For those who contract covid-19… What percentage remain asymptomatic for the ENTIRE duration of the illness.
The data I’ve linked states around 17%, though it’s a rather small sample size. Chris Ottawas links state 50-80%
I’m not an expert–not even expert-adjacent. With that said, my impression is we don’t have really good data on this as of yet, which is likely why the two of you can provide support for such wildly disparate estimates.
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Fair enough mate (or sir, in America when addressing an adult quite a lot older than I I’d say Mr or Sir), thank you for you’re time 
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This has direct implications for a variety of factors related to both covid-19 and the statistics. Please keep scientific/medical questions in this thread. Also will post in the other thread for any general comments.
First, this can affect both treatment options (e.g. chloroquine can have potential for cardiac side effects even though it’s been used widely for 60+ years… speculation: perhaps this is one reason it didn’t show increased effectiveness in one of the trials?).
Second, obviously if you have to bring in more staff for heart complications it affects supply use and exposure of the staff.
Third, this may be an additional source of uncertainty for mortality statistics and especially those related to covid-19–were patient deaths diagnosed as heart failure actually due to the virus?
Naturally, pretty much all those who die of pneumonia die because the heart stops–you can’t get enough oxygen. But the spectrum of heart failure or attack is much wider
We are seeing the confluence of clinical care and scientific literature review developing right before our eyes. This is a case where best practices will change very rapidly as our knowledge of the situation and illness changes rapidly
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From the three trials I’ve seen regarding hydroxychloriquine, the one that displayed effectiveness combined hydroxychloriquine with arythromyicin, the second trial only used hydroxychloriquine (found the substance to be ineffective). A third trial indicated a combination of azithromycin + hydroxychloriquine was ineffective at reducing viral load/improving prognosis.
Theoretically, if the drug didn’t increase effectiveness due to cardiotoxicity, you would’ve found the prognosis of patients treated with said drugs would’ve worsened (more on this down below)… however results amongst control/treated groups were equatable with one another. The majority of data indicating hydroxychloriquine to be effective against covid-19 is in the form of in-vitro studies. In-vitro doesn’t particularly account for numerous factors that may alter cellular function. The response pertaining to an in-tact organism exposed to X drug will differ from an isolated cellular culture exposed to X drug.
Supposedly there is new data out indicating the extensive dyspnea induced via covid-19 is related to the formation of micro-thrombi within the capillaries of the lung (note I’ve heard this, but haven’t seen the data yet)… why is this occurring? I don’t know… If enough capillaries are blocked via micro-thrombi formation, blood can’t reach airspaces within the lungs and thus oxygenated blood can’t be adequately delivered around the body. Capillary micro-thrombosis was also observed with SARS (thank god this isn’t sars, that illness had around a 10% CFR! This is sars-2… not as lethal, but far more infectious, so it’s killing more people… perhaps that’s worse?)
http://subject.med.wanfangdata.com.cn/UpLoad/Files/202003/43f8625d4dc74e42bbcf24795de1c77c.pdf
(trial involving hydroxychlorquine)
https://www.sciencedirect.com/science/article/pii/S0399077X20300858?via%3Dihub
(second trial hydroxychloriquine + erythromycin)
Also, I don’t believe the cause of death from pneumonia is always heart failure… (can induce heart failure/myocarditis induced cardiomyopathy, esp in those predisposed). Bacterial pneumonia is considerably more dangerous (cardiac wise) compared to viral pneumonia. Severe pneumonia can induce (most commonly) death due to asphyxiation, the lungs fill up with fluid and you literally drown without being embodied in water… imagine how terrible that would be! Without oxygenated blood being able to circulate throughout the body you’re organs literally can’t function, so theoretically your organs fail, but the prime cause of death is asphyxiation. People dying from Covid-19 are typically deteriorating rapidly from having mild symptomatology to ARDS and/or perhaps cytokine storm syndrome…. Though pneumonia may be present within some who have covid-19. Severe pneumonia can cause ARDS too, but generally the death from both covid-19/ARDS is statistically asphyxiation, not heart failure, though the heart will fail/stop beating secondary to asphyxiation. Those who have pre-existing cardiac complications/who develop viral/bacterial myocarditis/cardiomyopathy can experience cardiac events absent of asphyxiation.
