Covid-19 / SARS-Cov2 - naučne/medicinske informacije i analize

[Pletilja]

Moja generacija rodjena 1951 vakcinisana je vakcinom protiv decije paralize, masovno. Dakle, primenjena je vakcina koja je prosla sva ispitivanja i usla u protokol obaveznog vakcinisanja. Samo u mom gradu, u mojoj generaciji,  doslo je u 2 slucaja do nezeljenog dejstva, sin naseg pedijatra je ostao paralizovan u celu desnu stranu tela ( rast nije pratio rast leve strane) i jednoj mojoj drugarici je ostala delimicno paralizovana desna ruka, upadljivo se slabije razvila tokom vremena. Statisticki, nezeljena dejstva su bila zanemarljiva u odnosu na dobrobit, vakcina je kasjije unapredjivana.  Sve je pitanje tog racuna: da li ce procenat nezeljenog dejstva biti prihvatljiv ili ne i ko ce odlucivati o tome. S obzirom na urgentnost da se izbegnu ekonomski slomovi, osecam da ce biti tolerisan visok procenat nezeljeih dejstava, bar u pocetku. To smo mi i vreme u kojem zivimo.

[Jataganac]

To kazu i za vakcinu protiv velikih boginja, da je na kraju vise ljudi nastradalo od same vakcine nego od virusa tokom epidemije u SFRJ; naravno, da nije bilo same vakcine, variola vera se ne bi ni mogla zaustaviti, tako da se dobrobit vakcinacije ne moze dovoditi u pitanje.

[Pletilja]

36 minutes ago, Ruby Rhod (koji lebdi) said:

To kazu i za vakcinu protiv velikih boginja, da je na kraju vise ljudi nastradalo od same vakcine nego od virusa tokom epidemije u SFRJ; naravno, da nije bilo same vakcine, variola vera se ne bi ni mogla zaustaviti, tako da se dobrobit vakcinacije ne moze dovoditi u pitanje.

Jedva sam je prezivela a imala sam 20 godina i bila zdrava i jaka....mislim da cu ovu za Covid 19 da preskocim...kad si sam u gradu u kojem imas vise drustva na groblju nego na ulicama i nije tako tesko biti izolovan....vise brinem za decu koja su u naponu zivota i karijere....srecom, zive u srecnijim drzavama od  Srbije...

[CheshireCat]

4 hours ago, Ruby Rhod (koji lebdi) said:

To kazu i za vakcinu protiv velikih boginja, da je na kraju vise ljudi nastradalo od same vakcine nego od virusa tokom epidemije u SFRJ; naravno, da nije bilo same vakcine, variola vera se ne bi ni mogla zaustaviti, tako da se dobrobit vakcinacije ne moze dovoditi u pitanje.

 

Zna li se ta cifra? Koliko je ljudi stradalo od vakcine?

Znam da je umrlih od bolesti oko 100 i nešto.

[Jataganac]

1 minute ago, CheshireCat said:

 

Zna li se ta cifra? Koliko je ljudi stradalo od vakcine?

Znam da je umrlih od bolesti oko 100 i nešto.

 

https://www.vreme.com/cms/view.php?id=1041070

 

U roku od deset dana u Beogradu vakcinu na 727 punktova prima njih 1.849.341. Oko 600.000 ljudi je revakcinisano. Revakcinacija je završena 15. aprila.

Većina stanovništva vakcinisana je metodom skarifikacije – koža se prvo očisti alkoholom, a zatim se sterilnom lancetom vakcina nanese na dva mesta međusobno udaljena 5 do 10 cm, na spoljnoj strani nadlaktice, na kojima su napravljena dva uspravna i dva poprečna zareza, dužine oko 1 santimetar. Pištolji za vakcinaciju, po američkoj metodi ‘Jet-Gan’, stigli su tek pred sam kraj vakcinacije.

U toku vakcinacije u Institutu "Torlak" je obustavljena svaka proizvodnja i sve je bilo potčinjeno dijagnostici variole i kontroli vakcine i hiperimunogamaglobulina.

