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*** OFFICIAL *** COVID-19 CoronaVirus Thread. Fresh epidemic fears as child pneumonia cases surge in Europe after China outbreak. NOW in USA (13 Viewers)

Doug B said:
What are you saying was reported in March by the Chinese, specifically? That HBP medicine worsened COVID symptoms? If so ... I don't recall that, but would be interested in reading something about it from that early on.
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Yes, that HBP medication should be withdrawn for Covid admissions, this was very very early report.  I can't find it, I mean there is so much noise out there I wouldn't know where to look.

 
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culdeus said:
Doug B said:
What are you saying was reported in March by the Chinese, specifically? That HBP medicine worsened COVID symptoms? If so ... I don't recall that, but would be interested in reading something about it from that early on.
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Yes, that HBP medication should be withdrawn for Covid admissions, this was very very early report.  I can't find it, I mean there is so much noise out there I wouldn't know where to look.
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I've looked for a source, too, from early on. I haven't found a smoking gun, but I've found references in a few studies that responded to apparent speculation along the lines of "Should we be continuing HBP with COVID admissions?" So, it seems that at least a few doctors and researchers must've raised the question early on ... perhaps based on (what was then) educated professional "intuition" about the mechanism through which the virus spreads in the body.

 
beer 30 said:
Was trying to Google the supercomputer article and came across this which has some references to studies in March/April around this subject. Just throwing it out there, had never heard the word bradykinin until today. Cool stuff.

https://www.the-scientist.com/news-opinion/is-a-bradykinin-storm-brewing-in-covid-19--67876
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Good read, thanks. There is a paragraph in your link (see below) about a Dutch researcher who hypothesized about bradykinins early on, and got a preprint published in April.

From beer 30's link:

On a Sunday afternoon in mid-April this year, Daniel Jacobson, a computational systems biologist at Oak Ridge National Laboratory in Tennessee, was looking at gene expression data from the lung fluid of COVID-19 patients on his computer screen when he spotted something striking—the expression of genes for key enzymes in the renin-angiotensin system (RAS), involved in blood pressure regulation and fluid balance, was askew.

Jacobson followed this abnormal RAS in the lung fluid samples to the kinin cascade, an inflammatory pathway that is tightly regulated by the RAS. He found that the kinin system—in which a key peptide, bradykinin, causes blood vessels to leak and fluid to accumulate in tissues and organs—was thrown out of balance as well in COVID-19 patients ...

Unbeknownst to Jacobson, Frank van de Veerdonk, an infectious disease specialist at the Radboud University Medical Center in the Netherlands, was heading down the same molecular pathway in mid-March. He had noticed two features in COVID-19 patients in his clinic—fluid in the lungs and inflammation. Because other labs had pegged angiotensin-converting enzyme-2 (ACE2), a key enzyme in the RAS, as being the SARS-CoV-2 receptor, and because he knew that ACE2 regulates the kinin system, van de Veerdonk began connecting the dots. In April, (van de Veerdonk) and his group hypothesized that a dysregulated bradykinin system was leading to leaky blood vessels in the lungs and perhaps causing excess fluid to build up (link to preprint - db).
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Van de Veerdonk's preprint has a robust comments section at the bottom, featuring many medical researchers kicking around the bradykinin-storm hypothesis and related topics back in April and early May. Some of the reading in the comments is dense, but there are many interesting bits of what was then educated speculation.

 
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jamny said:
Wow, France really having a resurgence. Thankfully the mortality rate is still low but the case count is at April peaks.
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Here are some personal insights FWIW:

General: Cases have definitely gone up here and the government is on edge. They went from saying there will definitely not be another lockdown to having a plan on the ready in case it needs to happen. Many people have become more lax about the rules and as everyone comes back from their August holidays the virus is spreading with them. 

Masks: Many cities have implemented mask rules when out in public 24/7. Here in Paris it started out as only on a few streets/along the river & canal, then zones throughout the city (busy neighborhoods, touristy areas) then within the last week or two it was mandated that masks are required 100% of the time when outside throughout the city in all public spaces (all  and streets, parks, etc.) including the inner suburbs. Exceptions are when running and cycling. I'm happy with this ruling as it's quite reasonable and for the good of the city. The zones thing was a bit random and with no clear signage it was never going to work.

Work: My office (c. 50 people) has been open since June with us going back in shifts and having the office fully rearranged for distancing purposes. Up until Sept. 1st our office rule was you must wear a mask at all times except when at your desk. Beginning two days ago the government stated that all office workers must wear a mask 100% of the time in an open office arrangement. So unless you have a personal office you're SOL. All of this going into the office is optional for us though. I was going in 1-2 days/week but now will work from home 100% until this mask rule is lifted.  

