SirBillybob

I just read that older people will not be included in human vaccine trials but the age threshold is not clear. A viable vaccine is possibly less effective for the elderly and one priority will remain vaccinating formal caregivers, younger family members, etc. This seems to pose the conundrum that the effectiveness for seniors will be judged in real time based on peer contagion rather than in prospective research. Sheesh. It all suggests the aged in alternate level of care will need isolation, as a matter of policy, from their fellow inmates to enhance survival.

UPDATE: Thermas opened just 2 days past my recent post.

Yeah, I just coincidentally saw on the Pases Instagram feed Thermas is open. Even when travel clearance to Spain, though, will not likely fly there, or Zürich, due to contagion risk and trip medical insurance disqualification. Thousands of unspent dollars to be rolled over into my fattening travel purse.

In Canada, 37,000 currently available blood donation samples as well as samples from 10,000 home-administered kits randomly distributed to Canadians registered in a large polling database will be analyzed for antibodies this summer, all part of a 2-year one million person target. As this should control for the risk-prompted or symptom-based elective testing to date, I am glad that we should be getting some better true incidence numbers sooner than I thought. With an established confidence range the true prevalence, reproduction, and fatality proportion can then be much more accurately estimated whatever the new case trend going forward. It will be interesting to see how upcoming ramping up of antibody testing will be incorporated into nation-comparative epidemiological graphs. Obviously not all 200ish will be on the same playing field for funding or timeline. Much of the global data on incidence and outcomes will become meaningless. Canadians’ individual positive results will not be revealed to them.

Would you sign up for a vaccine efficacy study? Let’s assume it was approved based on an acceptable risk of adverse events found in earlier phasing ... that is a given anyway. Let’s also assume it met the necessary ‘warp speed’ required to get to the population-testing stage of development, thereby with reduced knowledge about temporal durability of protection. Finally, let’s assume it is 2:1 ratio in randomized double-blind format, two-thirds recipients vaccine and one-third placebo.

Perhaps you pop popcorn in a pot prior to porn, papi?

The current global ratio of death to recovery, based on closed cases (lately about half all cases), is unchanged from the average of 5-month duration of tracking so far. Granted, it has dropped steadily from April 9th but an earlier equal shift also occurred over a much shorter duration of 2 weeks for an obviously much smaller cumulative tally within a comparatively narrow geographical field. The interacting variables implicated in those two iterations of steadily declining fatality surely differ or differ in relative influence where they have relevance in common. That the current trend resembles an earlier trend has me a little less likely to scratch my head. The timeline ratio curve looks a lot less dramatic than the trending histogram graph disconnect of daily case and daily death tracking. This global recovery/death graph is naturally smoothed relative to many individual nations that have regular unexplained anomalies in the progression of closed-case outcome. Additionally, many of the nations driving the increasing new case tally may be more likely to under-report related mortality in conjunction with a steady incline in infection rates (as I think others mentioned).

This is how I understand Vitamin D in general and in Covid-2 context, as it pertains to my own supplementation at my age and considering I take no medications imposing interaction that may influence bioavailability. Take standard supplementation to mitigate hypovitaminosis yet avoid hypervitaminosis and over-tolerance. The instant I think I might be getting sick, add a megadose that is considered safe over a short term. The rapid increased saturation might offset things such as the ‘cytokine storm’ we hear about. Adjust according to upcoming findings.

The D supp research results expected first should be quite soon, likely July, in France where the study commenced in mid-April when daily new case rates were still high and facilitated recruitment.

It appears that Germany’s 5-day trend shows it has lost gains accruing up to 4 weeks ago, with a current reproduction rate of 2.88 that portends a case rate exceeding that which occurred at the introduction of relaxed restrictions in early May based on a protracted period of case reduction. Portugal has been steadily increasing to twice its new case rate of a month ago.

One could cherry-pick weather and validate weather as a factor in the Americas outside of other contextual variables. Take Ontario/Quebec versus Chile, contenders for the two most seasonally polarized and temporally opposite by season. I isolate the 2 provinces as they hold the majority of Canadian cases, the pop-adjusted totals approach Chile’s the most, and the larger the pop proportion infected the more meaningful substantial changes in new case trend. The population differential is merely about 10% and north-south latitude differentials are not terrible discrepant. Pandemic commenced at respective Equinox for each. Canada curve starts to drop following peak about May 6th (Equinox-Solstice midpoint) and Chile curve precipitously rises at that point. Ont\Qc doing its best ever at Solstice and Chile skyrocketing at theirs, even controlling for their large retroactive data-dump mid-June. That spike anomaly simply reinforces the notion that Chile and the 2 Canadian provinces were more neck-and-neck than otherwise appears over the dates prior to greater weather polarization (not to be confused with Geo-polar). BUT HERE IS THE KICKER: If it relates to weather, Canada could surge at the midpoint next to August, in other words early November. If mirror-imaged against Chile’s trend, by our holiday season this translates to 8 times Ontario’s peak seen in May and 4 times Quebec’s at that time. All I want for Christmas is a hazmat suit. ——- Does Argentina corroborate the pattern? Yes, to a degree. Was low for a long time but steadily though less steeply increasing since the early May seasonal mid-point, and now criss-crossed above overall Canada new case rates.

