Close comparison of the two viruses creates a worrisome picture of what could happen if COVID-19 becomes widespread in the United States, infectious disease experts say.
The new coronavirus is more infectious than the flu and appears to strike with much more severity in certain vulnerable groups. At the same time, there are no treatments on hand for COVID-19 (or a vaccination) as there are for the seasonal flu, experts added.
COVID-19 appears to be most harmful to old people or those with underlying health problems that make them more susceptible to infection or pneumonia. "No child has died of COVID-19," Glatt said. "There have been hundreds of cases and not one child under the age of 10 has died from COVID-19." By comparison, 125 children in the United States have died from the flu this season, the CDC says.
One other important difference: The new coronavirus appears to be more infectious than the seasonal flu, experts said.
When symptoms occur, COVID-19 appears to be more akin to the common cold than the flu. Coronavirus symptoms include fever, cough and shortness of breath, all of which may appear between two and 14 days after exposure, the CDC says.
The best prevention for the coronavirus appears to be the same as for the common cold. Wash your hands frequently, avoid contact with sick people, cover your cough or sneeze with your elbow to prevent hand contamination, and stay home if you're ill.
To receive updates to this post, please select the [Save post] box below this post - Admin
Accompanying image updated to show the different symptoms for Coronavirus, cold, flu, hayfever and asthma. Image courtesy of Priceline Australia, with the difference between COVID-19 and Seasonal Allergies expanded in the post below - Admin
Selected answers to Frequently Asked Questions (FAQs) about COVID-19
Covid19 information and disinformation explained by Dr Siouxsie Wiles, a British microbiologist and New Zealand based science communicator and New Zealand's cartoonist Toby Morris
A most comprehensive and yet easily understandable explanation of how to respond effectively to the coronavirus pandemic. Importantly, it explains why the responses work to save lives while providing a way back to a new norm. Highly recommended!
The American Society of Hematology (ASH) has committed a portion of its website to providing continually updated information addressing specific hematologic disorders in relation to COVID-19. hematology.org/covid-19
Petros Grivas, MD, PhD, on the Future of the CCC19 Registry
The CLL Society is proud to have taken a leadership role in producing Management of CLL Patients Early in the COVID-19 Pandemic: An International Survey of CLL Experts cllsociety.org/2020/05/cll-... published in the American Journal of Hematology.
CLL Society's CLL Society’s Official Statement Concerning CLL Patients Working and Travelling During the COVID-19 Pandemic (20th March 2020)
Can coronavirus spread through food? Can anti-inflammatories like ibuprofen make it worse? Coronavirus claims checked by experts- theconversation.com/can-cor...
For our US members wondering how safe it will be to venture out, here's how each state actually determines reopening criteria and how that differs from federal guidance:
Guidance on social distancing for everyone in the UK and protecting older people and vulnerable adults - and that's ALL OF US ***EXTREMELY IMPORTANT***
The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events. In contrast, outbreaks spread from shopping appear to be responsible for a small percentage of traced infections. (Ref)
Importantly, of the countries performing contact tracing properly, only a single outbreak has been reported from an outdoor environment (less than 0.3% of traced infections). (ref)
More than half of COVID-19 patients admitted to two hospitals in Spain developed some form of neurologic symptoms, a retrospective, observational study showed.
Among 125 hospitalized coronavirus patients selected by specialist physicians in the U.K., complications ranged from stroke (77 people) to altered mental states including brain inflammation, psychosis, and dementia-like symptoms (39 people), reported Benedict Michael, MD, PhD, of University of Liverpool, and co-authors, in The Lancet Psychiatry.
An interpretable mortality prediction model for COVID-19 patient
...machine learning tools selected three biomarkers that predict the mortality of individual patients more than 10 days in advance with more than 90% accuracy: lactic dehydrogenase (LDH), lymphocyte and high-sensitivity C-reactive protein (hs-CRP). In particular, relatively high levels of LDH alone seem to play a crucial role in distinguishing the vast majority of cases that require immediate medical attention.
Hyperglycemia predicts COVID-19 death even without diabetes
From a retrospective analysis of 605 patients with COVID-19 seen at two hospitals in Wuhan, China, Nearly half of hospitalized COVID-19 patients without a prior diabetes diagnosis have hyperglycemia, and the latter is an independent predictor of mortality at 28 days, new research indicates.
Here’s how long the coronavirus can live in the air, on different surfaces and on packages- nejm.org/doi/full/10.1056/N... (with thanks to Karni Perez, CLL ACOR Admin)
Note: "Vitamin C also helps clean up this cellular mess by producing specialised cells to mount an immune response, including neutrophils, lymphocytes and phagocytes." We've previously given regular warnings that vitamin C can increase lymphocyte production, so taking vitamin C may cause an increase in your CLL tumour burden.
Dealing with Anxiety over Coronavirus
From the Anxiety and Depression Association of America (updated daily)
Colchicine Shows Promise in COVID-19 Patients, With Caveats
Hospitalized patients with COVID-19 who received colchicine, an anti-inflammatory drug traditionally used to treat gout and rheumatic disease, had improved time to clinical deterioration versus standard of care, a randomized open-label trial from Greece found.
There's a suggestion that colchicine's mechanism of action to treat COVID-19 may be antithrombotic as well as anti-inflammatory, but it was a small trial that ended when Greece quickly flattened the COVID-19 curve.
Front-Runners Emerge in the Race for a Covid-19 Vaccine
The vaccine we’re testing in Australia is based on a flu shot. Here’s how it could work against coronavirus (A non- live SARS-CoV-2 vaccine targeting the spike protein)
An important feature of this trial is participants were over the age of 65. Older people tend to have poorer responses to vaccines, because immune cells become more difficult to activate as we age.
...although recent developments are encouraging, history and scientific reason say the day when a COVID-19 vaccine is widely available will not come this year and may not come by the end of 2021.