Restaurants: Over the summer Paris has allowed restaurants and cafés to spill out on the streets and take up parking spaces with semi-permanent patios. This allows for nearly everyone to eat outside and makes for fewer cars all-around. Was just announced to extend this through Summer 2021 and a really good initiative to allow restaurants to have priority over the street instead of cars. Many times at night entire streets will close so that restaurants can expand for evening dining. 

Travel: Have taken a couple of trips via train since full lockdown was lifted in May. To Normandy (June), Pyrénées Mountains (July), and Biarritz (August). All via train and took my bike on two of those trips. Long distance trains have been fairly crowded and must wear a mask 100% of time on the train. Nearly all are in compliance with this so that is a big plus. My wife is six months pregnant so won't be flying any time soon but we feel perfectly safe on the train with masks. Definitely noticed a difference in the August trip vs. the June/July trips. More masks in cities and what I would call "virus tension" in August as the cases increased. 

 
My daughter who is at ASU wants to come home for labor day weekend. She had the saliva test done and it came back invalid. I don't understand how that can be unless they messed up somehow. Does anyone here know how this works? The test also says negative. She is going to try and get a rapid read test done today. I guess a positive result would be worse but with it being invalid I am sort of stuck. The right thing to do is leave her there but she really wants to come for the weekend. She is very responsible and follows all the rules regarding masks, washing hands, distancing etc...

I hope she can get a rapid read with good results this morning.

* From emails and from what I can tell I would say ASU is making a solid effort at doing the right things.

 
prosopis said:
My daughter who is at ASU wants to come home for labor day weekend. She had the saliva test done and it came back invalid. I don't understand how that can be
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Possible explanation.

About a month ago my kid away at school called me - "Dad, can you, uh, text me a picture of your medical insurance card."  Um, yeah, kid, that's not something a parent really ever wants to hear.  Turns out his roomate was positive.  I drove 5 hours down, moved him, and 5 hours back the same day after he tested negative.  And he was 2 weeks from moving out, anyway.  :hot:

 
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So, an update

Deaths per capita: US is 10th per worldometer, 8th if San Marino is considered part of Italy, and Andorra part of Spain. Still rising in the lists, though Brazil is rising faster (currently 8th/6th) and Peru is (except for San Marino) worst off. Six US states have higher deaths per capita than Peru: NJ, NY, MA, CT, LA and RI. These are not the states where people are dying now, accounting for only 49 of yesterday's 1,000+ deaths. CA, FL, TX, GA and NC each had more people reportedly dying from COVID-19 than those six states did yday

Outcomes: The US has 4% of resolved cases resulting in death, in line with the world average. Peru is at 5.6%

Cases per capita: US is 10th just after Peru and ahead of Brazil. Worst off is Qatar but the three countries are rising and the ones higher on the list seem to be stagnating or falling.

Current cases: India is surging ahead of everyone (now over 80k per day) and even though they test 1m people per day they still rank low in overall tests. US and Brazil are #2 and #3 after an uptick from the levels of the past two weeks (particularly IL - not sure whether it's a one off). Only seven states in the US had less than 100 cases yday and 20 with over 1000. 

RT: Only 20 states have (per rt.live) an R0 number of less than one. That is 8 less than a month ago

Tests per Capita: A respectable 19th in the world and rising on the strength of 1m recorded tests per day for the past days (and possibly longer)

 
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belljr said:
How is NJ above 1.   The new cases have been very low I thought
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States with very low case numbers can easily pop above 1. By itself it is a worthless metric.

Eta: also looking at their methodology they dont explicitly state they use date of test. Clearing a 50 case backlog can cause a spike as well when case counts get lower. 

 
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Doug B said:
Where are you seeing hospitalization numbers for the whole U.S.? I can find a lot of numbers, for instance, on Worldometers ... but not hospitalizations.

I can see on WM that U.S. active case numbers are stabilizing and could be starting to lower (third graph below state numbers). But I can't see, at that site, hospitalization numbers.
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Covid tracking project by the atlantic. 

From like 55k to 32k give or take. 

Eta: there is an even better site that I will link later, but i have it bookmarked on my computer, not my phone. Allows you to chart various states comparatively. It has been linked in here before. 

 
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Atlantic's data compilation page is really impressive. It is presented with the necessary caveats, as it should be.

I have been using Worldometers as the gold standard since February. Compared to WM, Atlantic's compiled data seems slightly low on total cases (6,460,250 vs 6,247,397) and very low on recoveries (3,725,970 vs 2,315,995).  I wonder what accounts for the differences?

