jiejie

@trublu: Do you have any thoughts on the ACE-2 enzyme theory, that populations (such as Japanese and Han Chinese) who have higher levels of this in their lung tissues, are more susceptible to severe illness from COVID-19 than populations that have less of this enzyme?

wco81

Would be interesting to know what proportion of those deaths are in hospital vs. at the deceased's home or somewhere else.

Maybe secondary infections are at play.

Also what would the treatment regime be, ventilators and retrovirals, maybe IV fluids and something to control fever?

trueblu

I haven't seen any other data, but haven't looked too hard. It's very believable that there is considerable heterogeneity in both the number of cells expressing ACE-2, and the degree of expression of ACE-2. But I'm not sure that means the one Asian they had in this small study means that Asians are at increased risk. It's also not known if this heterogeneity presents a risk factor for disease susceptibility.

Going back to that preprint today, in the "comments" section someone has written a couple of days ago about an analysis they did on about 515 samples, most of them Caucasian and 8 Asians, but using a different methodology: "the result of comparison is shown below and in the figure; in my analysis I did not see significant difference between Asians and Caucasian in the ACE2 expression levels (P by two-tailed t-test = 0.858, P by generalized linear model [GLM] considering sex, age and type of death as covariates = 0.999). Also there was no difference between males (N = 300) and females" ....so according to this person, the Asian story doesn't add up, but they really need to publish their own data properly first.

tb

doctoravios

Yes, I agree. I think for case finding to institute quarantine, temperature screening is futile. We now know people are infectious well before developing symptoms (if they develop any at all). RT-PCR testing is also pretty futile for tracing spread among individuals but I think it does have a role for population-based epidemiology and has proved to be quite informative (sadly, for the wrong reasons) aboard the Diamond Princess. But I think now the shift needs to move away from contact tracing/screening and saving RT-PCR testing capacity for those who have moderate/severe symptoms as there may be a role for this in prognosis/clinical decision making Re: intensive interventions (HDU/ICU etc).

Exactly - it's all about buying time. Oxygen/bronchodilators/fluids/inotropes etc may not be disease modifying but they buy time for innate immunity to continue and adapative immunity (which can take several weeks) to begin. I think research now needs to focus on risk prediction - i.e. what are the risk factors which predispose to worse outcomes so that we can ensure people who are at high predicted risk have early access to good quality medical/intensive care and that healthcare systems are prepared with the right infrastructure for their populations.

trueblu

A more macabre place where we may end up if this all goes very badly wrong is to have two risk models: a) in the early stage of a pandemic, predictors of risk for very severe disease, and offer optimal supportive care. But once (and if) infrastructure starts to get overwhelmed, we may have to offer risk models of futility vs. likely recovery, and only offer supportive therapy to the latter. An absolutely horrid place to be, but something that's routinely done outside of the US.

tb

Stgermainparis

Is there any data re the ages (and perhaps exacerbating conditions) of patients who’ve died? The high profile deaths like the medic and hospital chief in Wuhan suggest that even those 30-55 are at serious risk.

TTT

https://www.bbc.com/news/world-asia-china-51540981
There is a chart in that article as well that shows fatalities by age group.

LAXlocal

Can you get 2 versions of Flu at the same time ?

Say you have an average case of the yearly flu , you are weak but can still walk and do daily things ,
Can you also get Covid-19 since you are already weak ?

And since this is Winter in Wuhan could that be why its killed so many ?

MSPeconomist

I was thinking the same thing: Once we have a pandemic or severe epidemic (or the Wuhan situation, which in terms of numbers probably wouldn't qualify as an epidemic), instead of being able to maximize each patient's chance of survival (or a good outcome if there can be bad after effects or the disease or its treatment), we need to allocate scarce resources in a way that is most effective. Triage.

OTOH, when we discuss testing and screening, for example on the Wuhan Princess or in the Wuhan area, what's the goal? The goal of quarantine, to be brutal, is to protect the rest of the population and not necessarily to protect or improve the health of those being quarantined, although of course it would be unethical to just lock them up and wait to see who dies. Ideally, we'd like to protect the people being quarantined, including especially those who have not yet caught the disease (although unless it can be spread before symptoms appear, there's no reason to quarantine anyone who is certainly asymptomatic). For the Wuhan Princess, one strategy might have been to remove anyone showing symptoms (essentially giving them a presumptive diagnosis of WuFlu without any testing), isolate and treat the same as ordinary flu, perhaps testing if more aggressive treatment appears necessary. Then save the scarce testing capacity for asymptomatic individuals, perhaps giving priority to crew distributing meals or to passengers sharing rooms with multiple other occupants.

IMO much of the failure stems from lack of a clearly articulated goal and associated plan, combined of course with the face saving determination to release passengers after fourteen days regardless of any evidence about the spread of WuFlu. Another part of the problem seems to be that appropriate expertise wasn't consulted to help with decision making, including decisions about procedures to be followed by crew and lower level medical workers.

anacapamalibu

Two Jetstar flight passengers in Australia wrapped themselves in plastic sheets amid fears of the coronavirus, viral footage shows.

https://nypost.com/2020/02/19/fliers...navirus-fears/

TTT

Well, you can't get sick when you die of suffocation first.

invisible

Here we go... new development

Two Iranians die after testing positive for coronavirus: official

How did they die so quickly? Or were they sick before and no one thought to run tests on the virus on them?

invisible

Here:

https://www.worldometers.info/corona...-demographics/

TTT

This will be interesting to watch - especially the information Iran makes available regarding these two cases and additional cases when they occur.

narvik

Thanks for that!

Still amazing that no kids died (same as for SARS).

Has there been more research into a possible connection to Measles/Rubella vaccinations and elevated immunity to COVID-19?