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  1. Good news for BOTL Low incidence of daily active tobacco smoking in patients with symptomatic COVID-19 Conclusions and relevance: Our cross sectional study in both COVID-19 out- and inpatients strongly suggests that daily smokers have a very much lower probability of developing symptomatic or severe SARS-CoV-2 infection as compared to the general population. Daily smokers are individuals reporting daily smoking or reporting a daily frequency of the number of cigarettes (manufactured or rolled) or other tobacco products (cigars, cigarillos, pipe, shisha). The quantities of tobacco smoked were calculated using the following equivalences: 1 cigar = 1 cigarillo = 2 cigarettes. Because this is a cross-sectional study, we cannot confirm the causality of this association. We cannot also identify which of the many compounds of tobacco exerts the protective effect of smoking on COVID-19. There are however, sufficient scientific data to suggest that smoking protection is likely to be mediated by nicotine. SARS-CoV2 is known to use the angiotensin converting enzyme 2 (ACE2) receptor for cell entry[14-16], and there is evidence that nicotine modulates ACE2 expression[17]which could in turn modulate the nicotinic acetyl choline receptor Buy some lifesaving cigars at FoH ?
  2. Italian town of 4,646 is 70% seropositive. Their death rate? 1.6% in eight weeks. The virus has torn through too many communities for a 0.1% CFR to be believed without extraordinary documented evidence.
  3. A friend of mine from college, very healthy (low BMI, low BP, no lung issues) had COVID-19 and is recovering. Her words: For me, it started with a cough. It was dry. It wasn't too bad. I thought I would get to escape easily. I hid in my apartment, and hoped it would pass. It didn't. Then it did. Then there was some fever. But I was alone, and the internet in America is out of thermometers, so I couldn't take my temperature. But when I sweated through my pants while sitting quietly, I decided probably... I had it. Being alone and being your own nurse is a thing. You have to pay attention to your body in a way that is disorientating and unfair, while your body is being disorienting and unfair. This thing comes in waves. Use those moments where you feel fine and think you've kicked to make all the food you might want to eat. For me, was soup. had no idea how bad it would get. I am so grateful I made soup for many when it was just me and an uncertain future. This thing kills your appetite, and you have to eat anyway. - The scary breathing didn't start until over two weeks in. The only thing that helped was an albuterol inhaler a doctor friend prescribed and steaming my lungs with near boiling water, eucalyptus and a towel over my head. Also, the recent things I've read suggest don't sleep on your back. Stay prone if you can, if the breathing gets bad, like an athlete trying to bike up the last hill. Basically, more of your lung volume is in your back than you think. And you need every single alveoli to work that can. I don't smoke, and craved more soft pink lung tissue as I wheezed through a night and tried to figure out if I needed to brave an overworked NYC hospital. - There is a lot of new (and this all new) research that as much motion you can do is important. Turns out a bunch of your lung volume is in your back. You need that volume. In hospitals they are putting people on their fronts to avoid putting them on ventilators. Luckily this was intuitive to me. I felt uncomfortable on my back. Sleep on your side if you can. Do yoga. Do breathing exercises, no matter how annoying. - Have a friend to check in with. Alone and sick is hard. And friends will worry. But you need a plan to get out. - I love and miss you all. Four weeks out, I still get chest pain. And I'm really lucky that this thing that keeps taking people I love and people people I love away didn't take me. But the rest of you, even the young and mighty, act like you already have it.
  4. Absolutely it's good news! By hook or crook, endgame at this point appears to require that magic number of 85% (+/- 5%) of folks that are seropositive. We need to get there as smartly as possible. The challenge at this point is : How? My guess is a combination of effective therapies and risk Mitigation. After the first wave has crested, we will have a much better understanding of the disease cycle for folks, especially the severe and critical cases. We can leverage that information to make an informed plan about how best to proceed. We're definitely not there yet, but we are moving in the right direction, Covidiots excepted.
  5. Herd immunity hypothesis officially debunked. 2.5% to 4.3% is far below herd immunity levels, typically 80% to 90% for a virus with a R0 similar to SARS-CoV-2.
  6. 2.5% to 4.2% of California's SF Bay Area test positive for coronavirus antibodies. This puts to rest the hypothesis that there existed a large percentage of the population that had been previously exposed. There are several very positive developments on the treatment front: Covalesent plasma therapy - good evidence that it works, available today Acterma - approved drug for Rheumatoid Arthritis, strong promise to arrest CRS caused by COVID-19 Remdesivir - Phase 3 drug nucleotide analog, early evidence that it works well on severe cases! Avigan - Approved in Japan, prevents viral RNA reproduction, effective for orthmyxoviruses and potentially coronavirus Two of the most promising treatments originate from California - You're welcome everyone ?
  7. Immediately proceeds to go conspiracy theory ? There's a reason why this exact scenario, coronavirus focused, was the subject of a global pandemic tabletop exercise last year. Coronaviruses have been spread exactly this way twice in the past, MERS and SARS. It just happens that this particular strain is different than previous outbreaks in that it has a long incubation period and asymptomatic spreaders.
  8. https://www.nytimes.com/interactive/2020/04/10/upshot/coronavirus-deaths-new-york-city.html Seasonally adjusted, death rate in NYC was at least double for March. "The recent numbers are most likely an undercount. Even in normal times, death certificates take time to be processed and collected, and complete death tallies can take weeks to become final. This is especially true for cases involving coronavirus. “Covid deaths all have to be manually coded,” said Bob Anderson, chief of the mortality statistics branch at the C.D.C.’s National Center for Health Statistics, adding that death counts from New York City typically lag actual deaths by 10 or 11 days. But even if the current count is perfect, roughly 9,780 people have died of all causes over the past month in New York City, about 5,000 more than is typical."
  9. Unfortunately, Stanford scientists' extensive PCR testing (n=2,888) indicates there was no such prevalence. Samples were analyzed from upper respiratory tract patients who had been sick between for early February to late February. Zero positives were found from samples before the last week in February.
  10. Done. FDA approved this last week. Scale up is relatively easy, since it's a western blot based test. Combo IgM / IgG testing allows some confidence about the date of infection, also helpful for confirmation testing for a PCR based active infection test. https://www.fda.gov/media/136625/download We need a diagnostic grade neutralizing antibody test (no small task). Those who are seropositive for Nab are most likely to be safe from further infection.
  11. Army field hospital for Covid-19 surge leaves Seattle after 9 days. It never saw a patient Great news, the first surge in Covid patients appears to have been effectively contained in Seattle. Three cheers for an effective governmental response in the US! The model of how to control the arc of disease in the population has been effectively laid out in several places.
  12. We're in the second inning here folks. There's a long slog ahead, barring some Hail Mary therapy. Stay safe out there. It is extremely premature to discuss what happens after the pandemic recedes. Persistent reservoirs will be out there, India for example, and the fact that asymptotic carriers can slip through detection even with mature testing infrastructure makes this a public health nightmare. A few cases metastasize rapidly to a full blown crisis in a matter of weeks. Until this can be fundamentally addressed, this crisis will be ongoing.
  13. US deaths over 1,000 per day A shocking worldwide leadership failure. Both national and international officials have made highly questionable decisions, and must be held accountable. Each country has a role in the failure. We're well beyond the looking glass.

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