper in layman's terms:

- Using computational analysis (modeling the behavior of a molecule in a computer), they've worked out the probable mechanism by which SARS-nCov-2 wreaks havoc on patients, as well as why chloroquine and favipiravir seem to work.

- Inside our red blood cells, there is a molecule called hemoglobin, which contains heme groups. Each heme group is a molecular "ring" (called a porphyrin) that can hold an iron (Fe) ion inside. Having an iron ion inside is what allows this heme to carry O2 (and CO2) in our blood. This is how our bodies move O2 to our tissues and remove CO2 waste products.

- The paper modeled these and found that the proteins produced when COVID replicates "collaborate" to knock iron ions out of heme groups (HBB) and replace them with one of the proteins. This makes the red blood cell unable to transport O2 and CO2!

- If the computer modeling is right, it shows that the virus hijacks our [red] blood [cells] and makes it unable to carry O2 to a patient's tissues/organs, and likewise unable to carry CO2 out of them. This would lead to organ and tissue death, roughly in the same way as if a patient were being suffocated. Even when a patient can breath (fill lungs with air), the oxygen isn't getting to the cells in their body.

- The inflammation in the lungs results from the lungs not being able to perform the oxygen/CO2 exchange, and would therefore appear to be a SECONDARY result of the hijacking of the blood. The lungs not working is a result of lack of O2 in blood, not the cause of it. Hence the "ground glass opacities".

- The paper models the behavior of chloroquine and faviparavir as well, which appear to bind to the non-structural viral proteins that hijack the heme groups, thus inhibiting them from knocking out the iron and wrecking the O2-carrying ability of the red blood cells.

- This also explains the observation made by various ER docs (incl this one in New Orleans) that patients tend to have elevated ferritin: ferritin is used to store excess iron. If a lot of iron is knocked out of heme groups and floating around, the body produces more ferritin

If true, this may mean a few things:

1. Starting drug treatment while symptoms are mild keeps virus from hijacking too much blood, enabling a still-healthy body to mount an immune response. Explains why early drug treatment (first week of symptoms) is often successful.

2. Drug treatment and intubation once patient is critical will rarely work because tissues/organs are already damaged, blood can't carry O2, and the body is too weak to produce new red blood cells able to carry Fe (and thus oxygen/CO2) even if drugs inhibit more hijacking.

3. Thus: start severe patients on drug treatment upon hospital intake to suppress further hijacking of blood by the virus, then give them a blood transfusion of new red blood cells immediately that are unhijacked. If all this is true, we would see rapid patient improvement.

---

The problem is we have not yet had studies testing whether patients will respond well to blood transfusions from people who have not had COVID-19. Right now medical attention is focused on blood transfusions from those who have beat COVID and have antibodies. This needs to be looked at

This research ties in to the fact that weight/age/high blood pressure are such risk factor and why certain blood types are less afflicted than other

NonAfrican malaria risk zones have a population with genetic thalassemia, which would explain the discrepancies in the population affected by CV, this is noted in Italy:" “

A doctor named David Sinclair I think was posting similar on Twitter a couple of weeks ago.  He believes that is why the chloroquine is effective.  I don’t understand the science but he seemed to think it would also explain why it’s harder on people with diabetes.  I’ll see if I can find the thread.

[Arcadia]

5 minutes ago, Ausmumof3 said:

A doctor named David Sinclair I think was posting similar on Twitter a couple of weeks ago.  He believes that is why the chloroquine is effective.  I don’t understand the science but he seemed to think it would also explain why it’s harder on people with diabetes.  I’ll see if I can find the thread.

 

March 14th https://mobile.twitter.com/davidasinclair/status/1238972087395659778

“new work out of China yesterday says COVID-19 might also involve abnormal blood production. CoV genes 1 & 8 are predicted to interfere with heme, the red compound in blood, by kicking out the iron. Would explain why chloroquine seems effective as a treatment #CoronaVirusUpdate”

“Chloroquine is predicted to prevent orf1ab, ORF3a and ORF10 from attacking heme (red in red blood cells) and inhibit the binding of ORF8 to heme. Although 99% of the virus is seemingly stable, what's disturbing is ORF 1 and 8 are mutating the fastest...”

ETA:

“It may explain why diabetics and elderly are more susceptible. Blood sugar levels usually increase as we get older, increasing the amount of glycated hemoglobin (HbA1c) (I've tweeted about this before). The authors suggest these people would be more susceptible to because...”

“...the virus could more easily disrupt the heme in red blood cells. If so, the virus is very smart: it destroys the lung so patients can't take up oxygen AND reduces the body's ability to carry oxygen. (For this & other reasons, you should eat healthily the next 2 years)..”

Edited April 7, 2020 by Arcadia

[teachermom2834]

12 minutes ago, itsheresomewhere said:

All 4H activities, fair etc are cancelled here through the end of August.  Since our university is part of our 4H through the extension, it makes me wonder if they are not planning for in person fall classes. 