Interestingly, 3 of the top 8 states surging out of all states&territories are in the top 4 for dry weather by full year. The flu (the SARS-CoV-2 comparator being most used) may like low humidity at any temperature and relatively but moderate higher temperature irrespective of humidity, all confounded by whether the weather regionally has a true polarized seasonality. (But I think it is a coincidence for this pandemic and population compliance with science is the overriding factor.) http://sitn.hms.harvard.edu/flash/2014/the-reason-for-the-season-why-flu-strikes-in-winter/

Arizona is startling in its recent new case trend normalized by population. It is two to three times greater than states placed 2nd to 9th. At one point, my province Quebec, similar population, was trending at levels now evident in the 8 states placing behind it, but Arizona now has 30 times the Quebec rate and is matching Louisiana’s skyrocketing in the early days. If Arizona were a nation it would currently be 2nd only to Chile.

Canada is not centring out the USA. It’s just that we share a border, so that restriction seems more pronounced. No foreign national can easily enter at this time, and qualified arrivals still quarantine for 2 weeks and must have special dispensation for a brief visit, but there are flights into Canada with qualified passengers from countries reporting cases. I note that Qatar is in the top 2 nations trending the worst in new cases adjusted for population, along with Chile, yet a flight arrives in Montreal from Doha on Monday. Perhaps it is a rare repatriation situation. Granted, a better picture in the USA may have otherwise lead to an earlier border opening. What is unclear is whether overseas foreign nationals will be greenlit for entry based on a hierarchy of demonstrated pandemic management, pending airline resumption. Unlike Europe, there is no set of contiguous nations reciprocally opening borders as a large collective.

I thought natural immunity occurred from non-deliberate exposure to a pathogen, and degree of symptoms is irrelevant. Therefore, everybody exposed to the flu, sick or not, acquires natural immunity. You don’t not get the particular flu that leads to immunity to it. Strain relatives may have conferred natural immunity but that applies to all of us and, as I understand it, new exposure prompts new antibody development added to the immunological soup. In contrast, the vaccine creates artificial immunity. Therefore, the original question would more accurately be: I am not immune to flu in general but I am not susceptible to flu symptoms, so is new uptake of vaccination a liability? Answer: no. It can help prevent an index case of a new strain finding an escape route around your apparently very uniquely strong defensive system and causing sickness and/or complications, as others here suggest. Why immunological imprinting varies among us is a different complex question. In my limited layperson view, annual vaccination since 1976 gave me many inactivated strains that I might have otherwise acquired in their natural state, immunization thereby additively providing greater protection going forward.

I think it’s called schadenfreude, the reward of something, usually humour or smug satisfaction, at someone’s expense. You might laugh accompanied by compassion ... think a friend spilling something but not injured ... so it may be reflexive. Ironically, we may overthink it if the mishap occurs to somebody we view with contempt, slapstick flavour or not. In other words, the less compassion the more potential guilt. Hope your pooch appreciates your risks.

The titles of most of the press articles referencing the NEJM study of Spanish and Italian patients are accurate. The summary paragraphs, in contrast, tend to contain wording that can lead to misinterpretation, including your recent attachment (medicalxpress.com). I might add that journalists do not typically have their guest commentators, in this case clinicians, vet the final draft. The press article main content errors in this case do not stampede the horses or lead to lowering guard. It is a problem, however, if an A blood type panics about susceptibility to hosting the virus, what is colloquially termed “catching” it. If you have Covid-19, you caught it for sure. You cannot catch severity. If you are writing or talking about severity, the redundancy of “catching” semantically gets translated to susceptibility to acquiring the virus. I should additionally add that not all clinical commentators read the manuscript they are asked to comment on. One clinician described the control group in such a way that the reader would interpret the control group as being infected with SARS-CoV-2 but not sick. As I wrote earlier, the control group was a reference sample that simply benchmarked normative blood type distributions within similar geographic jurisdictions as the Covid-19 patients. It would have helped if the researchers did not label them “participants” because it was simply a blood donor database. Your original post links to the NEJM article. There is nothing to stop you from comparing its content to press articles that assert the NEJM research paper links blood type to becoming infected (aka ‘hosting), asymptomatic or otherwise, with SARS-CoV-2; to acquiring any symptomatic presentation of Covid-19 disease along the pre-severity continuum within which the majority of symptomatic persons fall; or to death. The NEJM article does not report on any of those three associations. It reports on a subset of severity defined by respiratory distress.