Hi, are the pneumonia vaccinations, that Prevnar13 followed by Pneumovax23, something we should only do once, or is it something we should repeat every so many years?
The order and timing along with what vaccinations are repeated are covered in the relevant country guidelines, referenced here healthunlocked.com/cllsuppo... As these are subject to change, it's best that you confirm the latest recommendation for where you live
Hi Neil...Please correct me if I'm wrong, but I was under the impression zinc wasn't good if you're on Ibrutinib. On another post I posted I am staying in to not be around a lot of people. I think it's a good idea for all of us with suppressed immune systems. BTW; I've had both pneumonia shots. Is that supposed to give protection from pneumonia in the case of coronavirus? Carole
I would agree that having had your pneumonia vaccinations would give you some protection against developing pneumonia from the bacteria strains incorporated in the prevnar and pneumovax shots.
Neil...I really can't say where I read about zinc and IB at this point. I just put it out of mind as zinc is not a supplement I take. Thanks for addressing that also. Carole
Thank you for sending the information. Here in the States, we have the media going crazy with, it can be a pandemic, predicting how many will die, and on and on. This is true with the regular flu from year to year too, but those figures are never reported. However, with a suppressed immune system and being over 65, I am becoming concerned. So, as I said, staying in is what I'm choosing to do. Carole
Responding to Covid-19 — A Once-in-a-Century Pandemic?
An article in the New England Journal of Medicine, authored by Bill Gates of the Bill & Melinda Gates Foundation (See nejm.org/doi/full/10.1056/N...; no restriction on access).
This is a "view from 40,000 feet" about the need for effective leadership in the face of a pandemic.
It’s interesting to see the statement being made uncritically in several popular level articles that this is more infectious than the flu and that it is exponential. If the transmission rate really is firmly above one then the disease should be growing exponentially which it doesn’t seem to be (look at the log scales on the resource I linked to which are not showing a straight line which they would br if it was exponential growth).
I’ve also seen a reputable sources that say flu can have a much higher transmission rate than that which is often quoted see who.int/influenza/resources...
It is of note that this new disease can spread really quickly (see the early days in China and what’s happening in Italy for example) but at the same time so far we are not seeing truly explosive growth in each country effected at the moment with most cases currently remaining imported or close contacts of those imported.
It seems that whilst it is true that this can be quite infectious it is also amenable to some forms of control and quareentine procedures which are thought to be essentially futile with the flu do seem to work. Perhaps social distancing would work with the flu too but we just haven’t had the will to do it. Changing the law in the uk as an emergency to require employers to pay sick leave from the first day someone is sick not the fourth is a good step to help Ensure sick people stay home and don’t spread their Coronavirus like they currently do the flu.
Anecdotally some of us wirh poor immune systems seem to manage to avoid catching the flu by means of things like hand washing and keeping six feet away from anyone we suspect of being sick. Oh and not sharing towels. I’ve noticed that with me several members of my family can go down with flu and yet I usually escape. I sometimes make a cross wirh my fingers like a sick family member is a vampire and treat them as unclean!
I am heading anecdotes of kids being sent home from school because of coughs and schools rapidly back tracking about all their concerns about poor aftendance. We may yet see a cultural shift that means it is no longer acceptable to “solider on”. Tho I fear some younger people may look at the stats on mortality and conclude that they will definitely be safe and so not take infection prevention seriously.
I do wonder if part of the issue and thus maybe grossly over simplistic is that flu patients tend to sneeze explosively and Coronavirus patients only cough. Could that mean that you have to be sitting closer to someone to catch it?
Anyway the top experts in published papers (we are seeing lots of clinical data being rapidly published in a peer reviewed way in online journals) conclude that there is much about this virus we cannot yet be clear about. Some experts are saying its going to spread to the vast majority of peoole in the world like flu and we can’t contain it. Others are saying let’s at least try to contain it and if that fails let’s delay the peak as long as we can.
If the signs of particularly the lower number of cases being recorded in China are to be believed it seems that infection control procedures CAN make a difference with this disease. Let’s hope that countries that don’t have centralised control and command structures have the willpower to take the necessary steps to limit and control the spread in the way the Chinese have done. And also will there be the will to ramp up health card resources to provide intensive treatment to reduce mortality by ventilation etc.
The Uk government plan makes for encouraging reading as it really sounds like they are making sensible plans taking about a containment phase moving to a delay phase. The Uk also seems to be weighing things carefully and considering the social and economic costs of various interventions but claiming to be ready to act as appropriate. There are comments about how isolating a whole town or city whilst thus has been done in China and Italy may not be needed or practical if we find that multiple towns are affected at once. Tho if you are a small village you do have to wonder if banning outsiders from visiting might make a lot of sense....
This is a rather long way of saying we simply don’t know yet how much this is going to soread in the real world where
Sometimes radical Steps are taken to try and limit it.
Will this new disease turn out to spread as widely as the flu does is simply not yet known. (so many flu infectious are assymptomatic that it spreads to huge numbers of people).
I have to admit, I've been around for awhile. That being said, long before I was diagnosed (when I was still working), here's how things would go (long before anyone ever imagined something like COVID-19 would ever exist):
People would get sick, they'd come to work & spread their germs. I'd get sick & stay home. This was to avoid further spread of the germs & because I would REALLY get SICK. When others would get over the worst after a couple of days, I'd need more like a week.
At the end of the year, awards would go to those people who brought themselves, along with their germs, to work EVERY DAY (regardless of how many times they came but SHOULD HAVE STAYED HOME). These people, in my opinion, had this idea that the business COULD NOT GET BY A DAY WITHOUT THEM! They were PRAISED for their attendance & ENCOURAGED to come every day. Who cares how many people are inconvenienced by the self-importance of others.
No, I'm NOT a WHINER! I'm just stating facts. If you want to stay well, you have to look out for yourself. In other words, you cannot count on others to follow the rules of common courtesy.