"Vakcinacija je bila masovna", kaže dr Gligić. "Nažalost, posledice vakcinacije su bile veoma teške, bilo je i smrtnih slučajeva i smatra se da je od vakcinacije bila veća šteta nego od same variole", kaže dr Gligić navodeći da kod imunodepresivnih osoba koje nemaju imunitet dolazi do generalizovane vakcinije, što znači da čovek prosto bukne na mestu gde je vakcinisan, a može doći i do encefalita – da virus prodre do centralnog nervnog sistema (sin jedne infektološkinje je posle vakcinacije dobio zapaljenje moždanih opni, upravo od vakcine). Međutim, vakcinisalo se redom. To nije mimoišlo ni trudnice. Srećom, prema rečima dr Gligić, ni kod jedne nije došlo do prodora vakcine na plod.

[CheshireCat]

Da, ali je broj i dalje tajna. Krijenje tog broja ih (i nju) poprilično diskredituje.

[urosg3]

5 hours ago, Pletilja said:

Moja generacija rodjena 1951 vakcinisana je vakcinom protiv decije paralize, masovno. Dakle, primenjena je vakcina koja je prosla sva ispitivanja i usla u protokol obaveznog vakcinisanja. Samo u mom gradu, u mojoj generaciji,  doslo je u 2 slucaja do nezeljenog dejstva, sin naseg pedijatra je ostao paralizovan u celu desnu stranu tela ( rast nije pratio rast leve strane) i jednoj mojoj drugarici je ostala delimicno paralizovana desna ruka, upadljivo se slabije razvila tokom vremena. Statisticki, nezeljena dejstva su bila zanemarljiva u odnosu na dobrobit, vakcina je kasjije unapredjivana.  Sve je pitanje tog racuna: da li ce procenat nezeljenog dejstva biti prihvatljiv ili ne i ko ce odlucivati o tome. S obzirom na urgentnost da se izbegnu ekonomski slomovi, osecam da ce biti tolerisan visok procenat nezeljeih dejstava, bar u pocetku. To smo mi i vreme u kojem zivimo.

Pitanje je ko računa korist, i prihvatljivu žrtvu, ali to svakako nije za ovu temu. Očigledno je koliko se perspektiva javnosti promenila od tada do danas.

 

[Jataganac]

28 minutes ago, CheshireCat said:

Da, ali je broj i dalje tajna. Krijenje tog broja ih (i nju) poprilično diskredituje.

 

Da, na broj nigde nisam naisao, ali u svakom slucaju, jako lepo napisan clanak.

[ters]

34 minutes ago, urosg3 said:

Pitanje je ko računa korist, i prihvatljivu žrtvu, ali to svakako nije za ovu temu. Očigledno je koliko se perspektiva javnosti promenila od tada do danas.

 

 

Vlade svih drzava racunaju i odredjuju vrijednost zivota - na pocetku epidemije sam negdje naisao da ja za Australiju to oko 2,500,000$... 

 

[ciao]

U Francuskoj predvidjaju krizu u oktobru - ideja je da ce u septembru da pocnu skole i firme takoreci normalno da funkcionisu prvo put jos od marta i onda u oktobru kriza

[bohumilo]

1 hour ago, ters said:

 

Vlade svih drzava racunaju i odredjuju vrijednost zivota - na pocetku epidemije sam negdje naisao da ja za Australiju to oko 2,500,000$... 