The way covid-19 enters the heart differs from that of the cold/flu, enters through ACE II receptors. Levels of angiotensin II have also been reportedly elevated in those with covid-19. Excess angiotensin II could theoretically induce endothelial dysfunction/vasoconstriction, injure the heart, kidneys etc, esp in those with pre-existing hypertension/the elderly/pre-existing CVD. The rate of cardiomyopathy/cardiac complications in covid-19 appears to be far higher than that of the cold, flu or pneumonia.
Actually, in relation to
In one of the trials, hydroxychloriquine + azithromycin treatment was discontinued in one patient due to QT prolongation (can facilitate arrhythmia, torsades de pointes is an especially dangerous type of arrhythmia, can easily deteriorate into ventricular fibrillation. Can also induce seizure during arrhythmia…)
“
There were 7 men and 4 women with a mean age of 58.7 years (range: 20-77), 8 had significant comorbidities associated with poor outcomes (obesity: 2; solid cancer: 3; haematological cancer: 2; HIV-infection: 1).
At the time of treatment initiation, 10/11 had fever and received nasal oxygen therapy. Within 5 days, one patient died, two were transferred to the ICU. In one patient, hydroxychloroquine and azithromycin were discontinued after 4 days because of a prolongation of the QT interval from 405 ms before treatment to 460 and 470 ms under the combination. Mean through blood concentration of hydroxychloroquine was 678 ng/mL (range: 381-891) at days 3-7 after treatment initiation.”
So out of 11 treated patients, one developed a prolonged QT interval…. Not the greatest safety profile… and Donald Trump is recommending the masses use this
https://www.sciencedirect.com/science/article/pii/S0924857920300996
(trial 3, one that indicates the drug combination is effective)
In vitro covid 19 study
Clearly we need more data, reports are conflicting. Perhaps the status of the patients (severe vs non severe), medical pathology present between groups, age, hydroxychloriquine vs H+A impact overall results… Small sample sizes also make it difficult to interpret results. Perhaps a larger scale trial needs to be conducted.
Elevated angiotensin II in covid patients/abnormalities present within those effected (pneumonia, ARDS, elevated CRP etc)
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext
Looks over prospect of cytokine storm syndrome induced via covid-19, stipulates perhaps immunosuppression could be used to treat covid-19 induced hyper inflammation if said inflammation is mediated from an overt immune response.
Finally
Should be noted Chloroquine is considerably more toxic compared to hydroxychloroquine, but neither have the greatest track records regarding safety profiles. Better than malaria though…
Statistically Australia has mitigated the spread dramatically, last night we only had a 1.9% uptick in case numbers. Even the USA is starting to mitigate spread rates (though its a little bit late now given 300 thousand + have been infected… that we know of). Last night the USA only noticed an 8.8% uptick in case numbers, a few weeks ago it was between 25-50%/day
Multiple large prospective studies are underway. Further, good retrospective studies should be cropping up any time now. One way or the other, we will soon have compelling evidence to guide Plaquenil +/- azithromycin usage for COVID.
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What do you think about countries already stocking up on this medicine/some MD’s prematurely using it for sick patients?
Is it ethical (using it on sick patients)? Is it warranted (stocking up despite a lack of concrete evidence)
It shows that panic-buying is not limited to toilet paper. But unlike with toilet paper, hoarding Plaquenil will likely result in harm (to people who need it for their connective-tissue dz).
Under exigent circumstances, yes. OTOH, I would say that its use at this time for prophylaxis would be inappropriate and ethically dubious (unless such use was part of a clinical trial).
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Some are already posting online (in one Facebook group I’m on for example) about not being able to access hydroxychloroquine to treat lupus/rheumatoid arthritis… This is absolutely unacceptable…
Thank you for the answers, I wish you the best of luck (do you still have to work? That ought to be quite dangerous given you’re an opthalmologist, you’d have to be in close contact with patients on a regular basis)
Ideally you should probably be receiving hazard pay if you’re still required to work…
Weekly unemployment claims (taken from Mckinsey.com) 2000-2020
Thank you. Yes, still working (am at the hospital at the moment). I appreciate the offer of luck, but will send it on to my brothers and sisters working in ICUs all over the world–they need it more than I.