All you can do is find out the facts, listen to what your oncologist tells you about your susceptibility to whatever's going around & WASH YOUR HANDS anytime you believe it's necessary. Just make sure you also make frequent use of HAND MOISTURIZERS, because too much washing & hand sanitizing can tend to dry out your hands & those microscopic cracks in your skin leave you MORE VULNERABLE to all those nasty little germs trying to enter your body!
Am I going to travel by plane? NO. You're cooped up w/all the nastiness that your fellow travelers have brought w/them! The air keeps being recirculated, & on WHAT AIRLINE (or in which airport) ON THIS PLANET do you have 6 feet between yourself & others?
Do you believe the seats & armrests were cleaned between the last passenger & yourself? Do you just trust that the last person in the bathroom bothered to wash their hands? Do you believe that pillow you just received has been cleansed of the slobbers of the previous users? And WHAT WENT ON UNDERNEATH THAT BLANKET you just accepted from that friendly stewardess? OH, MY!!Yeah, the one who just picked up a child's bottle from the filthy, sticky floor. That child who's been crying since you boarded the plane; the one who's been incubating ONLY GOD KNOWS WHAT since yesterday (but his mom didn't want to reschedule her flight...again)!
SCARY? YES! FUNNY? I HOPE SO! Just be mindful & take care of yourselves out there, because our health IS COMPROMISED to one degree or another as members of the LEUKEMIA SOCIETY.
Oh, one more thing. When you vote, WASH BEFORE & AGAIN AFTER. The last person was probably one of those people who licks their fingers every time they touch a paper & the next person who votes might be immunocompromised, too!
As far as the exponential aspect, that's an idealized mathematical supposition based on preliminary numbers from China. I'd like to see what the South Korean numbers are on that.
I think that what makes our experience different from China are that so few people are tested, and at risk people - the ones who show up at hospital - seem to already be self-isolating, as they should. Europe and the U.S. are a month or 2 behind China on first infections.
...the most straightforward and compelling evidence that the true case fatality rate of SARS-CoV-2 is well under 1 percent comes not from statistical trends and methodological massage, but from data from the Diamond Princess cruise outbreak and subsequent quarantine off the coast of Japan.
...we need to divert our focus away from worrying about preventing systemic spread among healthy people—which is likely either inevitable, or out of our control—and commit most if not all of our resources toward protecting those truly at risk of developing critical illness and even death: everyone over 70, and people who are already at higher risk from this kind of virus.
A new study from Johns Hopkins Bloomberg School of Public Health is affirming early estimates suggesting 5.1 days is the average incubation period for Covid-19. It can extend out beyond 14 days for a few individuals, however.
"The transmission rate of coronavirus disease 2019 (COVID-19) was 1%-5% among 38,000 Chinese people in close contact with infected patients, according to the chief epidemiologist of the Chinese Centers for Disease Control and Prevention, Beijing, Zunyou Wu, MD.
:
Transmission from presymptomatic people is rare.
:
There’s no data yet for immunocompromised people...
:
The most common symptoms among hospitalized patients in China are fever, dry cough, fatigue, and headache. Truly asymptomatic cases are not common; most go on to develop symptoms. There have been reports of diarrhea before other symptoms by a day or two, but it’s probably a red herring. The virus has been isolated from stool, but there is no evidence of fecal-oral transmission, Dr. Wu said."
The COVID-19 (Coronavirus 19) is potentially very dangerous to CLL patients. Most CLL patients already fall into the higher risk group because of their age. Additionally, all CLL patients have compromised immune systems that are less likely to be able to fight early infection with their innate immune system and also clear the virus with long-lasting immunity from their adaptive immune system. Additionally, this is an entirely new virus that their immune system did not see prior to developing the impairment from CLL so we are not protected by our “older” antibodies as we are against many childhood illnesses.
Special precautions have to be taken that some may consider draconian. The best strategy in my opinion is for patients is to be proactive and take control and take action to do things that could prevent exposure to this. While most people likely will eventually be exposed to this, a latter time will ensure more is known both about the infection and how people should be treated. As we have talked in the past concerning therapy for CLL itself, delaying exposure could mean there will be something better known for prevention and treatment of COVID-19. It is also possible that we will find out the risk to CLL patients is less in the upcoming months. However, until that time, I would recommend the following:
1. Avoid anyone with direct exposure to an infected COVID-19 person or symptoms of this virus, at this time, it is not clear how long patients with COVID-19 remain infectious.
2. Avoid anyone returning from personal airline travel, regardless of location, or returning from a high-risk area, regardless of mode of transportation, for at least 14 days.
3. Frequent handwashing is crucial. Avoid door knobs and handles in public places or use a tissue to limit contact with surfaces. Do not touch your face, eyes, mouth, or ears. Avoid handshaking; rather practice foot tap or elbow bumps as a way of greeting others, if needed.
4. If you work in a high risk job such as teaching/supervising/interacting with children, service work where you are exposed to many individuals, direct health care providers (including physicians), consider taking a leave of absence or using your sick leave (after advice from your personal physician). I am giving people with these high-risk activities notes to allow isolated work at home, off site, or in a place away from others. If this is not possible, ask your employer if it is possible for you to have work isolated from these high exposure risks such as doing desk work.
5. Clean shared work surfaces at work after each use. This includes wiping down the keyboard, computer mouse and phone. If you see someone not doing this, please remind them of it. This is a very good practice at all times, but especially now.
6. All face-to-face group meetings of more than 4 people should be canceled. Video conferencing as an alternative that should be considered.
7. Practice social distancing as the best way to limit the spread of disease, especially around anyone who appears ill or has a cough. Apply this principle at work, home, and in your social network. It is a good idea to avoid large group events during the time of this pandemic including sports events, church, club meetings, weddings, family reunions, etc. Your churches and clubs still need your support so continue tithing, but do this online.