All that said, the overall hospitalization numbers (estimates) on Atlantic's site look really positive -- a sustained period of decline since late July. Let's hope that continues.

 
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Doug B said:
Atlantic's data compilation page is really impressive. It is presented with the necessary caveats, as it should be.

I have been using Worldometers as the gold standard since February. Compared to WM, Atlantic's compiled data seems slightly low on total cases (6,460,250 vs 6,247,397) and very low on recoveries (3,725,970 vs 2,315,995).  I wonder what accounts for the differences?

All that said, the overall hospitalization numbers (estimates) on Atlantic's site look really positive -- a sustained period of decline since late July. Let's hope that continues.
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Here is other site. U of Minnesota covid hospitalization tracking project.

 
Vitamin D reduces ICU admission rate from 50% to 2% in study (97% Reduction) : 

https://covid.us.org/2020/09/03/new-study-vitamin-d-reduces-risk-of-icu-admission-97/

"The intervention group received calcifediol, which is a type of vitamin D found in the blood. It is not the usual type of vitamin D found in supplements. Calcifediol is also known as 25(OH)D or 25-hydroxyvitamin D. The reason for giving this type of vitamin D is that the usual supplement type takes about 7 days to turn into calcifediol, so by giving patients calcifediol itself, you get the good effects without having to wait 7 or so days [per Wikipedia].

The dosage of calcifediol converts to IU (international units at a ratio of 200 to 1). So 10 micrograms of calcifediol is 2000 IU of vitamin D, whereas 10 micrograms of vitamin D3 is 400 IU (a 40:1 ratio). The dosage given to the patients, in IUs, was:

Day one: 106,400 IU of vitamin D
Day three: 53,200 IU
Day seven: 53,200 IU
Once-a-week thereafter: 53,200 IU

This is equivalent to about 30,000 IU per day for the first week, and 7,600 IU per day thereafter. Yes, you can take your vitamin D supplement in a once-a-week dosage, instead of daily.

The results were astounding (and highly statistically significant). “Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%)”. Would you rather have a 50% risk of needing ICU care, or a 2% risk? Almost all hospitalized Covid-19 patients who die, die in the ICU. That is where the most severe cases are sent. So this study shows that vitamin D reduces the severity of Covid-19. 

In the statistically adjusted results, vitamin D reduced the odds of ICU admission by 97%. The RR (risk reduction) for ICU admission in hospitalized Covid-19 patients was 0.03 as compared to the control, which is given the value of 1.00. The odds of Covid-19 patients in general, as compared to hospitalized Covid-19 patients, needing ICU care would be even lower, as you would first need to be hospitalized to enter that risk ratio, and vitamin D has been shown by other studies to reduce risk of hospitalization. So taking a vitamin D supplement has tremendous benefits."

:eek:   :unsure:

 
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[icon] said:
Vitamin D reduces ICU admission rate from 50% to 2% in study (97% Reduction) : 

https://covid.us.org/2020/09/03/new-study-vitamin-d-reduces-risk-of-icu-admission-97/

"The intervention group received calcifediol, which is a type of vitamin D found in the blood. It is not the usual type of vitamin D found in supplements. Calcifediol is also known as 25(OH)D or 25-hydroxyvitamin D. The reason for giving this type of vitamin D is that the usual supplement type takes about 7 days to turn into calcifediol, so by giving patients calcifediol itself, you get the good effects without having to wait 7 or so days [per Wikipedia].

The dosage of calcifediol converts to IU (international units at a ratio of 200 to 1). So 10 micrograms of calcifediol is 2000 IU of vitamin D, whereas 10 micrograms of vitamin D3 is 400 IU (a 40:1 ratio). The dosage given to the patients, in IUs, was:

Day one: 106,400 IU of vitamin D
Day three: 53,200 IU
Day seven: 53,200 IU
Once-a-week thereafter: 53,200 IU

This is equivalent to about 30,000 IU per day for the first week, and 7,600 IU per day thereafter. Yes, you can take your vitamin D supplement in a once-a-week dosage, instead of daily.

The results were astounding (and highly statistically significant). “Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%)”. Would you rather have a 50% risk of needing ICU care, or a 2% risk? Almost all hospitalized Covid-19 patients who die, die in the ICU. That is where the most severe cases are sent. So this study shows that vitamin D reduces the severity of Covid-19. 

