COVID19 update, June 29, 2020: March 2019 sample in Barcelona? Matt Margolis on lockdowns; Germans flock to Baltic beaches; 2nd wave in Israel

(1) Apparently, a sample of sewer water in Barcelona from March 2019 (!) tested positive for SARS-nCoV-2. Dr. John Campbell comments:

I am somewhat skeptical though.

(2) Matt Margolis blogs about lockdowns and argues they were a mistake. He also goes into the current spike, which does not seem to be accompanied by a spike in mortality (allowing for a 2-3 week lag).

Conventional wisdom suggests that a spike in cases should result in a spike in deaths, but that has not panned out. The protests and riots following George Floyd’s death have been going on for nearly a month now. Surely a spike in deaths should shave occurred by now. But so far, it hasn’t. 

Why not? 

According to Justin Hart, an information architect and data analyst from San Diego, “who” gets the virus is just as important as “how many” get the virus. “Right now the average age of infected cases has dropped nearly 20 years,” Hart told PJ Media. […]

According to the CDC’s current best estimate, the fatality rate of the coronavirus for symptomatic cases only are as follows:

0-49 years old: 0.05%
50-64 years old: 0.2%
65+ years old: 1.3%
Overall ages: .4%

As I mentioned the other day, it’s the same story in the UK, where mortality of COVID-19 hospital admittees has dropped from 6% to 1.5%.

(3) “Sunlight is the best disinfectant” — literally, in this case

In Germany, however, Die Welt worries (in German) about the epidemiological situation as tourists hit the Baltic Sea resorts 

(4) Israel has apparently a genuine 2nd wave on its hands. As in (2), it seems that cases are much younger than in the past. This infographic from the Israel COVID19 dashboard of the Ministry of Health makes this very clear. (Note that this is all documented cases — if the window were limited to those diagnosed in the past month, the distribution would be even more lopsided.)

[left=women, right=men, diffuse background=population pyramid, crisp bars=COVID19 case distribution]

Tomorrow school ends for kindergarten and elementary schools; junior high and high schools already finished. 

There were “corona cabinet” meetings yesterday and today. A second lockdown was dismissed out of hand, as were less restrictive closures, since “the economy won’t survive those blows”. For now, distance restrictions and masks remain mandatory (if seemingly honored more in the breach than the observance), and these will be enforced more vigorously. Some restrictions on attendance at public gatherings were re-introduced. 

Meanwhile, mothballed COVID-19 wards in various hospitals have been reopened. The general atmosphere in the healthcare system, as far as I can tell, is more relaxed than in March: more treatment options exist, more is knownabout how to manage moderate and severe cases, and younger patients typically mean mild cases that resolve on their own.

(5) I can’t add much to Instapundit’s response to Dr. Fauci’s complaint about the “anti-science bias in the US”.

If scientists were more pro-science, maybe the public would be. But when scientists are happy to subordinate science to politics or expediency — as the public health community has shown itself to be with masks and with its endorsement of mass protests — why should anyone trust them?

COVID19 update, June 19, 2020: Second wave in Israel; Q&A with Dr. Seheult

(1) So it looks like, sadly, we have a real second wave here, with new cases per day now crossing the 300 mark. Unlike in the winter, most of the new cases are kids or young people for whom the disease is usually not life-threatening, and our hospitals are doing fine for ICU capacity thanks to the earlier scramble to set up new “machlakot keter” (lit.: ‘crown departments’) at the various hospitals. Healthcare officials are basically saying, “we’re ready” rather than “the sky is falling”.

In part thanks to that, presumably, it appears officials have decided that the cost of a second lockdown, both economically and in terms of collateral damage to human life, will exceed any benefit, and that therefore we’re staying open.

 

Below is a graph from the new, and highly informative, COVID19 data dashboard of the health ministry. Male in blue, female in green, population pyramid is the fuzzy background, the focused bars are the age distribution of active cases. 

COVID19 age pyramid Israel

(2) this Q&A section with Roger Seheult MD is long but highly informative. 