 

Postoji nesto sto se zove "statisticki zivot" i "vrednost statistickog zivota", ali to ne odredjuju vlade nego sami ljudi (mi, gradjani), a vlade se koriste tim podacima. Ta vrednost se utvrdjuje kroz empirijska istrazivanja - ankete (prosto pitas ljude), posmatranje i analiziranje odluka i "trade-off"-ova koje su ljudi spremni da naprave kada se nadju u situaciji gde mogu da odlucuju o nekom stepenu povecanju ili smanjila sansa da izgube zivot (sto se desava konstantno u svakodnevnom zivotu, jer gotovo svaka odluka - od odlaska na tusiranje ili prelaska ulice do sedanja za volan ili paljenja cigarete - povecava sansu da izgubite zivot, tj. smanjuje ocekivanu (u smislu "statistickog ocekivanja") duzinu zivota, ali mi svi svesno pristajemo na to smanjenje jer zivot ima konacnu vrednost, koja se moze uporediti sa vrednoscu drugih stvari (i ultimativno izraziti u nekoj konvencionalnoj valuti)). Recimo, jedno od tipicnih pitanja na kojem se temelje ove analize je koliko su ljudi spremni da prihvate vecu/manju platu da se premeste na posao koji im u definisanom procentu povecava/smanjuje sansu da poginu, tj. koliko su spremni da plate/budu placeni/ da izbegnu/prihvate/ "ruski rulet" sa nekim velikim brojem rupa u buretu revolvera (npr, po istrazivanju harvardskog profesora Kipa Viscusi-ja prosecan Amerikanac je spreman da plati do $5 da izbegne 1/milion sansu da pogine (drugim recima, spreman je da uzme tu sansu za vise od $5), odakle se moze zakljuciti da prosecan Amerikanac svoj zivot vrednuje negde oko 5 miliona dolara). O tome ima dosta literature:

 

https://www.amazon.com/Pricing-Lives-Guideposts-Safer-Society/dp/0691179212

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3379967

https://www.oecd-ilibrary.org/environment/mortality-risk-valuation-in-environment-health-and-transport-policies_9789264130807-en

Edited August 13, 2020 by bohumilo

[RatzenStadt]

I dalje mi nije jasna ta prica o n-tim talasima virusa. Po kojim parametrima i kojom logikom dolaze do tih zakljucaka? Vise cemo vremena provoditi u zatvorenom na jesen/zimu? Kao sto su Kali i Florida eksplodirale sa prvim danom leta i jos drze brojke novozarazenih blizu petocifrene? Kao Indija koja je isto sa dolaskom leta na putu da zaseni Jenkije po broju registrovanih slucajeva? O Latinskoj Americi da ne pricam. Ispod radara prolaze i zemlje Centralne Amerike gde su zastrasujuce brojke vec dugo. Ako tamo moze korona da "besni", sta je sprecava trenutno u Holandiji, Nemackoj, Belgiji itd, gde se mere zastite stidljivo primenjuju, jer nije da je korona nestala - i dalje se registruju trocifrene brojke tamo. Da podsetim ponovo i da se u tim zemljama u svakom vecem gradu protestovalo pre 2 meseca vecim ("brojnijim") intenzitetom i duze u odnosu na proteste koji su bili u Srbiji nedavno.

[wwww]

U UK uveli brze testove za covid-19:

https://www.gov.uk/government/news/roll-out-of-2-new-rapid-coronavirus-tests-ahead-of-winter

Quote

Two new tests – both able to detect the virus in just 90 minutes – will be made available to NHS hospitals, care homes and labs. The 2 tests will be able to detect both COVID-19 and other winter viruses such as flu and respiratory syncytial virus (RSV). The tests do not require a trained health professional to operate them, meaning they can be rolled out in more non-clinical settings.

 

Quote

A new test that uses DNA to detect the virus will be rolled out across NHS hospitals from September, with 5,000 DNA machines, supplied by DnaNudge, to provide 5.8 million tests in the coming months.

Separately, 450,000 90-minute LamPORE swab tests will also be available across adult care setting and laboratories from next week, supplied by Oxford Nanopore.

 

Quote

5,000 DNA ‘Nudgebox’ machines, supplied by DnaNudge, will be rolled out across NHS hospitals in the UK to analyse DNA in nose swabs, providing a positive or negative result for COVID-19 in 90 minutes, at the point of care. The machines will process up to 15 tests on the spot each day without the need for a laboratory.

 

Quote

 

The new rapid LamPORE test will be able to process swab and saliva samples to detect the presence of COVID-19 in 60 to 90 minutes.