8. Encourage people not to come to work or to activities when sick! Notify your healthcare provider or PCP if you have the symptoms of coronavirus COVID-19 (cough, muscle aches, shortness of breath and fever greater than 100.4ºF [38ºC]) Muscle aches alone are okay if you have exercised robustly the day before. If in doubt about your symptoms or starting to get sick, please stay at home.
9. If you develop influenza or COVID-19 and have low immunoglobulins, I will be recommending that you receive IVIG therapy to replace this. Application of IVIG in this setting can potentially help protect you from developing bacterial pneumonia as a complication following a viral infection. It will likely not help the COVID-19 itself.
10. Know how you can help others with our good advice. We are all thinking of our friends and loved ones at this time as well. The recommendations above are what I am telling others who ask me. If you have parents, grandparents or friends that are older than 70, my personal advice would be to not visit them during the next two to four weeks and encourage them to stay at home. They should avoid contact with younger people (including children). Children and young adults can have this without being sick and pass it on to elderly patients at risk. This is the biggest risk population for being harmed by the COVID-19 virus infection.
11. If you have early-stage CLL, are not being treated, and have had stable blood counts, or if your disease is very stable, regardless of your treatment status, it may be better to discuss with your doctor about postponing your routine follow up visits to your doctor for at least 1-3 months while the initial wave of COVID-19 infections are being dealt with. Hospitals or doctor’s offices are much more likely to have sick patients who could have this. We are following up with patients by phone in this setting to determine any new symptoms and when necessary having them get their counts checked.
12. Patients on active treatment should still be seen as scheduled by their physician and health care team. We do not know how COVID-19 will affect CLL patients on therapy but hope that at least with the targeted therapies such as ibrutinib, acalabrutinib, idelalisib and duvelisib which improve immune function of CLL patients, that the risk of more serious infection will not be affected. With other agents used in CLL I am less certain.
We are at a special time that requires all of us to work together and support one another. These suggestions are ones I am providing my own patients as of today. As more data emerge it is likely these will change.
John C. Byrd M.D.
Distinguished University Professor
D. Warren Brown Chair of Leukemia Research
Senior Adviser for Cancer Experimental Therapeutics and Co-Director Leukemia Program
The Ohio State University Comprehensive Cancer Center -
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
Yes, we started doing the same from this morning. It's good that people following this forum are so clued up and being given such good advice, but we are worried how many other people almost seem to be in denial regarding the risks if they have underlying medical problems etc. In fact neighbours with quite bad COPD etc have been offering us help with shopping etc!
Check your sources before posting information about the coronavirus
"If you are going to copy information from other sources to share on this site, please do your best to use trusted sources. If the information claims to have come from a trusted source, but isn't being posted by them, look the source up so that you can post the original."
We've also had to delete a post quoting the same incorrect source mentioned in the above post.
Also, do not open emails from anyone you don't know claiming to have information about the coronavirus. Due to the high interest in this topic, malware is being spread by this means.
"Colloidal silver, herbal supplements and essential oils are among a number of products currently being fraudulently promoted as cures for COVID-19, as the US Food and Drug Administration targets seven companies peddling unproven treatments.
:
...there are no drugs, vaccines, or approved treatments for COVID-19 at this point in time. And while there are vaccines in development, the general public should be skeptical of any product claiming to treat, prevent or cure COVID-19."
A bit about why soap and SOME hand sanitisers work. - they dissolve the fatty outer covering of the virus and render it inactive. But, you need a sanitiser with a high alcohol content.
Wise words Seymour and I must admit I’ve been devouring every news clip and article being released on this wretched virus. I even dreamed I found a cure for it (but couldn’t tell you what it was!).
The trouble is, us CLL’ers live in a world of uncertainty with a condition that doesn’t always play fair and then comes along this sneaky little virus that’s hiding in corners in plain sight but invisible to the naked eye. It could at least give the affected a visible indicator so we have a fighting chance but no, it’s furtive and unpredictable in its intensity! 🙄
So now I’m going to watch some light, meaningless but enjoyable tv! 😊
COVID-19: Older Patients With Cancer Especially Vulnerable - but perhaps not as much as early data from China indicates. Given CLL is generally an older person's disease and it impairs our immunity even when we are not on treatment, it makes sense to be vigilant to minimise our risk of infection.
The first specific analysis of Chinese Covid-19 "Patients with cancer experienced a much more rapid deterioration in clinical status than did those without cancer. The median time to severe events was 13 days, vs 43 days (hazard ratio [HR] adjusted for age, 3.56; P < .0001).
The analysis also shows that patients who underwent chemotherapy or surgery in the past month had a 75% risk of experiencing clinically severe events, compared with a 43% risk for those who had not received recent treatment.
After adjusting for other risk factors, including age and smoking history, older age was the only risk factor for severe events (odds ratio [OR], 1.43; 95% confidence interval [CI], 0.97 – 2.12; P = .072), the study authors say.
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However, in comments in the Lancet Oncology, other authors in China say these findings should be interpreted with caution.
One group suggests that the increased susceptibility to COVID-19 in patients with cancer could be the result of higher rates of smoking compared with patients who did not have cancer. "Overall, current evidence remains insufficient to explain a conclusive association between cancer and COVID-19," say Huahao Shen, PhD, of Zhejiang University School of Medicine, Hangzhou, Zhejiang, and colleagues."
Another good reason to wash your hands regularly and avoid touching your eyes, mouth or nose. Take particular care when exiting public toilets, which nearly always have their doors opening the incorrect way. Use some paper tissue to shield your clean hand from contact with the door handle.
If you haven't seen it already please note the following post about a person in their 50s with a chronic Lukaemia who was in watch and wait, working and healthy and sadly died from COVID19 in Canada recently
Note that even the most pessimistic estimates of the risk to us would still conclude that the vast majority of even immune compromised patients would recover but the risk of us needing hospitalisation, ventilation, ITU, and even subsequenty death are clearly not a trivial percentage.