In the statistically adjusted results, vitamin D reduced the odds of ICU admission by 97%. The RR (risk reduction) for ICU admission in hospitalized Covid-19 patients was 0.03 as compared to the control, which is given the value of 1.00. The odds of Covid-19 patients in general, as compared to hospitalized Covid-19 patients, needing ICU care would be even lower, as you would first need to be hospitalized to enter that risk ratio, and vitamin D has been shown by other studies to reduce risk of hospitalization. So taking a vitamin D supplement has tremendous benefits."

:eek:   :unsure:
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Can't see if it is peer reviewed, but study only of 76 patients and as far as I read it 2/3rds got the calcifediol. 

Hopefully this works out with further study

 
msommer said:
Can't see if it is peer reviewed, but study only of 76 patients and as far as I read it 2/3rds got the calcifediol. 

Hopefully this works out with further study
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It is peer reviewed and is a legitimate study. The results are striking enough that it seems questionable. Vitamin D playing a role could explain why the death rate looks lower in the summer and also why people of color have been hit harder.

 
Drunken Cowboy said:
It is peer reviewed and is a legitimate study. The results are striking enough that it seems questionable. Vitamin D playing a role could explain why the death rate looks lower in the summer and also why people of color have been hit harder.
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Well, there should be plenty of opportunity to set up larger studies asap

 
msommer said:
Well, there should be plenty of opportunity to set up larger studies asap
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Vitamin D has been part of the meta for this thing since the onset.  Not sure what else people need to get a bottle.  It's completely safe and there is no known indications against it I know of.

 
culdeus said:
Vitamin D has been part of the meta for this thing since the onset.  Not sure what else people need to get a bottle.  It's completely safe and there is no known indications against it I know of.
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Most people are vitamin D deficient. It is god for you even if it doesn't help COVID. If you take it and don't need it, your body will produce less. Taking a reasonable amount daily is a good idea for almost everyone.

 
culdeus said:
Vitamin D has been part of the meta for this thing since the onset.  Not sure what else people need to get a bottle.  It's completely safe and there is no known indications against it I know of.
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I think the only issues with vitamin d are when people take way too much for too long. The rogan podcast with rhonda patrick mentioned one issue but I cant remember it. Didnt pay much attention because it was some insane level for a long time. 

 
I’ve never spent more time in the sun in my life than the last 6 months. Of course, need to see the dermatologist soon.

 
culdeus said:
Vitamin D has been part of the meta for this thing since the onset.  Not sure what else people need to get a bottle.  It's completely safe and there is no known indications against it I know of.
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It’s fat soluble, so it can accumulate and cause toxicity, albeit rarely. 
 

While taking a D supplement is reasonable for most people, the formulation and dose they use in the study are far from typical. They percentage of ICU admissions for the non-D group is also eyebrow-raising. And it’s interesting all their patients got hydroxychloroquine, azithromycin and possibly one other antibiotic. None of that is standard of care in the US, nor is vitamin D supplementation, BTW.

 
Terminalxylem said:
It’s fat soluble, so it can accumulate and cause toxicity, albeit rarely. 
 

While taking a D supplement is reasonable for most people, the formulation and dose they use in the study are far from typical. They percentage of ICU admissions for the non-D group is also eyebrow-raising. And it’s interesting all their patients got hydroxychloroquine, azithromycin and possibly one other antibiotic. None of that is standard of care in the US, nor is vitamin D supplementation, BTW.
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This is somewhat out of context. I was responding to someone asking for more research on vitamin d.

 
Doug B said:
Something else @[icon] and @Blick :

That Medium article about bradykinins seems to suggest that (1) people with high-blood pressure who are (2) regularly taking their blood pressure medicine may actually increase the severity of their COVID-19 symptoms if they contract the virus. So in doing the right thing controlling their BP,  they may get blindsided by COVID.

EDIT: Changes"will" to "may" ... all of this is preliminary and theoretical. More work to be done.
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The data have not borne this out in practice. A number of observational studies found no relationship between ACE inhibitors and angiotensin receptor blockers -- the BP meds that act on the ACE2 receptor, which the virus acts on, and were thus the meds of concern -- and risk for getting COVID-19 or experiencing a severe outcome from it. Some of them actually suggested the opposite, that they may be protective, at least in some people. The first randomized controlled trial in this area, BRACE CORONA, in which patients taking ACE inhibitors or angiotensin receptor blockers admitted to the hospital with mild to moderate COVID-19 were randomly assigned to continue or suspend their BP meds for 30 days, also found no benefit to stopping these meds. The results were presented last week at the European Society of Cardiology Congress. 

But we need more data specifically in people of African descent, for the reasons you mentioned. 