The new test has the same sensitivity as the widely used PCR swab test, but can be used to process swabs in labs, as well as on-location through ‘pop up’ labs. The desktop GridION machine can process up to 15,000 tests a day, or the palm-sized MinION can process up to 2,000 tests a day for deployment in a near-community ‘pop-up’ lab.

 

 

Komentar dva nemacka virologa/epidemiologa u jednoj emisiji sinoc je bio da klasicni PCR test je vrlo precizan i tacno se zna da si detektovao bas SARS-CoV-2 virus. Nedostatak je sto treba vremena i odgovarajuca laboratorija. Da bi se epidemija drzala pod kontrolom ovaj test nije nuzno neophodan (narocito ako se predugo ceka na rezultat). Mnogo su bolji testovi poput ovih u UK koji u kratkom roku daju informaciju o zaraznosti. Ako sam ja dobro shvatila prag detekcije je nesto visi (u smislu da treba nesto visa kncentracija virusa da bi se on detektovao), ali je to za epidemiju i onako manje vazno jer se polazi od toga da onaj s vrlo malom koncentracijom virusa nije vise zarazan. Ovo brzi UK testovi su i prilicno jeftini (reda nekoliko EUR, u poredjenju s nekih 100EUR +- za standardni PCR test), nije neophodno da dobro obuceno medicinsko osoblje uzima uzorak, vec prakticno svaki pojedinac moze sam da uzme svoj uzorak. Ovo trstovi nisu na raspolaganju u Nemackoj (jos uvek), mada postoje neke radne grupe koje su razvile pandane ovim UK testovima. Ne znam sta treba da se desi da bi se ti testovi masovno proizvodili i bili u upotrebi (pretpostavljam da prvo treba da dobiju odobrenje).

 

Eto, UK je u ovome bolja reagovala od Nemacke. Videcemo da li ce se ovdasnji nadlezni organi postarati da se ovo uvede i u NEmackoj (sto bi od posebne koristi bilo u skolama, ali i u firmama).

 

Takodje su diskutovali rusku vakcinu. Kazu da imaju malo podataka i da je prilicno sumnjivo sto nista od rezultat nije nigde objavljeno. Kako su oni shvatili, Rusi su primenili istu tehnologiju/metodologiju/mehanizam kao neka grupa u Kini, s tim sto oni veruju da su Kinezi ranije poceli s razvojem te vakcine a jos uvek se nisu javili s nekim pozitivnim rezultatima. Zbog toga im je ova ruska vakcina posebno sumnjiva. Pored toga, Rusi su zavrsili samo 2 faze (nekih stotinak ispitanika), a 3. tek pocinju. Plase se da ako nesto ne bude u redu s tom vakcinom to ce baciti vrlo negativno svetlo i na sve ostale vakcinne koje su propisno ispitane, a to bas nije nesto sto zelimo. Zato im drze pesnice da ipak sve bude u redu (ali ne bi narucili rusku vakcinu).

[wwww]

While Covid-19 damages the lungs less often than expected, other organs are affected much more than expected. The brain, heart and blood vessels are often permanently attacked via the ACE-2 receptor if it is mild. Good review article with example.

 

 

originalni tekst o posledicama zaraze virusom:

https://www.sciencemag.org/news/2020/07/brain-fog-heart-damage-covid-19-s-lingering-problems-alarm-scientists

 

 

 

Edited August 14, 2020 by wwww

[ciao]

Ovo za te brze testove iz Oxforda mi lici na ove seroloske brze testove koji postoje i rade se u Fra vec izvesno vreme - svaka apoteka ima pravo da radi te testove i moze da da rezultat u roku od sat vremena medjutim ne radi ih mnogo njih bas sam se raspitivala u "mojoj" uobicajenoj apoteci, kaze ako je test negativan onda znaci nikad nisi imao kontakt sa covid-om medjutim ako je test pozitivan to moze da znaci svasta u smislu da si imao ili imas neki drugi virus a sa druge strane je obavezujuci i za pojedinca i za apoteku koja radi test - ako se pojavi da si pozitivan (a izgleda da ima dosta ljudi koji jesu a nemaju covid) onda moraju da se rade detaljne dalje analize. Inace ti testovi su ovde besplatni ali niti su apoteke zainteresovane niti ljudi