Lets lock ourselves up, throw away the key and hide from COVID19 (walks in the countryside where we are way more than 6 feet away from others are allowed at present). The UK government also advises patients who have families living with them to ask thier families to also consider joining them in isolation to the extent of not even going out to go to the shops or phamaccist for an initial period of 12 weeks.
They have published some of their scientific evidence here but not the details behind how they have determined our risk status (I suspect there must however be other cases perhaps from Italy where the patients families have asked not to be publicised).
Cancer care must go on, but changes may need to be made in the way some care is delivered. USA and UK perspectives.
"Systemic treatments, including chemotherapy and immunotherapy, leave cancer patients vulnerable to infection, but ASCO says there is no direct evidence to support changes in regimens during the pandemic. Therefore, routinely stopping anticancer or immunosuppressive therapy is not recommended, as the balance of potential harms that may result from delaying or interrupting treatment versus the potential benefits of possibly preventing or delaying COVID-19 infection remains very unclear.
A study in China suggests that infectiousness starts about 2.5 days before the onset of symptoms, and peaks 15 hours before ( medRxiv, doi.org/dqbr ).
We know that coughs and sneezes spread the virus, so how is it possible for asymptomatic people to spread the infection?
People with mild or no symptoms can have a very high viral load in their upper respiratory tracts, meaning they can shed the virus through spitting, touching their mouths or noses and then a surface, or possibly talking. Even people who don’t feel ill occasionally cough or sneeze.
Once symptoms develop, a person’s viral load declines steadily, and they become increasingly less infectious. However, people appear to keep shedding the virus for around two weeks after they recover from covid-19, both in their saliva and stools ( medRxiv, doi.org/dqbs ). This means that even once a person’s symptoms have cleared, it may still be possible to infect other people.
Airborne droplets are likely to be the main infection route, but contaminated surfaces could play a role too...
More evidence of why social distancing or isolation is critical to slow the pandemic.
Australia's coronavirus spread and the difference between states is largely due to differences in how the disembarking of cruise ship passengers has been handled.
Can you catch the coronavirus twice? We don’t know yet
“Immunity to SARS-CoV-2 is not yet well understood and we do not know how protective the antibody response will be in the long-term,” says Erica Bickerton at the Pirbright Institute in the UK.
“For ordinary coronavirus infections, you do not get lasting immunity,” says Longini. “You can be infected over and over, and we really don’t know for this novel coronavirus if that’s also true.”
Other infectious disease specialists are more optimistic. “The evidence is increasingly convincing that infection with SARS-CoV-2 leads to an antibody response that is protective. Most likely this protection is for life,” says Martin Hibberd at the London School of Hygiene & Tropical Medicine. “Although we need more evidence to be sure of this, people who have recovered are unlikely to be infected with SARS-CoV-2 again.”
UK has enough intensive care units for coronavirus, expert predicts
"Neil Ferguson at Imperial College London gave evidence today to the UK’s parliamentary select committee on science and technology as part of an inquiry into the nation’s response to the coronavirus outbreak.
He said that expected increases in National Health Service capacity and ongoing restrictions to people’s movements make him “reasonably confident” the health service can cope when the predicted peak of the epidemic arrives in two or three weeks. UK deaths from the disease are now unlikely to exceed 20,000, he said, and could be much lower."
[Last week, David Price stared into his laptop camera with the sore face of someone who has been wearing a mask a lot and hasn’t slept much, the numbed face of someone who has been to some sort of war, and began to explain what he’d been learning.
“You may hear a little inflection in my voice, like I’m emotional,” says Price, a doctor at Weill Cornell Medical Center in New York City who has been treating coronavirus patients. “It’s not because I’m scared. It’s actually the opposite. For the first time in a while,” he says, choking up, “I’m actually not scared.”]
Jennie R. Crews, MD, the medical director of the Seattle Cancer Care Alliance (SCCA), discussed the SCCA experience and offered advice for other cancer centers in a webinar hosted by the Association of Community Cancer Centers.
No staff members or patients were diagnosed with COVID-19 after “strict protective measures” for screening and managing patients were implemented at the National Cancer Center/Cancer Hospital, Chinese Academy of Sciences, in Beijing, according to a report published online April 1 in JAMA Oncology.
We're all on the same learning curve with this virus. It's a tricky one and a number of experts have been proved wrong after making public assertions about C19's behaviour.
Yes children are at low risk, but we have seen healthy kids die of it. And fit 40-somethings, while the majority of 70-somethings will recover.
Government in UK and elsewhere are pinning their exit strategy on testing and sending those with C19 antibodies back to work on the basis that they can't possibly infect others. While having had the virus probably makes the risk of reinfection and subsequent transmission a lot lower, this is yet to be fully tested in C19, and to rule out the possibility altogether is dangerous, especially when planning to send health professionals back to the front line. The Korean experience is that confirmed C19 patients can recover and later relapse.
I just read an expert statement that there's no data on how long C19 survives on different surfaces. That statement is out of date, see New England Journal of Medicine, March 2020.
Cardboard several hours, plastic 48 hours, steel 72 hours.
[How long can the coronavirus that causes COVID-19 survive on surfaces?
A recent study found that the COVID-19 coronavirus can survive up to four hours on copper, up to 24 hours on cardboard, and up to two to three days on plastic and stainless steel. The researchers also found that this virus can hang out as droplets in the air for up to three hours before they fall. But most often they will fall more quickly.
There's a lot we still don't know, such as how different conditions, such as exposure to sunlight, heat, or cold, can affect these survival times.
As we learn more, continue to follow the CDC's recommendations for cleaning frequently touched surfaces and objects every day. These include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables.
If surfaces are dirty, first clean them using a detergent and water, then disinfect them. A list of products suitable for use against COVID-19 is available here. This list has been pre-approved by the U.S. Environmental Protection Agency (EPA) for use during the COVID-19 outbreak.]