Today ours cancelled everything through July 31. Made me a little hopeful that they are planning on classes on campus in the fall.

Two local universities have announced postponing commencement to August. That gave me a little hope too. 

[ElizabethB]

Any other states have these initiatives?  Utah and Idaho, individuals and companies donating money to buy tests to get more people tested.

Utah website: https://www.testutah.com 

Idaho website: https://www.crushthecurveidaho.com

Article abut Idaho program: https://www.idahostatesman.com/news/coronavirus/article241836391.html

[Ausmumof3]

https://mobile.abc.net.au/news/2020-04-08/us-navy-secretary-thomas-modly-resigns-coronavirus-ship/12131594
 

@Sneezyone

Navy secretary Thomas Modly has resigned over the coronavirus ship.

[math teacher]

The governor of Arkansas has closed all state parks.

[EmseB]

38 minutes ago, Ausmumof3 said:

https://mobile.abc.net.au/news/2020-04-08/us-navy-secretary-thomas-modly-resigns-coronavirus-ship/12131594
 

@Sneezyone

Navy secretary Thomas Modly has resigned over the coronavirus ship.

The dude flew halfway around the world to lecture a bunch of sick sailors about doing their duty while calling their former CO whom he fired naive or stupid for letting his letter leak to the media while speaking on the shipwide PA. Gotta at least admire his chutzpah were it not for his lack of self awareness.

I have also noticed that the navy is mighty quiet about who approved or insisted on that port call in Vietnam.

[hopeallgoeswell]

10 minutes ago, Terabith said:

Yeah, that's the biggest issue.  Lots of folks in their 30s and 40s not doing well.

Something to note: Americans aren't very healthy (https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm).  Looking at the summary from NYC, approximately .08% and .03% of the people in the 18-44 and 45-64, respectively, have no underlying conditions (that does not include the few with pending results).  How does that compare to other illnesses?  How many people in America usually die from lower respiratory infections/pneumonia/influenza every year ( https://www.cdc.gov/nchs/nvss/leading-causes-of-death.htm#publications) ? How often do people in those age ranges succumb to other viral or bacterial infections?  I have found that putting things into perspective during this time helps with not overreacting. 

[Terabith]

8 minutes ago, hopeallgoeswell said:

Something to note: Americans aren't very healthy (https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm).  Looking at the summary from NYC, approximately .08% and .03% of the people in the 18-44 and 45-64, respectively, have no underlying conditions (that does not include the few with pending results).  How does that compare to other illnesses?  How many people in America usually die from lower respiratory infections/pneumonia/influenza every year ( https://www.cdc.gov/nchs/nvss/leading-causes-of-death.htm#publications) ? How often do people in those age ranges succumb to other viral or bacterial infections?  I have found that putting things into perspective during this time helps with not overreacting. 

I don't think it's overreacting to say that it's alarming that so many people under 60 are succumbing to this.  I'm 43.  Other than accidents and a couple of people with cancer (mostly children), I have not known anyone under 60 who died in my life.  I've known a few people who had cancer in middle age, but they've all beaten and lived with it.  Certainly, I know people DO die under 60, but I do not think that most Americans are so unhealthy that they're dying of viral or bacterial infections all the time.  I mean, folks my age, especially with younger kids, certainly get sick with strep throat or bronchitis or even pneumonia, but they get BETTER the vast majority of the time.

[Sneezyone]

1 hour ago, EmseB said:

The dude flew halfway around the world to lecture a bunch of sick sailors about doing their duty while calling their former CO whom he fired naive or stupid for letting his letter leak to the media while speaking on the shipwide PA. Gotta at least admire his chutzpah were it not for his lack of self awareness.

I have also noticed that the navy is mighty quiet about who approved or insisted on that port call in Vietnam.

For real. You didn’t expect those sailors to record you? I saw in a report today that the person who approved the port call was, as expected, very senior. Crickets from the flags.

[Wheres Toto]

2 hours ago, itsheresomewhere said:

All 4H activities, fair etc are cancelled here through the end of August.  Since our university is part of our 4H through the extension, it makes me wonder if they are not planning for in person fall classes. 

We just got this notice today too.   Cancelling the entire summer seems like such a big deal.  It didn't seem so bad when things were closing down for a couple weeks or a month.  That's FIVE months of things being cancelled.  

Our governor also shut down all state and county parks today because too many people were having large gatherings.  

[Arcadia]

@Ausmumof3@StellaM@Melissa in Australia@lewelma@kiwik

https://www.channelnewsasia.com/news/world/covid-19-uruguay-australia-new-zealand-greg-mortimer-12620210

“MONTEVIDEO: Uruguay said on Tuesday (Apr 7) it has authorised a humanitarian flight to evacuate Australian and New Zealand passengers stranded on a coronavirus infected cruise ship.

About 128 of the 217 people on board the Australian-owned Greg Mortimer, including passengers and crew, have tested positive for the deadly virus.