 

 

More later… Shabbat shalom…

COVID19 update, June 16, 2020: Blue-chip Oxford trial finds inexpensive steroid dexamethasone saves lives in severe COVID-19 cases; flare-ups in Israel and in China

(1) [Hat tip: Yves not-Cohen]: via De Standaard and the BBC, Oxford University reports a breakthrough in the management of severe COVID-19 cases: https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf

I have blogged earlier about anecdotal reports that steroids (for the group I was quoting, methylprednisolone) were being used in an attempt to hold “cytokine storm” at bay, and intuitively this makes a lot of sense. But now we have a large-scale clinical trial to back it up.

A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%). Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14). Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone. Given the public health importance of these results, we are now working to publish the full details as soon as possible.

In plain English, p=0.0003 means there are three chances in ten thousand that the difference is due to coincidence , p=0.0021 that there are 2.1 chances in a thousand of this happening. That the steroid would have no benefit in patients who show no signs yet of “cytokine storm” makes perfect sense.

The study’s authors tout this as the first drug that actually saves lives. Indirectly, Remdesivir and other antivirals may do so if given early in the disease progression, by preventing escalation to cytokine storm: once you get there, you have missed the boat for antivirals and need to focus on stopping the patient’s immune system from killing him.

That dexamethasone is a dirt-cheap drug that has been in common use for decades is of course a nice bonus.

(2) Related, via The Epoch Times (an expat Chinese newspaper fiercely opposed to the regime) a report by the British Heart Foundation about TRV027, an experimental drug by Trevena that restores the angiotensin II vs. angiotensin 1-7 balance (which the virus disrupts through binding to ACE 2 receptors) and thus tries to prevent excessive blood clotting at the source.

Also related, US Senate testimony  by Pierre Kory MD of the COVID19 Critical Care Group.

 

(3) Israel, after a lull and after essentially fully reopening, is now seeing a flare-up of about 200 cases per day. In part this can be ascribed to more intensive testing efforts: past data indicate we had about 10 undocumented asymptomatic or mild cases for each documented case.  (Yesterday, 13,425 were tested, of which 196 found positive.)

The head of the research division of the Maccabi HMO (one of the four authorized Health Maintenance Organizations in Israel, and one of the “big three”) explains to The Times Of Israel that this time around, most of the cases are children or young people (which are less vulnerable), and that many of the children are asymptomatic.

 

In Tel Aviv, which is seeing the fastest spread of the virus, some 57 percent of Maccabi members who tested positive in June are aged 18 or under, Anat Ekka-Zohar told The Times of Israel. There is a similar pattern in other central Israeli cities where cases are growing, she said. In Peta[c]h Tikva the figure is 77%, in Jaffa 60% and in Bnei Brak 43%.

Lots of the current adult carriers are aged 45 or under, Ekka-Zohar said. Some 73% of Maccabi members nationally who tested positive in June are 45 or under, and in Tel Aviv, the figure is 79%.

Maccabi, which is responsible for the health of 2 million Israelis, says that just 1.3% of the people it found to be infected in June are aged 75 or older, Ekka-Zohar said.

Looking at the figure for the 65-plus age group, which is considered the most at-risk of serious illness or death if infected, Ekka-Zohar said it stands at 6.7% for June cases. In April, that age group accounted for around 12% of Maccabi’s cases, she added.

The fact that the most vulnerable aren’t being infected in large numbers bodes well, Ekka-Zohar said, commenting: “It’s not going to provoke a crisis in terms of the number of hospitalizations or in terms of ventilators.”

 

(H/t: Mrs. Arbel.) A somewhat PG-13 rated piece of local humor about masks: the caption says “wearing your mask like thisis like wearing your underpants like that. [And underneath] Please wear your mask correctly.”

Israeli mask humor

(4) “Nothing to see here, move along.” The regime is now blaming “European salmon” for a new coronavirus outbreak in Beijing?! Yeah right — if you believe that, I have some beachfront land in Arizona for sale. Most likely, this is just the 2nd wave of the epidemic they claimed they had under full control. Remember this piece of advice by a Hong Kong resident (warning: language alert).