Sunshine State

Doktor je naveo jedan simptom koji nije spominjan na listi najcesce navodjenih simptoma - dve trecine su opisale gubitak mirisa i ukusa koji traje nekoliko dana, toliko da jedna majka cak nije osecala "miris" sadrzaja pelene njene bebe: Fast alle Infizierten, die wir befragt haben, und das gilt für gut zwei Drittel, beschrieben einen mehrtägigen Geruchs- und Geschmacksverlust. Das geht so weit, dass eine Mutter den Geruch einer vollen Windel ihres Kindes nicht wahrnehmen konnte. Evo njegovog objasnjenja - slicno onom od strane WHO - testirati, testirati, testirati: U Italiji su testirani samo vrlo teški simptomatski slučajevi. Na primer, trenutna studija iz Shenzhena je otkrila da se deca zaraze patogenom jednako često kao i odrasli, ali oni razvijaju samo blage ili nikakve simptome. Ako se prati studija i pretpostavi se da 91% Covid-19 ima samo blage ili umerene simptome, Italijani su se u početku usredotočili na preostalih 9 %. Pored toga, mrtvi se naknadno testiraju i na Sars-CoV-2. I u Kini se na početku naglo povećao broj smrtnih slučajeva, ali ne i broj zaraza, jer su se skoncentrisali na mrtve. Sada je obrnuto, jer u Kini ima puno više testiranja. U Nemačkoj su od pocetka testirani i pacijenti sa samo blagim simptomima. Na primer, naš indeksni pacijent u Bonnu imao je samo ogrebotinu u grlu; siguran sam da se to nikad ne bi testiralo u Italiji.

Bold - pa to je super vest, jer u tom slucaju na 40 000 zarazenih imamo 20 umrlih, te je smrtnost manja nego kod redovnog gripa! Naravno, uvek postoji mogucnost onog sto @ciao napisa, sto otezava neke zakljucke Ja uopste nisam odusevljena holandskim zdravstvenim sistemom (bar ono sto licno znam), ali brojke (opet te brojke) kazu drugacije: https://worldpopulationreview.com/countries/best-healthcare-in-the-world/ Healthcare outcomes are changes in health that result from specific measures or investments. Healthcare outcomes include amenable mortality, readmission, and patient experience. The Healthcare Access & Quality (HAQ) Index ranks healthcare outcome scores on a scale of 0 to 100, with 100 being the best. Countries with the best healthcare systems in the world have scores between 90-96.1. The Netherlands holds the highest score of 96.1.

Neko pametniji ( @Doorn ) da objasni ovoliku razliku u brojkama/procentima u dve EU zemlje sa, relativno, istim standardom, zdravstvom, etc...Naravno, velicina / naseljenost drzave igra vaznu ulogu, no svejedno, smrtnost ne bi trebala da bude toliko razlicita: Nemacka: zarazenih 8000 umrlih 20 (0.25 %) serious 2 Holandija: zarazenih 1705 - umrlih 43 (2.5 %) serious 45

Razmisljam naglas i racunam, uzimajuci u obzir brojke lekara iz Johns Hopkins - ako ima 25-50 zarazenih na jednog potvrdjeno zarazeno, brojke u ovom trenutku za US su onda ovako: Zarazenih: 4700, znaci 120 k - 250 k (in reality) Umrlih: 93 U kriticnom stanju: 12

Johns Hopkins professor estimates at least 50,000 people have coronavirus in US “Don’t believe the numbers when you see, even on our Johns Hopkins website, that 1,600 Americans have the virus,” Makary said. “No, that means 1,600 got the test, tested positive. There are probably 25 to 50 people who have the virus for every one person who is confirmed.” https://thehill.com/policy/healthcare/487562-johns-hopkins-professor-estimates-at-least-50000-people-have-coronavirus-in

Ako je zaista tako (ovde opet dolazimo do toga koliko je sve nepoznato i nepotrvrdjeno), odakle jos uvek 233 (1/3) active cases na Diamond Princess, koji je u karantinu jos od 1 februara? A tu su kontrolisani uslovi, pretpostavljam da je ozbiljan karantin/izolacija, pa vec 6 nedelja traje agonija, uz trecinu jos uvek aktivnih slucajeva.