Six of those have been taken off suffering from a "life-threatening" illness for treatment in the capital Montevideo.

The plight of the Greg Mortimer is the latest affecting the global cruise industry, which has seen vessels refused entry to ports and others locked down after new-coronavirus cases were confirmed onboard during the pandemic.

The cruise ship's owner, Aurore Expeditions, has "contracted a medical plane ... to repatriate the Australian and New Zealander passengers", Uruguay's foreign ministry said, adding that the plane had been given permission to arrive on Thursday.

About 100 Australians are aboard, and negotiations were underway to allow the New Zealanders to fly with them, Aurore said.

The Airbus A340 plane contracted to fly the Aussies and Kiwis home "is configured with medical facilities aboard... to look after the health and security of everyone", said Aurore.

The plane will carry passengers who test both positive and negative for the virus.

...

As for the European and American passengers on the Greg Mortimer, they must "wait until they test negative" before organising their repatriation via Sao Paulo, the company said.”

[TCB]

1 hour ago, hopeallgoeswell said:

Something to note: Americans aren't very healthy (https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm).  Looking at the summary from NYC, approximately .08% and .03% of the people in the 18-44 and 45-64, respectively, have no underlying conditions (that does not include the few with pending results).  How does that compare to other illnesses?  How many people in America usually die from lower respiratory infections/pneumonia/influenza every year ( https://www.cdc.gov/nchs/nvss/leading-causes-of-death.htm#publications) ? How often do people in those age ranges succumb to other viral or bacterial infections?  I have found that putting things into perspective during this time helps with not overreacting. 

Honestly I think you will find not a lot do usually. Even during H1N1 we only lost a very few in that age range where I work.

[Arcadia]

@mathnerd

https://www.nbcbayarea.com/news/coronavirus/bay-area-healthcare-workers-say-wearing-scrubs-in-public-sparks-fear/2269070/

“Some doctors and nurses in the Bay Area said they have to watch what they wear when they are in public. NBC Bay Area has learned that the healthcare workers' scrubs are becoming a stigma.

"We have had some nurses that have said anecdotally that they've been at the grocery store, or somewhere else, after they left work, and although people are grateful, they don't want them around them in their scrubs because they fear they're carrying COVID-19," said Mark Brown, chief nursing officer at San Jose's Good Samaritan Hospital.

Nurses at another South Bay hospital shared the same story of scrubs triggering fear.

"It definitely doesn't help when it comes to all the stress they're dealing with, but there is more education that needs to go on," Brown said. "It's nobody's fault. It's a new thing. It's a novel coronavirus."

Brown said his staff is now allowed to shower and change into civilian clothes at the hospital so they can go home without worrying about the negative public reaction.

"Doing our part when it comes to giving them our scrubs so they can go home in normal clothes and not have to worry about the scarlet letter attached to them, or bringing it home to their families," Brown said.

Brown also said looking at all the data, there is little concern of infection from hospital scrubs, but he understand the public fear.”

[Ausmumof3]

Bno:  12,469 Americans died over the course of 1 year during the H1N1 flu pandemic in 2009. In just over 5 weeks, coronavirus has been linked to nearly 13,000 deaths in the U.S

[Ausmumof3]

18 minutes ago, Arcadia said:

@mathnerd

https://www.nbcbayarea.com/news/coronavirus/bay-area-healthcare-workers-say-wearing-scrubs-in-public-sparks-fear/2269070/

“Some doctors and nurses in the Bay Area said they have to watch what they wear when they are in public. NBC Bay Area has learned that the healthcare workers' scrubs are becoming a stigma.

"We have had some nurses that have said anecdotally that they've been at the grocery store, or somewhere else, after they left work, and although people are grateful, they don't want them around them in their scrubs because they fear they're carrying COVID-19," said Mark Brown, chief nursing officer at San Jose's Good Samaritan Hospital.

Nurses at another South Bay hospital shared the same story of scrubs triggering fear.

"It definitely doesn't help when it comes to all the stress they're dealing with, but there is more education that needs to go on," Brown said. "It's nobody's fault. It's a new thing. It's a novel coronavirus."

Brown said his staff is now allowed to shower and change into civilian clothes at the hospital so they can go home without worrying about the negative public reaction.

"Doing our part when it comes to giving them our scrubs so they can go home in normal clothes and not have to worry about the scarlet letter attached to them, or bringing it home to their families," Brown said.

Brown also said looking at all the data, there is little concern of infection from hospital scrubs, but he understand the public fear.”

Similar issues reported here in Aus

they also have an adopt a health care worker campaign going on where people offer to grocery shop etc for nurses/doctors who are working overtime due to covid19

[Ausmumof3]

Just now, square_25 said:

Yeah, I think H1N1 wound up with a CFR less than that of the usual flu. Although of course, not having immunity is still a problem. But then they had effective antivirals, too, I think? 

I don’t really remember.  It didn’t end up being a huge thing here though there were a few unexpected deaths.