Thanks, I believe this bulletin is based on the study published in NEJM. The advice is sound, but here in the UK government agencies are not putting out guidance on anything but the most basic level: stay at home, maintain 2 metres of personal space outside the home (it's permitted to exercise and to shop for essentials) and wash hands often. Mask and gloves not relevant?? Officials here even advise that face masks are only appropriate in a clinical setting, and (see below) one wonders if this advice is about conserving stocks for health workers - even though they should all be using (but don't all get) much higher spec kit.
Elsewhere it varies wildly.
- Italian friends of ours are leaving their shoes outside in case the virus attaches to the soles.
- Korea's top prof with deep experience of corona viruses says general wearing of basic face masks helps inhibit transmission; that coughs and sneezes can easily project spray 6 metres with no mask.
- In Sweden it's virtually business as usual, just keep the old and sick under wraps and it will be OK.
There is pooling of information between countries, but at the highest level there's no global coordination, no global leadership like there was in the banking crisis. That being so, how will any country reboot their economy until the whole world has been vaccinated?
Nice summary table, thank you, and good discussion. As a hay fever sufferer I’ve not looked forward to the warm pollen laden days and sneezing, ending in all neighbours looking at me strangely.
Talking about strange, there are some empty posts in this thread that show up as 2021 years ago! New bug?
(The paper has not been peer-reviewed, which should be kept in mind in considering its conclusions).
"Obesity is well-recognized to be a pro-inflammatory condition." They focus on the inflammation aspect because it has been cited in several studies as being a possible factor in COVID-19, in particular, inflammations that seem to be in a hyper-activated state. But it's not entirely clear what role it plays.
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RNA virus researcher Gregory Poland summed-up the conditions aggravating the COVID-19 situation globally: "We have an increasingly older age demographic across virtually all countries, as well as unprecedented rates of obesity, smoking, diabetes, and heart and lung disease, and an ever-growing population of people who are immunocompromised—all comorbidities that lead to significantly higher risks of severe disease and death from coronavirus disease 2019 (COVID-19)."
I have been doing my research about the inflammation and one way it starts is from chronic stress. The body responds to this stress with a lot of different ways and one of them is weight gain. I'm wondering which happens first: the inflammation that can cause weight gain in some people or the weight gain that causes inflammation.
In CLL context it may be different and more complicated...
Smoking increases your coronavirus risk. There’s never been a better time to quit
Early data from China suggests smoking history is one factor that the risk of poor outcomes in COVID-19 patients.
Smokers are more susceptible to developing heart disease, which so far seems to be the highest risk factor for the COVID-19 death rate. The Centre for Evidence-Based Medicine at the University of Oxford reports that smoking seemed to be a factor associated with poor survival in Italy, where 24% of people smoke.
We know that immunosuppressed people are at higher risk if they get COVID-19 and cigarette smoke is an immunosuppressant.
And the hand-to-mouth action of smoking makes smokers vulnerable to COVID-19 as they are touching their mouth and face more often.
The benefits of quitting smoking are almost immediate. Within 24 hours of quitting, the body starts to recover and repair. Lung function improves and respiratory symptoms become less severe.
In more encouraging news, the WHO reports that there are over 70 coronavirus vaccines in development, with 3 candidates already undergoing human trials: who.int/blueprint/priority-...
Of particular interest, is the prompt availability of convalescent plasma. In one "study of 10 severely ill patients, symptoms went away or improved in all 10 within 1 to 3 days after the transfusion. Two of the three on ventilators were weaned off and put on oxygen instead. None died.
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Researchers who reviewed the track record of convalescent therapy for other conditions recently concluded that the treatment doesn’t appear to cause severe side effects and it should be studied for COVID-19."
Although information on side effects specific to this treatment is evolving, Joyner says they are “very, very low.”"
Disappointingly for those of us in the Northern Hemisphere, " SARS-CoV-2 may confound seasons and persist in warmer months.
Although conflicting, the available data indicate that SARS-CoV-2 could continue to spread in warmer spring and summer months in the US, according to a new report from the National Academies of Science, Engineering, and Medicine (NAS)."
FDA allowed more than 90 antibody tests for the virus that causes COVID-19 to hit the U.S. market without prior review, which the agency has openly admitted includes some of dubious quality. The only four vetted through emergency use authorization are those from Cellex, Chembio Diagnostic Systems, Ortho Clinical Diagnostics and Mount Sinai Laboratory.washingtonpost.com/health/2...
“When we test plasma samples from COVID-19 patients who have recovered, we find very large variation in the levels of SARS-CoV-2 neutralizing antibodies,” says Paul Bieniasz, one of the researchers working on the Rockefeller project. “In some people the levels are so low that their plasma is virtually inactive, while others have very potently neutralizing plasma.”
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As well as developing an efficient process to test blood samples for the most potent antibodies, the team has developed the technology to clone these bNAbs and produce a general treatment. This entire process is claimed to take as little as a few weeks.
Huge Study Throws Cold Water on Antimalarials for COVID-19
— No support for continued use seen in analysis of 15,000 patients who got controversial drugs
Chloroquine or hydroxychloroquine (HCQ), with or without an antibiotic, in hospitalized COVID-19 patients were associated with increased risk of death in the hospital and higher rates of arrhythmias, analysis of outcomes in nearly 100,000 patients indicated.
The 15,000 patients who received HCQ or chloroquine were about twice as likely to die compared to controls who did not receive these agents after adjusting for covariates (18.o% for hydroxychloroquine and 16% for chloroquine versus 9.3% for controls)
Hydroxychloroquine (HCQ) with or without azithromycin (AZ) is not associated with a lower risk of requiring mechanical ventilation, according to a retrospective study of Veterans Affairs patients hospitalized with COVID-19
Further reports “underscore the potential risk associated with widespread use of hydroxychloroquine and the combination of hydroxychloroquine and azithromycin in ambulatory patients with known or suspected COVID-19. Understanding whether this risk is worth taking in the absence of evidence of therapeutic efficacy creates a knowledge gap that needs to be addressed,” wrote Robert O. Bonow, MD, a professor of medicine at Northwestern University in Chicago.