I posted earlier about blood type after reading the NEJM paper ... yep, actually read the manuscript because news outlets are distorting the content of the study. I only posted about age and comorbidity because somebody else added them to the mix when bringing up personal circumstances. That said, because odds ratios regarding blood type were presented in the paper, it is not a terrible idea to position the magnitude of blood-type predictability of disease severity against predictability of age and/or underlying health conditions, factors that far exceed the effects of blood type. The influence of blood type on respiratory severity is similar to the variable of gender on mortality. Oops, I did it again, bringing up sex in a thread on blood type. What I did not do earlier was critique the thread title. The study did not report on the influence of blood type on final outcome. In fact, the ARS cohort was stratified across a 4-level range of interventions from minimally to maximally invasive. One would reasonably assume that outcome among the ARS patients was known in terms of recovery versus death. Perhaps the association was not robust or significant and was conveniently omitted. It is not a stretch to extrapolate that blood type influenced death if it firstly influenced severity UNLESS it didn’t in the former (death) and if that reality was excluded or the test of related mortality hypotheses is sidelined to another manuscript. Researchers should know their audience, though, and anyone interested in morbidity severity is even more interested in the bottom line regarding death. Because the researchers compared the predictability of blood type between mechanical ventilation and less invasive respiratory support, finding no difference, it is even more spurious to extrapolate that blood type (O is salutary, A is liable) is implicated in Covid-19 death.

It is a challenge to determine the relative risk of age and comorbidity because it is easier to control and adjust for age in assessing the risk of any one health condition than to adjust for comorbidity in assessing the risk of age, because underlying health conditions increase with age and there are age factors other than the official presence of any of the half dozen or so underlying health conditions evaluated that may account for mortality risk. So far, meta-analysis (techniques combining multiple similar studies) suggests that age alone, at the threshold of 65 years, is a far greater predictor of Covid-19 death than any single one of the health conditions assessed individually. Health conditions additively obviously paint a different picture. If you are older and otherwise healthy, as I am, it is reasonable to assume the age-exclusive odds ratio at one’s age threshold (mine is 65; 80 is another matter) does not as robustly apply.

As many know, the rent sauna in Barcelona, Thermas, is one of 5 operated by the Sauna Pases group (4 are regular venues): 3 in Barcelona, 1 in Valencia, and 1 in Seville. The Seville location reopened on June 10th with the typical hygiene and security upgrades one would expect, so itsa happening, no dates yet but some of the locations suggest imminently.

From what I understand, the European study has been partly misinterpreted in the press, conflating acquiring or “catching” SARS-CoV2 (analogy HIV) with the virus actually developing to the disease state: Covid-19 (analogy AIDS). In fact, the Euro study in NEJM only compares the distribution of 4 blood types among Italian and Spanish patients with severe Covid-19 against control groups of blood donor samples from mainly prior to the new coronavirus. One component of the donor comparison was more recent and happened to show about 4% SARS-CoV-2 positivity; the overall comparison cohort was diluted to negligible (or perhaps 0, they may have been excluded in analyses ... too many appendices to scan). This may explain why there is some misunderstanding among a few media sources that think the blood type distribution was compared between (1) those with Covid-19 and respiratory failure and (2) those who did not have enough severity for one or more of the 4 respiratory failure interventions or indeed may have the virus yet asymptomatic. The (2) was not in the methods but will likely be incorporated in future research. It might be a challenge retrospectively because a (2) comparison group likely has little to no serology yielding blood alleles compared to hospitalized/ICU patients, yet one would prefer contemporaneous sampling. To sum up, the study did not research susceptibility to picking up the virus according to blood type. I believe there is a Chinese study in preprint, and perhaps other ongoing, completed, or reported research that is assessing that piece.

Sorry, ignore, just trying to figure out in what order to put +/- quote and reply. I now have the mnemonic ‘q precedes r’ anchored, I hope.

How are Americans explaining to Canadian Border Services getting from BC to Alaska considering the BC/Yukon border remains closed? Are their vehicles amphibious at Prince Rupert?

To my way of thinking a spike generally represents an increase (worsening) in prevalence of active cases following a decrease (improvement). A continuous increase to the same endpoint as the apparent spike may be worse for morbidity and mortality but somehow a spike becomes more newsworthy. I think the narrative around a spike is one of greater import because it assumes behavioural error, prematurity, etc, and because losing something you gained may feel worse than no change in terms of loss or gain. Easing confinement followed by either trend is difficult to interpret because it may have impeded a natural reduction or have spurred an increase that might not have otherwise occurred. I do not know that there is consensus on definitional criteria of a spike. What seems to be described as a spike can be, it seems to me, either steady continuous worsening or two consecutive directional shifts on a graph (a visual draws the eye to the image of a spike). What seems apparent for USA, in contrast to Canada for example, is a May 29th peak in active cases was followed by a steady decline by 5.9% to a trough about 6 days later, followed by a nullification of improvement about 9 days after that (as though steady state) and a current increase of 8.6% above the June 4th trough and 2.2% above the May 29th peak. Call me crazy, but I think I would deem a spike in this context, while suspending temporality, as an equal degree rebound back from any drop point to the peak preceding it, followed by an increase equal to the breadth of the previous drop ... essentially 5.9% above the May 29th peak. As such, 69,000 more active cases compared to today. Suspending recovery tallies, that would occur in about 4 days, obviously longer depending on outcomes relative to incidence.