Edited August 14, 2020 by ciao

[wwww]

 

 

The imperfect accuracy of rapid tests is not a major problem and is MORE than canceled out by the pace of execution plus result based on the most important modeling studies. Rapid tests plus short quarantine for cluster participants would have a great effect.

 

 

Principle: The PCR test also shows a low viral load (VL). The rapid test is less sensitive and only shows high VL (= usually infectious phase). There is only a short phase in which the VL is initially low and the rapid test turns out negative compared to the PCR (8-24h).

 

 

If you miss a low VL at the beginning with the rapid test, the next test should work. Therefore regularly. Tests planned: Rapid test every 3 days + Q. is more effective than every 3 days PCR (with time delay) + Q. Daily Rapid tests in widespread use could reduce infections to zero!

In contrast, today: Until the positive PCR test result is received or during the PCR test itself, one is often hardly / no longer infectious. Nevertheless, longer quarantine and tracing of contacts, which could long ago be contagious again, will take place or only then (officially)

 

Ergo: test frequency and evaluation time are more important than test sensitivity!

Or also: It depends more on the test strategy than on the test!

Motto: Testing for infectivity instead of infection!

 

Important: In the case of rapid tests, a distinction is made in the EU between near-patient (point-of-care test / POCT) and self-tests. The former can only be carried out by health professionals. In the USA and GB 2 POCT each have been approved. One of them ( https://ir.quidel.com/news/news-release-details/2020/Quidels-Sofia-SARS-Antigen-FIA-Updates-EUA-Performance-Data-to-96.7-PPA-Versus-PCR-Product-Supports-U.S.-Initiatives-to-Expand-Access-to-COVID-19-Testing-in-Nursing-Homes-Receives-CE-Mark-for-Use-With-Sofia-and-Sofia-2-Instruments/default.aspx ) and..

..some others (e.g. http://sdbiosensor.com/xe/product/7672 + http://rapigen-inc.com/wp/portfolio-items/covid-19ag/?lang=en&ckattempt=1 ) are already CE certified / approved in DE to my surprise (see also https://dimdi.de/dynamic/de/medizinprodukte/datenbankrecherche/corona-tests/ + https://covid-19-diagnostics.jrc.ec.europa.eu/devices ).

 

Edited August 14, 2020 by wwww

[wwww]

The already approved point-of-care tests could be used regularly in practices, hospitals + old people's / nursing homes in addition to diagnostics. Screening of the MA can be used. A deployment by "school health professionals" should be checked or, if necessary, made possible!

And the hopeful antigen self-tests described (paper strips) are already marketable! For example the test of

@E25Bio

. The function / performance of this quick test is clearly explained in the video below.

 

 

Interim conclusion: Cheap, quick self-tests are a public health screening tool and are already marketable and, in my opinion, approvable and could, with broad, regular (ideally daily) use, contain the infection rate to a minimum.

 

Edited August 14, 2020 by wwww

[wwww]

https://www.rapidtests.org/

In addition to rapid antigen tests, there are also so-called RT-Lamp or CRISPR rapid tests (point-of-care and / or self-test), which are somewhat more expensive :

 

https://www.nature.com/articles/s41587-020-0513-4

 

Quote

Our CRISPR-based DETECTR assay provides a visual and faster alternative to the US Centers for Disease Control and Prevention SARS-CoV-2 real-time RT–PCR assay, with 95% positive predictive agreement and 100% negative predictive agreement.

 

 

Quote

 

To my surprise, the following are already approved in Germany:
a CRISPR test (40 min.) from Vision Medicals (https://medrxiv.org/content/10.1101/2020.02.22.20025460v2) and an RT-LAMP test (30 min.) from the Green Cross MS (see https : //dimdi.de/dynamic/de/medizinprodukte/datenbankrecherche/corona-tests/). However, both point-of-care, no self-tests.