"The potential for serious arrhythmias from hydroxychloroquine treatment of COVID-19 patients received further documentation from a pair of studies released on May 1, casting further doubt on whether the uncertain benefit from this or related drugs to infected patients is worth the clear risks the agents pose."
UPDATE: 24 May 2020 Hospitalized patients with COVID-19 who received remdesivir had a median recovery time of 11 days versus 15 days with placebo (rate ratio for recovery 1.32, 95% CI 1.12-1.55, P<0.001), reported John Beigel, MD, of the National Institute of Allergy and Infectious Diseases (NIAID), and colleagues.
This is off topic of this thread but I have been thinking all day today about one of your comments having to do with being quite appropriately happy with your blood products achieving normal levels. I thought you said you were now hoping that new healthy B cells would eventually propagate from B cell marrow progenitors.
I hadn’t heard that that was possible with novel immunotherapy to get new healthy functioning infection fighting B cells and therefore plasma cells which would ultimately generate the very valuable IgG.
We don't know yet if it is possible with novel combination treatments for immunoglobulin counts to recover, but I remain hopeful, because this is my first treatment and it is "non-chemo", so hopefully no long term bone marrow impact. We have seen some immunoglobulin recovery in patients while they remain on Ibrutinib treatment, mainly increases in IgA and IgM. It can take 6 to 12 months for CD20 monoclonal antibodies to disappear, so A+V or I+V first line patients should be the first to see a recovery if this is possible. This the breakthrough we need to live more comfortably in a post pandemic world, as it appears unlikely that we will eliminate SARS-CoV-2 as we did MERS and the first SARS coronavirus.
In 8 months I will be off all CLL drugs, so my B and T CD4 lymphocyte counts should recover. It's both these that are needed for the process of B cell hypermutation to produce antigen aware B cells that then mature into plasma cell immunoglobulin factories. My IgG has been below reference range and falling for at least 11 years, so I have a lot of recovery to do.
Recent data from the Netherlands and France suggest that of the patients with coronavirus who are admitted to intensive care units (ICU), 30-70% develop blood clots in the deep veins of the legs, or in the lungs.
Around one in four coronavirus patients admitted to ICU will develop a pulmonary embolism.
Patients who present to hospital with COVID-19 are also more likely to have a stroke when compared with the general population.
But the virus does not seem to be attacking just any size blood vessel in young adults, but larger blood vessels that feed important parts the brain that are critical to movement, thinking, and breathing.
Response from: Dr Rick Furman on the Groups.io CLL/SLL community
Date: Sat, 02 May 2020 06:26:33 ACST
We really don’t know the answer to this question, regardless of what is reported. Much of the data is coming out of China where CLL is exceedingly rare, as well as probably somewhat unreliable. We always assume CLL patients are immunodeficient due to their CLL, and that immunodeficient patients do worse with infections, but we just don’t know. As mentioned, much of the damage is possibly the result of a cytokine storm, as well as antibody responses with complement activation, and DIC. We also see many healthy young adults run into great trouble.
Since the only guarantee is that you are better off not being infected, follow the guidelines for social distancing, hand washing, wearing a mask, etc.
"The thing to remember with pre-prints is they have not been peer reviewed. While many publications don’t change a great deal after peer review, some articles require considerable amendment or even withdrawal.
All of this doesn’t mean that what you read in a pre-print is rubbish. Actually, pre-prints are an important part of the publication process.
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But if you want to decide whether a pre-print contains valid information, try finding another article making similar claims."
Results from 11 American Heart Association funded COVID-19 studies on the effects on the cardiovascular and cerebrovascular systems are expected within months
Update on data demonstrating a higher risk for patients with blood cancer from COVID. Includes data from a huge 17M patient study in the UK: healthunlocked.com/cllsuppo...
Use of systemic anticoagulation may improve the chance of survival in patients hospitalized with the COVID-19 virus, a large study from the epicenter of the U.S. outbreak suggests.
Among nearly 3,000 patients with COVID-19 admitted to New York City’s Mount Sinai Health System beginning in mid-March, median survival increased from 14 days to 21 days with the addition of anticoagulation.
The results were particularly striking among sicker patients who required mechanical ventilation, in whom in-hospital mortality fell from 62.7% to 29.1% and median survival jumped from 9 days to 21 days.
Taking 10-mg rivaroxaban (Xarelto) for 45 days post-discharge reduced fatal and major events by a relative 28% in patients with additional risk factors for venous thromboembolism (VTE) in a prespecified secondary analysis of the MARINER trial.
Symptomatic VTE, myocardial infarction, nonhemorrhagic stroke, or cardiovascular death occurred in 1.28% of rivaroxaban-treated patients versus 1.77% on placebo
Huge Study Throws Cold Water on Antimalarials for COVID-19
— No support for continued use seen in analysis of 15,000 patients who got controversial drugs
Chloroquine or hydroxychloroquine (HCQ), with or without an antibiotic, in hospitalized COVID-19 patients were associated with increased risk of death in the hospital and higher rates of arrhythmias, analysis of outcomes in nearly 100,000 patients indicated.
The 15,000 patients who received HCQ or chloroquine were about twice as likely to die compared to controls who did not receive these agents after adjusting for covariates (18.o% for hydroxychloroquine and 16% for chloroquine versus 9.3% for controls)
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The drug was also associated with a higher risk of ventricular arrhythmia during hospitalization (6.1% for hydroxychloroquine, 4.3% for chloroquine versus 0.3% for controls), the authors wrote in The Lancet.
