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Dennis OConnor

The CDC and States Are Misreporting COVID-19 Test Data - The Atlantic - 0 views

www.theatlantic.com/...611935

testing covid antibodies

shared by Dennis OConnor on 22 May 20 - No Cached
  • A negative test result means something different for each test. If somebody tests negative on a viral test, a doctor can be relatively confident that they are not sick right now; if somebody tests negative on an antibody test, they have probably never been infected with or exposed to the coronavirus. (Or they may have been given a false result—antibody tests are notoriously less accurate on an individual level than viral tests.) The problem is that the CDC is clumping negative results from both tests together in its public reporting.
  • Mixing the two tests makes it much harder to understand the meaning of positive tests, and it clouds important information about the U.S. response to the pandemic, Jha said. “The viral testing is to understand how many people are getting infected, while antibody testing is like looking in the rearview mirror. The two tests are totally different signals,” he told us. By combining the two types of results, the CDC has made them both “uninterpretable,” he said.
  • “Combining a test that is designed to detect current infection with a test that detects infection at some point in the past is just really confusing and muddies the water,” Hanage told us.
  • Dennis OConnor on 22 May 20
     
    "The government's disease-fighting agency is conflating viral and antibody tests, compromising a few crucial metrics that governors depend on to reopen their economies. Pennsylvania, Georgia, Texas, and other states are doing the same."
Dennis OConnor

Researchers Cast Doubt On Theory Of Coronavirus Lab Accident : Goats and Soda : NPR - 1 views

www.npr.org/...ry-of-coronavirus-lab-accident

covid research origins-covid-19

shared by Dennis OConnor on 24 Apr 20 - No Cached
  • April 23, 2020
  • Virus researchers say there is virtually no chance that the new coronavirus was released as result of a laboratory accident in China or anywhere else.
  • after corresponding with 10 leading scientists who collect samples of viruses from animals in the wild, study virus genomes and understand how lab accidents can happen, NPR found that an accidental release would have required a remarkable series of coincidences and deviations from well-established experimental protocols.
  • ...12 more annotations...
  • All of the evidence points to this not being a laboratory accident," says Jonna Mazet, a professor of epidemiology at the University of California, Davis and director of a global project to watch for emerging viruses called PREDICT.
  • all believe that the virus was transmitted between animals and humans in nature, as has happened in previous outbreaks — from Ebola to the Marburg virus — and with other known coronaviruses such as SARS and MERS.
  • Regardless, genetic analysis shows the virus began to spread sometime in the fall or winter of 2019, says Robert Garry, a microbiologist at Tulane University. Those same analyses refuted an earlier theory that the virus was genetically engineered in a laboratory.
  • the exact route from nature to people remains a mystery,
  • Rather than a laboratory misstep, researchers believe that this new coronavirus reached humans in the same way that other coronaviruses have: through "zoonotic spillover," or humans picking up pathogens from wildlife.
  • The CDC estimates that 6 out of 10 infectious diseases in people come from animals, including diseases caused by coronaviruses.
  • "As we change the landscape to suit our purposes, we come more and more into contact with viruses and other pathogens that we don't have much exposure to," says Dr. Brian Bird, associate director of the OneHealth Institute at UC Davis School of Veterinary Medicine and a former CDC scientist.
  • "Zoonotic transmission" or "zoonotic spillover" generally happens three ways: through excretion (feces that comes into contact with humans), slaughter (meat consumed by humans) and vector-borne (an animal biting a human). But even under these circumstances, the virus must then overcome barriers within the human body, defeating the immune system, to successfully replicate and transmit between humans themselves.
  • Despite the evidence, misinformation about the virus's origins continue to proliferate. For Daszak, who has worked on other outbreaks, the pattern is all too familiar: "Every time we get a new virus emerging, we have people that say, 'This could have come from a lab,' " he says.
  • "It's a real shame that the conspiracy theories can get to the level they've got with policymakers,"
  • The political heat has strained the very scientific collaborations meant to detect these viruses as they emerge, warns Jonna Mazet.
  • Daszak says the time for finger-pointing is over. "We have a bat virus in my neighborhood in New York killing people," he says. "Let's get real about this."
  • Dennis OConnor on 24 Apr 20
     