Evo na TC sam, opet nam lekari iz US ponavljaju da se wave in the US ocekuje u julu, avgustu... 😞

Gde pise "dugotrajna terapija", recimo u ovom dole? Izdvajam: "... that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used..... The finding in two randomised trials that advice to use ibuprofen results in more severe illness or complications helps confirm that the association seen in the observational studies is indeed likely to be causal" Prof Paul Little, Professor of Primary Care Research, University of Southampton, said: “There is now a sizeable literature from case control studies in several countries that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used – both respiratory or septic complications (1-10) and cardiovascular complications (11, 12). The observational evidence is always difficult to interpret due to so called protopathic bias/confounding by indication (i.e. were the NSAIDs prescribed at an early stage of the complications developing and so the NSAID use reflects the complications or a more severe illness rather than causing it), but where this has been controlled for the associations still persists(2). The finding in two randomised trials that advice to use ibuprofen results in more severe illness or complications (13, 14) helps confirm that the association seen in the observational studies is indeed likely to be causal. Advice to use paracetamol is also less likely to result in complication

Pa ne pricam ja, pricaju neki pametniji od mene: Prof Paul Little, Professor of Primary Care Research, University of Southampton, said: “There is now a sizeable literature from case control studies in several countries that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used – both respiratory or septic complications (1-10) and cardiovascular complications (11, 12). The observational evidence is always difficult to interpret due to so called protopathic bias/confounding by indication (i.e. were the NSAIDs prescribed at an early stage of the complications developing and so the NSAID use reflects the complications or a more severe illness rather than causing it), but where this has been controlled for the associations still persists(2). The finding in two randomised trials that advice to use ibuprofen results in more severe illness or complications (13, 14) helps confirm that the association seen in the observational studies is indeed likely to be causal. Advice to use paracetamol is also less likely to result in complications(13).” Prof Ian Jones, Virologist at the University of Reading, said: “The advice relates to Ibuprofen’s anti-inflammatory properties, that is, it dampens down the immune system, which may slow the recovery process. In addition, it is likely, based on the substantial literature around SARS I and the similarities this new virus (SARS-CoV-2) has to SARS I, that the virus reduces a key enzyme which part-regulates the water and salt concentration in the blood and could be part of the pneumonia seen in extreme cases. Ibuprofen aggravates this while paracetamol does not. It is recommended that people use paracetamol to reduce temperature if you are feverish.” Prof Paul Little, Professor of Primary Care Research, University of Southampton, said: “There is now a sizeable literature from case control studies in several countries that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used – both respiratory or septic complications (1-10) and cardiovascular complications (11, 12). The observational evidence is always difficult to interpret due to so called protopathic bias/confounding by indication (i.e. were the NSAIDs prescribed at an early stage of the complications developing and so the NSAID use reflects the complications or a more severe illness rather than causing it), but where this has been controlled for the associations still persists(2). The finding in two randomised trials that advice to use ibuprofen results in more severe illness or complications (13, 14) helps confirm that the association seen in the observational studies is indeed likely to be causal. Advice to use paracetamol is also less likely to result in complications(13).” Prof Ian Jones, Virologist at the University of Reading, said: “The advice relates to Ibuprofen’s anti-inflammatory properties, that is, it dampens down the immune system, which may slow the recovery process. In addition, it is likely, based on the substantial literature around SARS I and the similarities this new virus (SARS-CoV-2) has to SARS I, that the virus reduces a key enzyme which part-regulates the water and salt concentration in the blood and could be part of the pneumonia seen in extreme cases. Ibuprofen aggravates this while paracetamol does not. It is recommended that people use paracetamol to reduce temperature if you are feverish.” Dr Tom Wingfield, Senior Clinical Lecturer and Honorary Consultant Physician, Liverpool School of Tropical Medicine, said: “In the UK, paracetamol would generally be preferred over non-steroidal anti-inflammatory drugs (“NSAIDS”) such as ibuprofen to relieve symptoms caused by infection such as fever. This is because, when taken according to the manufacturer’s and/or a health professional’s instructions in terms of timing and maximum dosage, it is less likely to cause side effects. Side effects associated with NSAIDs such as ibuprofen, especially if taken regularly for a prolonged period, are stomach irritation and stress on the kidneys, which can be more severe in people who already have stomach or kidney issues. It is not clear from the French Minister’s comments whether the advice given is generic “good practice” guidance or specifically related to data emerging from cases of Covid-19 but this might become clear in due course. It should also be noted that, in the UK, we would not commonly use cortisone to relieve infection-related symptoms such as fever.” Dr Rupert Beale, Group Leader in Cell Biology of Infection at The Francis Crick Institute “There is a good reason to avoid ibuprofen as it may exacerbate acute kidney injury brought on by any severe illness, including severe COVID-19 disease. There isn’t yet any widely accepted additional reason to avoid it for COVID-19. Patients taking cortisone or other steroids should not stop them except on advice from their doctor. The Society for Endocrinology has issued advice for patients who are taking hydrocortisone or other steroids for pituitary or adrenal deficiency. https://www.endocrinology.org/news/item/14050/Coronavirus-advice-statement-for-patients-with-adrenal%2fpituitary-insufficiency.”