Moreover, risks for both in-hospital mortality and ventricular arrhythmia were even higher compared to controls when either drug was combined with a macrolide antibiotic, they noted.
Mehra said in a statement these drugs should not be used as treatments for COVID-19 outside of clinical trials.
"This is the first large scale study to find statistically robust evidence that treatment with chloroquine or hydroxychloroquine does not benefit patients with COVID-19," he said. "Instead, our findings suggest it may be associated with an increased risk of serious heart problems and increased risk of death. Randomised clinical trials are essential to confirm any harms or benefits associated with these agents."
Peer-reviewed findings were published late Friday from one of the key trials of remdesivir, perhaps the most promising antiviral agent for COVID-19, confirming and extending topline results announced a month ago via press release.
Hospitalized patients with COVID-19 who received remdesivir had a median recovery time of 11 days versus 15 days with placebo (rate ratio for recovery 1.32, 95% CI 1.12-1.55, P<0.001), reported John Beigel, MD, of the National Institute of Allergy and Infectious Diseases (NIAID), and colleagues.
And that is likely the tip of the iceberg with Remedivir. Antivirals are best when given earlier in the disease process (like Tamiflu). This study only looked at severe cases which generally have gone two weeks or more.
I bet earlier on in the process that Remesdivir will do a lot better than published so far. The manufacturer (Gilead ) is trying to develop an oral or inhaled form for people to take long before they get to a hospital situation.
For our US members wondering how safe it will be to venture out, here's how each state actually determines reopening criteria and how that differs from federal guidance:
Ruxolitinib, a “Janus-associated kinase (JAK1/2) inhibitor,” shows promise in severe COVID-19. Ruxolitinib is a rather expensive drug which has been used in an M D Anderson trial to reduce CLL related fatigue. news-medical.net/news/20200...
Some patients on the M D Anderson trial trial benefited significantly, others, not so much. cllsociety.org/2018/09/cll-...
It’s Not Whether You Were Exposed to the Virus. It’s How Much.
The pathogen is proving a familiar adage: The dose makes the poison.
When experts recommend wearing masks, staying at least six feet away from others, washing your hands frequently and avoiding crowded spaces, what they’re really saying is: Try to minimize the amount of virus you encounter.
A few viral particles cannot make you sick — the immune system would vanquish the intruders before they could. But how much virus is needed for an infection to take root? What is the minimum effective dose?
A precise answer is impossible, because it’s difficult to capture the moment of infection.
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The new coronavirus, SARS-CoV-2, is more similar to the SARS virus and, therefore, the infectious dose may be hundreds of particles, Dr. Rasmussen said.
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But in the case of the new coronavirus, people who have no symptoms seem to have viral loads — that is, the amount of virus in their bodies — just as high as those who are seriously ill, according to some studies.
And coronavirus patients are most infectious two to three days before symptoms begin, less so after the illness really hit.
"The head of the World Health Organization warned that the coronavirus pandemic is worsening globally, even as the situation in Europe is improving. At a press briefing on Monday, Tedros Adhanom Ghebreyesus noted that about 75% of cases reported to the U.N. health agency on Sunday came from 10 countries in the Americas and South Asia. He noted that more than 100,000 cases have been reported on nine of the past 10 days -- and that the 136,000 cases reported Sunday was the biggest number so far. Tedros said most countries in Africa are still seeing an increase in cases, including in new geographic areas even though most countries on the continent have fewer than 1,000 cases. "At the same time, we're encouraged that several countries around the world are seeing positive signs," Tedros said. "In these countries, the biggest threat now is complacency."
Preliminary results from a clinical trial just released indicate the drug seems to reduce your chance of dying from COVID-19 if you’re in hospital and need oxygen or a machine to help you breathe.
...dexamethasone also suppresses the immune system when it reduces inflammation. So, it’s not usually recommended for people who are sick, or could be sick, from other infections. So doctors will need to make sure patients have no other infections before they are prescribed the drug.
If the results of this trial are correct though, the drug doesn’t appear to compromise the patient’s ability to fight COVID-19; it might just affect their ability to fight off other diseases.
Second, the drug is only useful for patients with difficulty breathing and needing some assistance either through ventilation in a hospital or from oxygen therapy.
There appears to be no benefit for patients who don’t need help breathing.
The reporting of coronavirus cases varies drastically around the world. Tim Russell and his colleagues at the London School of Hygiene and Tropical Medicine have estimated that, as of 15 June, more than 95 per cent of symptomatic cases have been reported in some countries, including Ghana, Kazakhstan, Morocco and Oman.
However, the team estimates that only 35 per cent of symptomatic cases have been reported in the US, and the figure is even lower for some other countries. The UK is estimated to have reported only 14 per cent, Sweden about 19 per cent..
In many countries the coronavirus pandemic is accelerating, not slowing
The numbers of new infections are now growing at such a rate that while it took some three months to reach the first 1 million cases, the last million cases was reached in just eight days. The total number of COVID-19 infections now exceeds 9 million worldwide.
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What remains abundantly clear is that testing, contact tracing, isolation and quarantine, and community engagement are essential to halting the spread of COVID-19 across the world. Importantly, though, all of these measures depend on leadership and a shared sense of vulnerability. We need to marshal that, putting aside our differences and coming together to defeat a common foe. And we need to do it now.
Some good news if you share your abode with under 16s!
“Unlike with other viral respiratory infections, children do not seem to be a major vector of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, with most pediatric cases described inside familial clusters and no documentation of child-to-child or child-to-adult transmission,” said Klara M. Posfay-Barbe, MD, of the University of Geneva, Switzerland, and colleagues
I've been maintaining regular updates to this post for 5 months now, primarily in my first reply Selected answers to Frequently Asked Questions (FAQs) about COVID-19. Given the time involved and I suspect a waning in interest in this post as we adjust to living with SARS-CoV-2, this will probably be my last update.
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