    "April 23, 2020"
Dennis OConnor

Mimi Guarneri: Coronavirus Patient Testing & Care Health Services Flowchart - Pacific P... - 0 views

pacificpearllajolla.com/care-health-services-flowchart

covid outpatient infographic

shared by Dennis OConnor on 17 Apr 20 - No Cached
  • Dennis OConnor on 17 Apr 20
     
    "How Will Coronavirus Patients Flow through Health Services? Many of you have called asking to be tested for Coronavirus. Given recent testing challenges, the CDC and County have provided physicians with a simple coronavirus patient testing & care health services flowchart. As you can see, if symptoms are mild, testing is not indicated at this time. It is my hope that we will soon be able to test everyone! The 211 number mentioned below is a San Diego County information line that helps people efficiently access appropriate services, and provides vital data and trend information. The website for 211 is https://211sandiego.org/"
Dennis OConnor

CDC - Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiec... - 0 views

www.cdc.gov/...recommendedguidanceextuse.html

testing covid first-responders safety

shared by Dennis OConnor on 21 Mar 20 - No Cached
  • This document recommends practices for extended use and limited reuse of NIOSH-certified N95 filtering facepiece respirators (commonly called “N95 respirators”). The recommendations are intended for use by professionals who manage respiratory protection programs in healthcare institutions to protect health care workers from job-related risks of exposure to infectious respiratory illnesses.
  • Minimize the number of individuals who need to use respiratory protection through the preferential use of engineering and administrative controls;
  • Use alternatives to N95 respirators (e.g., other classes of filtering facepiece respirators, elastomeric half-mask and full facepiece air purifying respirators, powered air purifying respirators) where feasible;
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  • mplement practices allowing extended use and/or limited reuse of N95 respirators, when acceptable; and
  • Prioritize the use of N95 respirators for those personnel at the highest risk of contracting or experiencing complications of infection.
  • Respirator Reuse Recommendations
  • There is no way of determining the maximum possible number of safe reuses for an N95 respirator as a generic number to be applied in all cases. Safe N95 reuse is affected by a number of variables that impact respirator function and contamination over time.
  • Risks of Extended Use and Reuse of Respirators
  • Dennis OConnor on 21 Mar 20
     
    Recommended by Jessica Block
Dennis OConnor

CDC Global | Facebook - 0 views

www.facebook.com/CDCGlobal

cdc covid facebook

shared by Dennis OConnor on 11 Jan 21 - No Cached
  • Dennis OConnor on 11 Jan 21
     
    "Follow this page to share information that can benefit someone you know. The U.S. Department of Health and Human Services (HHS) touches the lives of nearly all Americans from research to food safety, health care, aging and much more."
Dennis OConnor

Coronavirus kills far more Hispanic and Black children than White youths, CDC study fin... - 0 views

www.washingtonpost.com/...deaths-hispanic-black-children

covid diversity

shared by Dennis OConnor on 15 Sep 20 - No Cached
  • Dennis OConnor on 15 Sep 20
     
    "The coronavirus is killing Hispanic, Black and American Indian children at much higher numbers than their White peers, according to federal statistics released Tuesday."
Dennis OConnor