Ja razumem o cemu pricas, i prva stvar i u mojoj struci, kao i u medicini je "do no harm" - da nije tako, pola lekova bi bilo na trzistu posle dva meseca, a ne posle 10 godina ispitivanja. U konkretnom slucaju, ibuprofen vs. paracetamol - koji je, actually, harm, ako neko poslusa, pa uzme paracetamol umesto ibuprofen? Nikakav, ili skoro zanemarljiv ... stoga, ne vidim cemu tolika buna oko ovog - ja licno, i inace, uzimam paracetamol (acetaminophen)/caffeine (Panadol extra, ), a ne ibuprofen/ Brufen/Advil

Sacekacu s povratkom dok ne postignete herd immunity! Popicemo kafu negde na leto 🙂

Ma da, svi cemo skociti da pijemo masnu sodu, ako nam ti/mediji kazu - daj malo vise poverenja bar u ljude koji ovde kuckaju. Hajde hipoteticki - ako se potvrdi da je ibuprofen stvarno stetan, kako ces to objasniti umrlima, koji su (mozda), umrli zbog toga, a mogli su da uzmu paracetamol?

Postavih ranije neki link koji su nam juce slali, da ce sve vezano za COVID-19 biti fast track, nece ici redovnim, najcesce dugogodisnjim procedurama. S jedne strane treba naci vakcinu, lek, testirati da je efikasno, a s druge osigurati da nije stetno....nece sutra, svakako - plasim se da cemo pre doci do herd immunity, nego do approved vakcine/leka, koja je "potvrdjena" ( by McLeod)

Bold - nek si nam i kaz'o! Mi, inace, ne znamo, nego iz dosade i radoznalosti prenosimo ono u sta i malo strucniji od nas nisu sigurni. Ja radim na jedno klinickoj studiji vec 5-u godinu, pa jos se ne moze sa sigurnocu potvrditi niti da nema serious adverse effects, niti da je efikasan toliko da ga treba odobriti,.... a ne da ocekujem da, u jeku nepoznatog virusa, bilo ko na svetu ima POTVRDJENE podatke, terapije, etc za taj isti virus.... Bold: To je vec stvar drzave - ne mozes u Nemackoj opustositi apoteku, ako je lek na recept, taman da se svaki minut vrti na svim medijima da taj lek leci coronu.