 

 

Edited August 14, 2020 by wwww

[wwww]

Maske:

 

 

 

 

 

 

 

 

Edited August 14, 2020 by wwww

[wwww]

Harvard study shows that in comparison, Covid-19 in New York was even more fatal than the Spanish flu in 1918

[wwww]

The time from infection with Covid-19 to the onset of symptoms is longer than originally assumed. More recent studies assume 7.5 days. This is relevant for the work of the health authorities and superspreader events. Another reason for quick tests

 

 

[wwww]

 

 

 

 

 

Radiology: Surprisingly, radiological abnormalities were rare, and most were in patients with pre-existing lung disease. 2 patients had HRCT that showed fibrosis. Importantly no patient with mild disease (no 02) had an abnormal CXR. This has useful implications for f/u!

 

Lung function: Unsurprisingly, lung function was worse in severe disease, but actually, lung function was pretty normal in many patients in mild/moderate disease. Again, no patient with mild disease had significantly abnormal spirometry.

Symptoms: Unlike radiology/lung function - symptoms were VERY common across all severities of COVID-19 - this is #LongCovid. 74% of patients had >=1 symptom at follow up. Breathlessness, insomnia, and excessive fatigue were very common.

Bloods: (we looked at initial bloods in a previous paper - https://medrxiv.org/content/10.1101/2020.06.25.20137935v1). However, reassuringly, 'routine' blood abnormalities were rare in this cohort. Perhaps unnecessary in f/u?

Summary: Reduced QoL and symptoms very common at around 3 months in COVID-19. However, reassuringly, CXR and lung function findings are reassuring (particularly in patients who never required oxygen). Implications?

Many bodies/people have proposed f/u strategies: e.g.

@BTSrespiratory

(https://brit-thoracic.org.uk/about-us/covid-19-information-for-the-respiratory-community/) or this (rather excessive) figure from https://thelancet.com/journals/lanres/article/PIIS2213-2600(20)30349-0/fulltext or https://bmj.com/content/370/bm

 

 

 

 

 

 

 

Edited August 16, 2020 by wwww

[wwww]

 

 

 

This (small) study shows that clinical (radiographic, spirometric, blood) abnormalities are rare (well, non-existent!) in mild (no oxygen requirement) COVID-19, and infrequent in moderate disease. However..

QoL and symptom burden are massive (#LongCovid ). We need effective strategies to manage these impacts of COVID-19 - on people - perhaps rather than performing lots of testing on patients who have had mild COVID-19.

Bonus: We didn't include exploratory analyses in the work, but I include a scatter plot of the correlations between some of the lung function/time from follow up / QoL. There is a hint that: QoL is worse in those with severe disease, and Symptoms and spirometry results seem to get better over time ... But numbers were a bit too small and we didn't have the time to include all the data and perform the appropriate analyses.

 

 

 

 

 

[wwww]

 

Here is a brief description of the LAMP rapid test, is approved in the UK. Technology is interesting. Because small laboratories can be operated in schools and airports. Similar to PCR, fraction of the cost, fewer reagents. Up to 15,000 tests / day / device

 

[Angelia]

Odlican intervju.

 

We may already have herd immunity – an interview with Professor Sunetra Gupta

Are we already immune to coronavirus? Professor Sunetra Gupta, a theoretical epidemiologist at Oxford University, discusses her recent study on the herd immunity threshold, as well as her views on the social costs of lockdown, the inaccuracy of epidemiological models, and the curtailment of academic debate.

 

 

A study produced by a team at Oxford University indicated that some parts of the United Kingdom may already have reached herd immunity from coronavirus. A significant fraction of the population, according to the study published last week, may have “innate resistance or cross-protection from exposure to seasonal coronaviruses”, making the proportion vulnerable to coronavirus infection much smaller than previously thought.