Manic of a panic is geopolitical

[Nick]

Possible new insight from Radboud University in Nijmegen (not yet peer reviewed):
https://www.radboudumc.nl/en/nieuws/...-into-covid-19

[Spherical Cow]

Originally Posted by ewmayer

As with other hot spots, human error was contributory - in NYC, mayor DeBlasio insisted on keeping the city "open for business" until the mounting case numbers forced his hand, at which point the underwater portion of the pandemic iceberg - the asymptomatic silent-spreaders - were in all likelihood already present all over the city in large numbers. In New Orleans, state & local authorities decided that letting the annual huge Mardi Gras party go ahead was a good idea.

There's going to be some fascinating statistics coming out of all this, given the different reactions state-by-state to the growing pandemic, the different populations, and different population densities. As of yesterday, the comparison of California and New York is interesting- At 39.5 million people, CA has twice the population of NY (19.5 million), yet CA has 4.6 Covid cases per 10,000 people, while NY has more than 17 times that, at 80.7 cases per 10,000 people. Both states have dense population centers (CA has Los Angeles and the SF Bay area), and NY has Manhattan, of course). As business centers, both states have a lot of international travel in and out, so there probably isn't a big difference regarding when Covid was first introduced in each state. Wonder how much of that 17 times difference is in the reaction (or lack thereof) in New York City. Looking like CA did a good job.

[retina]

Originally Posted by Spherical Cow

There's going to be some fascinating statistics coming out of all this, given the different reactions state-by-state to the growing pandemic, the different populations, and different population densities. As of yesterday, the comparison of California and New York is interesting- At 39.5 million people, CA has twice the population of NY (19.5 million), yet CA has 4.6 Covid cases per 10,000 people, while NY has more than 17 times that, at 80.7 cases per 10,000 people. Both states have dense population centers (CA has Los Angeles and the SF Bay area), and NY has Manhattan, of course). As business centers, both states have a lot of international travel in and out, so there probably isn't a big difference regarding when Covid was first introduced in each state. Wonder how much of that 17 times difference is in the reaction (or lack thereof) in New York City. Looking like CA did a good job.

The testing regimens differ. You can't compare so easily.

[Uncwilly]

Originally Posted by retina

The testing regimens differ. You can't compare so easily.

Los Angeles (City) has been testing "high risk" people with symptoms for a while and recently opened up to any resident with symptoms. That is outside the standard healthcare system. I suspect they are using their crime lab to process them. And then in the region there are drive-up testing events (by appointment). In San Francisco there was a bunch of work done early to limit the spread. And the closures by local and state government happened sooner in California than New York
https://www.npr.org/sections/health-...doubling-times.

[Spherical Cow]

Originally Posted by retina

The testing regimens differ. You can't compare so easily.

Yes, definitely- that's part of the state-by-state differences that hopefully someone drills down into to ferret out answers. Testing regimens, test reporting, definitions; lots of stuff to look at. I think a large part of it will be attributable to the reaction times by local and state governments.

[CRGreathouse]

Originally Posted by Spherical Cow

There's going to be some fascinating statistics coming out of all this, given the different reactions state-by-state to the growing pandemic, the different populations, and different population densities. As of yesterday, the comparison of California and New York is interesting- At 39.5 million people, CA has twice the population of NY (19.5 million), yet CA has 4.6 Covid cases per 10,000 people, while NY has more than 17 times that, at 80.7 cases per 10,000 people. Both states have dense population centers (CA has Los Angeles and the SF Bay area), and NY has Manhattan, of course). As business centers, both states have a lot of international travel in and out, so there probably isn't a big difference regarding when Covid was first introduced in each state. Wonder how much of that 17 times difference is in the reaction (or lack thereof) in New York City. Looking like CA did a good job.

Originally Posted by retina

The testing regimens differ. You can't compare so easily.

NY is doing a better job of testing people, but CA and upstate NY locked down before NYC did (by ~6 days), and that made a big difference.

[kriesel]

Originally Posted by Spherical Cow

There's going to be some fascinating statistics coming out of all this, given ...

Deborah Birx made reference to multivariable analysis recently. Different testing regimens/criteria are among those variables. So is demographics, for some unfortunate reasons. Urban density can be rather quickly deadly in plague/pandemic times or times of shortage or unrest. https://www.channel3000.com/dhs-rele...d-19-patients/ People will be doing these analyses and publishing on this for years to come.

[kriesel]

https://www.insider.com/yanomami-tri...us-case-2020-4
Isolated Brazilian tribe reached by Sars2 Wuhan coronavirus

[Dr Sardonicus]

See, e.g. some of the links in this post...