Ne postoji approved lek/tretman za COVID-19, kao sto svi znamo.... ovo sto se daje/pokusava je vise empirijski, na osnovu tretmana slicnih virusa Postoje neka saznanja na osnovu dosadasnjih slucajeva, i mora se od neceg krenuti, npr. laboratorijski nalazi koji mogu da ukazuju na COVID-19: Laboratory findings — In patients with COVID-19, the white blood cell count can vary. Leukopenia, leukocytosis, and lymphopenia have been reported, although lymphopenia appears most common [23,37-39]. Elevated lactate dehydrogenase and ferritin levels are common, and elevated aminotransferase levels have also been described. On admission, many patients with pneumonia have normal serum procalcitonin levels; however, in those requiring intensive care unit (ICU) care, they are more likely to be elevated . High D-dimer levels and more severe lymphopenia have been associated with mortality. Certain investigational agents have been described in observational series or are being used anecdotally based on in vitro or extrapolated evidence. It is important to acknowledge that there are no controlled data supporting the use of any of these agents, and their efficacy for COVID-19 is unknown. ●Remdesivir – Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19 [71]. Remdesivir is a novel nucleotide analogue that has activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies [72,73]. The compassionate use of remdesivir through an investigational new drug application was described in a case report of one of the first patients with COVID-19 in the United States [74]. Any clinical impact of remdesivir on COVID-19 remains unknown. ●Chloroquine/hydroxychloroquine – Both chloroquine and hydroxychloroquine inhibit SARS-CoV-2 in vitro, although hydroxychloroquine appears to have more potent antiviral activity [75]. A number of clinical trials are underway in China to evaluate the use of chloroquine or hydroxychloroquine for COVID-19 [76]. ●Lopinavir-ritonavir – This combined protease inhibitor, which has primarily been used for HIV infection, has in vitro activity against the SARS-CoV [77] and appears to have some activity against MERS-CoV in animal studies [78]. The use of this agent for treatment of COVID-19 has been described in case reports [79-81], but its efficacy is unclear. In one report of five patients who were treated with lopinavir-ritonavir, three improved and two had clinical deterioration; four had gastrointestinal side effects. It is being evaluated in larger randomized trials. ●Tocilizumab – Treatment guidelines from China's National Health Commission include the IL-6 inhibitor tocilizumab for patients with severe COVID-19 and elevated IL-6 levels; the agent is being evaluated in a clinical trial [82]. Other interventions of interest but with limited or no clinical data include interferon beta and convalescent serum.

GMO! Al' svet se vise boji GMO-a, nego corona virusa

Ne mogu da editujem moj poslednji post - vazno da dodam, za sve moje upise: radim u Drug Safety, Medical Affairs and Pharmacovigilance i vrlo dobro znam koliko je vremena, para i znanja potrebno da bi se bilo sta moglo tvrditi - pa ni onda nije "zapisano u kamenu" (hint: slucaj Vioxx), tako da sve ovo sto se sad radi i pokusava sa COVID-19 su upravo to, samo pokuaji, zasnovani na prethodnim saznanjima i iskustvima, sa slicnim virusima (SARS, MERS).

Ako se odnosilo na moj post - sorry, ne pricam o uzimanju lekova na svoju ruku Chloroqine, remdesivir, oseltamivir, lopinavir/ritonavir, tocilizumab, steroidi (methylprednisolone) su lekovi koji se daju u bolnicama, od strane lekara, nije paracetamol koji kupis OTC.