Don't "Flatten the Curve," stop it! - Joscha Bach - Medium - 1 views

medium.com/...a-deadly-delusion-eea324fe9727

Cognitive mit AI covid data visualization containment

shared by Dennis OConnor on 17 Mar 20 - No Cached
  • What all these diagrams have in common:
  • They have no numbers on the axes.
  • They don’t give you an idea how many cases it takes to overwhelm the medical system, and over how many days the epidemic will play out.
  • ...46 more annotations...
  • They suggest that currently, the medical system can deal with a large fraction (like maybe 2/3, 1/2 or 1/3) of the cases, but if we implement some mitigation measures, we can get the infections per day down to a level we can deal with.
  • They mean to tell you that we can get away without severe lockdowns as we are currently observing them in China and Italy.
  • nstead, we let the infection burn through the entire population, until we have herd immunity (at 40% to 70%), and just space out the infections over a longer timespan.
  • The Curve Is a Lie
  • suggestions are dangerously wrong, and if implemented, will lead to incredible suffering and hardship.
  • Let’s try to understand this by putting some numbers on the axes.
  • California has only 1.8.
  • The US has about 924,100 hospital beds (2.8 per 1000 people)
  • Germany have 8
  • South Korea has 12
  • Based on Chinese data, we can estimate that about 20% of COVID-19 cases are severe and require hospitalization
  • many severe cases will survive if they can be adequately provided for at home
  • by some estimates can be stretched to about a 100,000, and of which about 30,000 may be available
  • mportant is the number of ICU beds
  • oxygen, IVs and isolation
  • About 6% of all cases need a ventilator
  • if hospitals put all existing ventilators to use, we have 160,000 of them
  • CDC has a strategic stockpile of 8900 ventilators
  • number of ventilators as a proximate limit on the medical resources, it means we can take care of up to 170,000 critically ill patients at the same time.
  • Without containment, the virus becomes endemic
  • Let’s assume that 55% of the US population (the middle ground) get infected between March and December, and we are looking at 180 million people.
  • the point of my argument is not that we are doomed, or that 6% of our population has to die, but that we must understand that containment is unavoidable, and should not be postponed, because later containment is going to be less effective and more expensive, and leads to additional deaths.
  • About 20% will develop a severe case and need medical support to survive.
  • Severe cases tend to take about 3–6 weeks to recover
  • 6% may need intubation and/or ventilation
  • Once a person is on the ventilator, it often takes about 4 weeks for them to get out of intensive care again.
  • The “flattening the curve” idea suggests that if we wash our hands and stay at home while being sick aggressively enough, we won’t have to stop the virus from becoming endemic and infecting 40% to 70% of all people, but we can slow the spread of the infection so much that out medical system can deal with the case load. This is how our normally distributed curve looks like when it contains 10.8 million patients, of which no more than 170,000 are ill at the same time:
  • Dampening the infection rate of COVID-19 to a level that is compatible with our medical system means that we would have to spread the epidemic over more than a decade!
  • confident that we will have found effective treatments until the
  • reducing the infectivity of the new corona virus to a manageable level is simply not going to be possible by mitigation, it will require containment.
  • My back-of-the-envelope calculation is not a proper simulation, or a good model of what’s going on either. Don’t cite it as such!
  • Of the 180 million, 80% will be regarded as “mild” cases.
  • Containment works
  • China has demonstrated to us that containment works
  • lockdown of Wuhan did not lead to starvation or riots
  • made it possible to focus more medical resources on the region that needed it most
  • implemented effective containment measures as soon as the first cases emerged.
  • South Korea was tracking its first 30 cases very well, until patient 31 infected over 1000 others on a church congregation.
  • For some reason, Western countries refused to learn the lesson.
  • The US, UK and Germany are not yet at this point: they try to “flatten the curve” by implementing ineffective or half hearted measures that are only meant to slow down the spread of the disease
  • instead of containing it.
  • some countries will stomp out the virus and others will no
  • few months from now
  • almost all travel from red zones into green zones will come to a hal
  • world will turn into red zones and green zones
  • Flattening the curve is not an option for the United States, for the UK or Germany. Don’t tell your friends to flatten the curve. Let’s start containment and stop the curve.
  • Dennis OConnor on 17 Mar 20
     
    "Flattening the curve is not an option for the United States, for the UK or Germany. Don't tell your friends to flatten the curve. Let's start containment and stop the curve." Strong article with data visualizations from a Phd working out of MIT/Harvard.
Dennis OConnor

