SirBillybob

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.

Montreal is finally trending close to the overall Quebec provincial rate of new “official” reported CoV cases, about 1 in 65,000 population daily, a steady decline that I think now puts it out of contention as the exclusive provincial city-specific “hot spot”. Whew. Montreal likely now figures as among a scattered grouping of urban areas within the province that drives up the tally. Quebec overall now also appears to be on an equal footing with Ontario. Ontario had never spiked to the same degree but is showing a slower reduction in new infections.

Montreal is finally trending close to the overall Quebec provincial rate of new “official” reported CoV cases, about 1 in 65,000 population daily, a steady decline that I think now puts it out of contention as the exclusive provincial city-specific “hot spot”. Whew. Montreal likely now figures as among a scattered grouping of urban areas within the province that drives up the tally. Quebec overall now also appears to be on an equal footing with Ontario. Ontario had never spiked to the same degree but is showing a slower reduction in new infections.

Paragonya in Zürich reported it can accommodate up to 130 patrons! That would be close to a tin of sardines. Apart from queue spacing at reception, emphasis on protecting employees, and typical disinfecting (mattresses, etc), it appears that anything goes in terms of interaction with trade.

As far as dates, what we know is there is no planned or even tentative timeline set for bars in Quebec. Restaurants, and bars/clubs with licensed kitchens, are able to open today in Quebec and June 22nd in Montreal with the regulations (density, spacing, hygiene) one would expect. I suppose the coronavirus daily rate will be closely monitored prior to any future additional openings in the venue hierarchy. BTW, Le 281 male stripper club for women was already slated to close September 1st as I believe the building was sold to a developer. This may eventually draw more business to “ladies nights” in our usual haunts. I cannot imagine anyone taking the risk to pump money into a new venue.

Ah, lol, I was going to say the Belgium inquiry was about mortality rates, but that was your inquiry. I think it got a little off track and ‘sprouted’ suppositions about transmission rates and associated factors. I find it harder to flex muscles about Brussels or elsewhere the broader the terms/variables.

Actually, a denominator of 850 cases in Andorra and 675 cases in San Marino is not a terrible basis for outcome and population calculations in those small landlocked nations. They would offer poorer cross-national comparisons in chi-squared analyses but for the relatively high mortality rate of Covid-19. Granted, each is embedded or in close proximity to a hot zone. I wonder, too, if a smaller (developed) nation is advantaged by more accurate organizational capacity in compiling data. I believe, however, that Iceland is the winner among all nations on that count. Seeing as cruise ships, etc, are up for grabs, I’ll be a princess and toss in my city of a few million, Montreal ... if it were an independent small yet densely populated nation, places third behind San Marino and Belgium in per capita pandemic mortality. The weather has been great; I have not used my umbrella in almost 3 months.

What is striking is the disparity among countries in the ratio of ‘recovered’:’mortality’ outcomes. Belgium reports one death for every two recoveries. Health officials there, when criticized for scaring future tourists away, etc, counter that they are being radically transparent and are including “presumptives” ... that underreporting is widespread elsewhere. Again, perhaps a lack of standardization in tallying leads to the apparent contradiction of San Marino reporting a much lower death rate by infection but much higher death rate by population compared to Belgium. But here is where the numbers get really tricky: in spite of Belgium reporting 37% of outcomes to date as death, only 1% of the current thousands of cases are deemed to be serious or critical. Population is the greatest constant; followed by mortality (however skewed by erroneous estimates, upwards by presumptives and downwards by undiagnosed/home-based); and lastly case count, skewed by reported versus actual, also determined in part by cross/sectional general asymptomatic-inclusive test sampling (limited by short antigen detection duration) and by the more accurate antibody testing for truer epidemiological rates. Of course, other variables such as age and long-term care outbreaks impact on how to interpret the figures as far as general population risk. Broad-based antibody testing, including post-mortem where necessary is the only way to reconcile case count and mortality. Otherwise, I respect the disease but suspect the tallies.

Paragonya Wellness Club (Zürich) will re-open June 6th. The country has only gone as far as to commit to most EU visitors as of July 9th (with some, like Italy, up in the air), and depending on infection rates going forward, so permission to Americans and Canadians, etc, could be a ways off.

I also recently called the Quebec hotline for screening because I had a very sore throat like one typically gets prior to a rhinovirus or adenovirus. I had already recovered in March from a common cold. I was rejected for an appointment for nasal/pharyngeal swab. Today I am going for routine swabs for strep and gonorrhea (was sexually active in February) because they are authorized. Act 2 of the shit show. LOL

Shifting gears a bit: I think I am or should be envious of Americans’ capacity to acquire a SARS-CoV-2 antibody test. Am I correct in that it is obtainable there, even if you have to pay out of pocket? One candidate in Canada has been approved but the authorities do not want general access. It might be because they wish a structured roll-out to accurately assess general population reactivity. So far, I believe the research initiative is one million tests over two years. That seems too long to wait. I suspect there will be a type of (above-board?) “black market” because the one test has approval and the company may have a free reign to sell it outside of research jurisdiction. Because one’s primary care or other MD might not want to be in the cross-fire it might be necessary to go to an alternate private clinic for a test requisition to take to the lab partnering with the antibody test manufacturer. What a shit show.

I recommend not distorting your history because there is strong ongoing gay advocacy. Better to challenge than lie. I believe some of the activism results have been quick in relation to convalescent plasma donation.

I am gearing up for Valhalla Murders (Netflix), something broodily Nordic to contrast with satirical comedy The Great. The Great is on Hulu, not easily accessed in Canada, but I discovered it is on Apple TV where I have the initial year free. Near the end of latest Stranger Things. An inevitable gay self-outing between nosebleeds.