Pa nije na nivou belog luka -chloroquine je jedan od lekova u protocolu za tretman simptoma COVID-19, uz nekoliko '...vire" lekova i methylprednisolone-a

Sta ocekivati od "obicnog" sveta, kad su lekari KBC Rebra precutali da su isli na vikend u Austriju, vratili se na posao zarazeni i sad je 140 medicinskih radnika u izolaciji, "neupotrebljivi" za ono za cega su obuceni i placeni! 😞

Ako sve ovo prodje bez da Crnogorci imaju ijednog zarazenog, Mila odmah na celo WHO 😄

Stiglo nam juce, olaksace/ubrzace sve research koji su vezani za COVID-19: https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/covid-19-guidance-sponsors-sites-and-researchers/ 1. New studies relating to COVID-19 An expedited review process is available for studies relating to COVID-19 where there are public health grounds for rapid review. The full process for fast-track reviews is set out in the Standard Operating Procedures for Research Ethics Committees.

Vrlo lepo objasnjen herd immunity i UK approach: Prof Matthew Baylis, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, said: “What is herd immunity? In a nutshell, everyone in a population is protected from infection before all of them are immune. The reason is that at a certain level of immunity (i.e., a proportion of people are immune, from having had the disease or having been vaccinated), the point comes when – on average – one infected person does not manage to contact and pass the infection on to one other person. Most of their contacts are already immune. The occasional contact is still susceptible, and the odd transmission event happens, but not often enough to sustain the disease. Transmission grinds to a halt, even though some or even many people have still not had the disease. This is herd immunity. It is one of the reasons boys are vaccinated against rubella: by vaccinating boys, boys are less likely to transmit to girls (an effect of immunity), and by vaccinating boys, girls are less likely to transmit to girls (an effect of herd immunity). For herd immunity, it does not matter whether the immunity comes from vaccination, or people having had the disease; people just need to be immune. “A key question is how much immunity is needed before we get herd immunity? It varies per disease, depending on how transmissible it is. For a highly transmissible disease, like measles, on average one person might infect up 20 others, and herd immunity kicks in at 95% immune – and so, the target coverage for MMR vaccine is 95%. For flu, on average one person infects just 1.3 others; in this case herd immunity kicks in at about 25% immune or less; and so the target coverage for flu vaccine is much less than it is for measles (three quarters of over 65s). “So what about COVID-19? Estimates are that one person may infect as many as 2-3 others, on average, meaning herd immunity should kick in at 50 – 67% of the population immune. And so in the absence of a vaccine, there would appear to be nothing to stop the spread of the virus until 50-67% of us have had it; and at that point herd immunity will kicks in and transmission will decline or stop. This is where the 60% of the population statistic has come from. And this is deeply concerning – taking the low fatality rate estimate of 1%, even 50% of the UK population infected by COVID-19 is an unthinkable level of mortality. “But it doesn’t have to be – and it won’t be – this way. By reducing the number of people that one person infects, on average, then we lower the point at which herd immunity kicks in. If we reduce it to 1.3, COVID19 becomes more like flu, and herd immunity kicks in when about one quarter of the population has had the disease and is now immune. So, from an epidemiological point of view, the trick is to reduce the number of people we are in contact with (by staying more at home), and reduce the chance of transmission to those we are in contact with (by frequent hand washing) so that we can drive down the number of contacts we infect, and herd immunity starts earlier. The sweet spot comes at the point where one infected person infects one, or less than one, person on average. But, importantly, we will need to sustain this until we have a vaccine: only at that point can we return to normal behaviour patterns, with herd immunity now achieved by vaccination, not disease.”

Stra'ota! https://m.youtube.com/watch?v=9-8zcBogaKY

Ovde u mom "malom mistu" divan, suncan dan - zasto ne dozvoliti starijim ljudima da prosetaju pola sata-sat napolju, ne u guzvi? Mi imamo divan kej, odrediti vreme, recimo 11-12 h kad starji ljudi mogu da izadju i prosetaju - sanse da se zaraze coronom setajuci po polupraznim ulicama, parkovima, kejovim, su manje nego da ih strefe slogovi sedeci u stanovima i ne krecuci se.