First U.S. Company Announces an Upcoming Home COVID-19 Test | Time - 0 views

time.com/...home-covid-19-test-everlywell

covid research testing EverlyWell

shared by Dennis OConnor on 19 Mar 20 - No Cached
  • Food and Drug Administration allowed certified labs, including commercial lab testing companies, to develop and distribute COVID-19 tests on Feb. 29.
  • People can order the Everlywell COVID-19 test on the company’s website, after first answering questions about their basic health, symptoms and risk factors for the coronavirus disease. A doctor still needs to prescribe the test, so telemedicine doctors from PWNHealth, a national network of physicians who prescribe diagnostic tests, then reviews these answers to determine if a person qualifies for testing, based on criteria established by the Centers for Disease Control and Prevention.
  • Currently, because COVID-19 tests are not plentiful in the U.S., doctors are trying to rule out other respiratory diseases like flu first, and only ordering tests for people with symptoms who also have other risk factors for infection, such as being in close contact with others who have been diagnosed.
  • ...7 more annotations...
  • If the telemedicine doctor decides to prescribe an Everlywell COVID-19 test, the company says it will send the $135 test kit in two days (customers can pay $30 more to receive the kit overnight).
  • As with many of the commercially available tests, this one extracts SARS-CoV-2, the virus behind COVID-19, from the sample and then probes for specific genetic signatures of the virus.
  • If the test is positive, the company also provides a full telemedicine consultation with one of around 200 physicians that is included in the cost of the test.
  • Everlywell says it is ready to ship 30,000 COVID-19 tests, and plans to expand the number of labs processing the sample
  • kits will depend on the availability of swabs for collecting samples
  • global shortage of swabs for any lab performing the test.
  • We’re working hard to ramp up weekly capacity to test 250,000 Americans,” says Cheek
  • Dennis OConnor on 20 Mar 20
     
    DeAunne Denmark, M.D. Phd - I was just reading about this last night. Dr forum blowing up about it. It could be a gigantic win for EverlyWell (and at-home D-T-C Direct-to-Consumer) if they do it right. But *must* do it right, e.g. including transparency re: methods, interfacing with HCP/EMRs, etc. The big issue may be collection variability, not unlike the microbiome. Nasal swab not trivial, more talk now about collection variability possibly accounting for a large proportion of "negs" turning positive. Hate to see a lot of false confidence running around at large infecting others.
Dennis OConnor

In the coronavirus pandemic, we're making decisions without reliable data - 4 views

www.statnews.com/...ecisions-without-reliable-data

covid testing research pandemic data

shared by Dennis OConnor on 19 Mar 20 - No Cached
  • A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data
  • This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19.
  • As most health systems have limited testing capacity, selection bias may even worsen in the near future.
  • ...8 more annotations...
  • The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.
  • Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%).
  • Although successful surveillance systems have long existed for influenza, the disease is confirmed by a laboratory in a tiny minority of cases.
  • Some worry that the 68 deaths from Covid-19 in the U.S. as of March 1610 will increase exponentially to 680, 6,800, 68,000, 680,000 … along with similar catastrophic patterns around the globe. Is that a realistic scenario, or bad science fiction? How can we tell at what point such a curve might stop?
  • In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns.
  • This has been the perspective behind the different stance of the United Kingdom keeping schools open12, at least until as I write this. In the absence of data on the real course of the epidemic, we don’t know whether this perspective was brilliant or catastrophic.
  • One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health.
  • At a minimum, we need unbiased prevalence and incidence data for the evolving infectious load to guide decision-making.
  • Dennis OConnor on 19 Mar 20
     
    Dr. Michael Kurisu D.O. "My take is this article is written by a very credible source. John P.A. Ioannidis is from Stanford and great resource. Makes argument that we are basing a LOT of our decisions on faulty or NO data ! Its fascinating to me that there has been less than 10,000 deaths globally and we have had SO MUCH DISRUPTION in the economy. I definitely feel we should be tracking the amount of deaths that are going to occur from people that will be pushed into poverty as well as the number of people being denied access to medical care right now. Yes… with COVID19, it CAN get much worse…. But maybe not… we don't know yet. This article actually increased my morale and put me on track to help GET MORE DATA. Then we can make informed decisions. And then TRACK ALL THE DATA moving forward.
  • Dennis OConnor on 19 Mar 20
     
    DeAunne Denmark, MD, PhD, "Excellent piece spelling out the pervasive and critical issues due to abysmal lack/tardiness in US testing, especially of large populations where initial outbreaks occurred, for those both visibly sick and not. And most importantly, healthcare workers. We cannot even begin to estimate CFR, much less develop reliable projection models, without valid data on everybody who is carrying. "The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections."
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