FDA warns Alex Jones to stop pitching bogus virus remedies

WASHINGTON (AP) — U.S. health officials are warning conspiracy theorist and radio host Alex Jones to stop pitching bogus remedies for the coronavirus.

The Food and Drug Administration sent a warning letter Thursday ordering Jones to stop falsely claiming that toothpaste, mouth wash and other products sponsored by his show can help prevent COVID-19.
<snip>
The FDA warning follows earlier government warnings against Jones last month. New York’s attorney general Letita James sent a cease-and-desist letter March 12 demanding Jones stop promoting many of the same phony products.

[kladner]

https://www.newyorker.com/news/lette...-garbage-bags?

On Saturday, March 21st, while Donald Trump was tweeting about the “Chinese virus” and circulating praise for the “great job we’ve done,” Eric Ries received a phone call from another Silicon Valley C.E.O. His friend Jeff Lawson, of the firm Twilio, told Ries that, to deal with the rapidly escalating coronavirus crisis, the White House was recruiting tech executives to help. Ries—the founder and C.E.O. of a new company, the Long-Term Stock Exchange, and the author of a best-selling book, “The Lean Startup,” which had made him a well-known figure in the Valley—was an obvious choice for someone looking to stand up a high-tech solution to the disaster quickly. He had long preached the virtues of going to market as fast as possible with what he called M.V.P.: minimum viable product.

America was watching, shocked, as doctors and nurses pleaded for protective gear and medical equipment such as ventilators. Ries was asked to help start a Web site that would match hospitals and suppliers. Sure, Ries said, he could have something up and running by Monday. What followed over the next two weeks was an inside glimpse of the dysfunction emanating from Trump’s Washington in the midst of the pandemic, a crash course in the breakdown that has led to nurses in one of the wealthiest countries in the world wearing garbage bags to protect themselves from a virus whose outbreak the President downplayed until it was too late to prepare for its consequences.

[ewmayer]

By way of followup to the ibuprofen-related discussion ack on page 19 of the thread:

Coronavirus Research Done Too Fast Is Testing Publishing Safeguards, Bad Science Is Getting Through | naked capitalism

Nothing better illustrates how trusted institutions can make misinformed recommendations than the recent fiasco over ibuprofen.

The most common early symptom of COVID-19 is fever, and ibuprofen is one of the most widely used drugs in the world to treat fever. In a letter published in The Lancet Respiratory Medicine, European researchers raised concerns that ibuprofen use could worsen COVID-19 symptoms. The idea is that since ibuprofen increases the quantity of ACE2 in human cells – the protein that the coronavirus uses to enter lung cells – the virus could infect lung cells more easily if a person was on ibuprofen. This was not a study nor did it present sufficient experimental evidence; it was simply a theoretical concern based on a mechanism.

Three days after the letter was published, the French health minister tweeted a message urging people to avoid ibuprofen for coronavirus associated fever based on four “cited” cases of people getting sicker after taking ibuprofen. These cases were never published in a journal. The French Health Ministry followed this with a broad ban on treating COVID-19 fever with nonsteroidal anti-inflammatory drugs like ibuprofen. The WHO tweeted an essentially similar warning. The media followed with more case anecdotes, dubiously relating worsening early symptoms with ibuprofen use and referring to the letter as a “study,” adding to the confusion and fear.

The Lancet letter also hypothesized that two other drugs commonly used to treat hypertension and diabetes – ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) – could be problematic in people with COVID-19. However, the mechanism they put forward was incompletely described and neglected that a protein these drugs promote can be helpful in reducing inflammation and tissue damage in the lungs and heart.

The Response

This letter to The Lancet slipped past the safeguards in research and institutional and media interpretation, but one of science’s oldest pastimes – definitively calling out the errors of others – reestablished patience and perspective.

Clinicians and scientists pushed back swiftly, supporting the use of ibuprofen in COVID-19 patients. The support was outlined in a published literature review. In response, the WHO quickly reversed its position on ibuprofen.

There was a similar rapid response to the statements about ARBs. Within days, three prominent cardiology groups, including the American Heart Association, released a joint statement urging practitioners not to discontinue ACE-I and ARBs in their patients.

The risk-benefit ratio is always a clinical factor for the use of any drug in any patient. But the risk must be more than theory for the use of a drug to be discontinued or any major policy change to be implemented.

Some Perspective

As the coronavirus rampages across the U.S., it is incredibly important to know whether commonly used drugs like ibuprofen or ARBs are risky, neutral or of therapeutic potential. There are ways to find out quickly. Researchers can look for correlations between the use of ibuprofen or ARBs and more severe infections or deaths, for example. And standard clinical trials can, should and are being done. There are several studies currently underway testing the effect and risk of ARBs for COVID-19 patients. But until the science is finished, it is foolish and potentially dangerous to flee from tested clinically important drugs.