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I hadn’t known this one existed, the first attempts were made during the 1918 pandemic. One problem is that they might have difficulty getting up to large scale production.
Has Trump been touting this so far? I just had to ask.
Melatonin.
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Seemed interesting for this thread
https://www.yahoo.com/news/most-york-coronavirus-cases-came-120729916.html
From a mate of mine at Oxford, @Aragorn asked for details, so I’ll replicate the post here:
He says the strategy for making the vaccine is a total crapshoot, and they don’t know what the immune response will be like.
They know what the response is like for MERS, which is what they’ve adapted it from. They also picked the viral spike protein, which may not be the most useful antigen, but they don’t know for sure right now.
The other barrier is that it may need a booster, and there’s potential for production bottlenecks. Those were the key difficulties he identified anyway.
-Some hot goss from the premier university of England and their vaccine rush.
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What does anyone make of the Smithfield Pork processor employees getting sick in South Dakota? How much do we need to be worried about regular food sources being a vehicle for infection?
Not worried about meat. I cook it, and always wash my hands after handeling raw meat anyways. Fresh veggies and fruit on the other hand, not to mention food packaging is a little dicey.
This is an interesting question. I’m going to defer for comprehensive answers to the others, as they have a more clinical related background–or at least contact networks–since I’m pretty much basic research only.
My instinct however is that packaging is more problematic than the meat itself if you cook it and thoroughly wash your hands.
I’d say probably the best thing to do is to keep it in a secondary container (bag, etc.), and have the trash bin out next to you (not in the drawer). Then just put the meat directly into the pan, and both primary and secondary empty containers into the trash, and wash your hands. Just take out the trash when you’re done cooking.
I don’t worry very much about this scenario, but I’d rather hear from others.
My doc friend told me not to touch the food packaging for three days. When I’m getting deliveries of non-perishable foods I tell them to leave the items in the trunk of my car in the yard, and I pick it up after four days.
Maybe it’s an overkill, but we’ve devised this approach for my in-laws who are in the riskiest bracket so my family is also applying it.
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I’d say it’s probably a safe approach. Overkill? Hard to say, but if you’re not hard up for food it’s easy to do and safe for boxed goods.
Meat obviously can’t operate like that since low temps also preserve the virus
I live in S.D. I hadn’t heard of that place before it happened, but it sounds like a cluster f*ck. I believe they said they would be shutting down, but spouses of employees who know relatives of mine said they are not and will not shut down, rather just cleaning sections of the place at a time…because that’ll work out well until an infected person comes back to the area and sneezes or something.
The town it’s in is called Sioux Falls. It’s our biggest city - probably just 185k people or so. The mayor has been begging our governor for a shut down; she has so far refused saying she doesn’t want to limit freedoms and that people will make the right decisions. I get where she’s coming from but I think it’s ridiculous to expect people to “make the right decisions” haha…when do most people ever do that? I don’t think we can count on it.
My dad’s a mason. He was kinda laid off, but not officially. His boss got them a job out of town, so he and his coworkers all have to travel now, about 2 hours from where we live. None of them want to, since coincidentally many of them have wives with major health concerns, but if they refuse to go they won’t be paid and since they technically have work available, they won’t get unemployment.
Anyway, they’re working on a hospital in a small town, and a company from Sioux Falls is there. None of the S.F. guys want to be there, but they need to work and since our gov. won’t say no traveling, their bosses are making them travel and work. This is the issue - when you say “people will make the right decisions,” some of them literally can’t. Many of these guys want to stay home, but they have to go to work because no one’s forcing their employers to give them some time off.
Was told today that two guys, one from S.F. and one from my dad’s company were sent home due to coughs and fevers…they’ve all been rooming together in motels, and half of them are coming from one of the country’s biggest hotspots for the virus…should turn out well. My parents are separated but my dad usually comes by on the weekends to see my little siblings. Probably won’t be seeing him for a while now, just to be safe.