 
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Terminalxylem said:
It’s fat soluble, so it can accumulate and cause toxicity, albeit rarely. 
 

While taking a D supplement is reasonable for most people, the formulation and dose they use in the study are far from typical. They percentage of ICU admissions for the non-D group is also eyebrow-raising. And it’s interesting all their patients got hydroxychloroquine, azithromycin and possibly one other antibiotic. None of that is standard of care in the US, nor is vitamin D supplementation, BTW.
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I agree the dose here is large. Taking a reasonable dose it us hard to get toxicity. 

 
culdeus said:
This is somewhat out of context. I was responding to someone asking for more research on vitamin d.
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Maybe I misunderstood, but it really seemed like you were promoting vitamin D as part of COVID management. While I have no beef with those who want to take a supplement, it isn’t standard of care.

 
culdeus said:
This is somewhat out of context. I was responding to someone asking for more research on vitamin d.
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No. I suggested more research in calcifediol as a treatment for COVID-19 would be required and beneficial due to the small sample size in this study. Also, please note from the OP 

The intervention group received calcifediol, which is a type of vitamin D found in the blood. It is not the usual type of vitamin D found in supplements.
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Not sure why people are discussing vitamin D supplements inthis context

 
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msommer said:
No. I suggested more research in calcifediol as a treatment for COVID-19 would be required and beneficial due to the small sample size in this study. Also, please note from the OP 

Not sure why people are discussing vitamin D supplements inthis context
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It only takes a week for the  OTC stuff to convert.  Considering most of us aren't seriously ill right now an OTC at reasonable dosages is the right thing to consider.  

This study would indicate they can stuff you with the good stuff like cramming for a test. Which is neat, but I would rather get out ahead.

 
Pip's Invitation said:
The data have not borne this out in practice. A number of observational studies found no relationship between ACE inhibitors and angiotensin receptor blockers -- the BP meds that act on the ACE2 receptor, which the virus acts on, and were thus the meds of concern -- and risk for getting COVID-19 or experiencing a severe outcome from it. Some of them actually suggested the opposite, that they may be protective, at least in some people. The first randomized controlled trial in this area, BRACE CORONA, in which patients taking ACE inhibitors or angiotensin receptor blockers admitted to the hospital with mild to moderate COVID-19 were randomly assigned to continue or suspend their BP meds for 30 days, also found no benefit to stopping these meds. The results were presented last week at the European Society of Cardiology Congress. 

But we need more data specifically in people of African descent, for the reasons you mentioned. 
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Yeah, IIRC there were plausible mechanisms why ACEi and/or ARBs could be helpful or harmful. TMK, existing data doesn’t show a clear effect either way. In addition to the study you mention, there are ongoing studies in outpatients with COVID requiring antihypertensive therapy.

We’ll see if the bradykinin storm hypothesis pans out, but not everything in that article makes a lot of sense.

 
culdeus said:
It only takes a week for the  OTC stuff to convert.  Considering most of us aren't seriously ill right now an OTC at reasonable dosages is the right thing to consider.  

This study would indicate they can stuff you with the good stuff like cramming for a test. Which is neat, but I would rather get out ahead.
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I'd prefer waiting with stuffing myself with something until it has been tested thoroughly and shown scientifically to actually have beneficial effects, but maybe that's just me. You do you

 
Drunken Cowboy said:
It is peer reviewed and is a legitimate study. The results are striking enough that it seems questionable. Vitamin D playing a role could explain why the death rate looks lower in the summer and also why people of color have been hit harder.
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I’ve read enough for weeks to start taking daily Vitamin D and I never take daily vitamins.  Someone linked an article last week (the one about it not being a cytokine storm) that helps explain it a little from what I recall.

 
msommer said:
I'd prefer waiting with stuffing myself with something until it has been tested thoroughly and shown scientifically to actually have beneficial effects, but maybe that's just me. You do you
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You feel at this point vitamin D has no benefits outside of covid?

 
Terminalxylem said:
We’ll see if the bradykinin storm hypothesis pans out, but not everything in that article makes a lot of sense.
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I understand that it may take time that you don't have at the moment -- but would you be able to go into a little detail about what in that article (link) doesn't make sense?

I ask sincerely ... as a layman, I only know enough to be dangerous. If something looks and sounds plausible, was in a respected journal and was peer-reviewed ... I don't have enough background to mentally debate against a "We got COVID beat now!" study. Quite a few of which have been coming out of late.

...

Vitamin D? Really? How long is that going to take to go through dozens (if not hundreds) of hard studies worldwide and achieve replicable results and then consensus?

 
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