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Dennis OConnor

Can a Wearable Detect Covid-19 Before Symptoms Appear? - WIRED - 0 views

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    This overview article mentions Ben Smarr's work along with Eric Topol's research and a newly launched project from Stanford.
Dennis OConnor

Antibodies and coronavirus immunity: everything we know. - 0 views

  • Antibodies will probably be key to getting us out of this—in one way or another. By Shannon Palus
  • one promising solution is the idea of antibodies and antibody tests.
  • as with everything about the virus, it’s not yet clear what role antibody tests will be able to play in getting us out of this, and it’s even not completely clear how much getting the coronavirus once prevents you from getting it again
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  • What is an antibody?
  • How do I get the anti-coronavirus antibodies?
  • The most basic (and worst) way to get the antibodies is to get the coronavirus.
  • So once you have the antibodies, you are immune against the virus?
  • We can’t count on immunity right now.
  • Wait, but aren’t there people out there who have gotten the novel coronavirus twice, within a short period of time?
  • So if I’ve been sick with COVID-19 already, should I assume I’m immune, or not?
  • OK. Let’s get to the tests. What’s the deal?
  • The fantasy of antibody tests is that they might be deployed to help us determine who can go back to work and school and normal social gatherings.
  • That sounds very promising!
  • even though the tests can provide a guess at immunity, even a positive result cannot guarantee anything.
  • So what are antibody tests actually good for right now?
  • They are tools to gather more data.
  • This is why the National Institutes of Health is currently recruiting 10,000 volunteers to take antibody tests.
  • There’s one clear way that they could help right now on an individual level: We’ve all been asked to basically assume we have the coronavirus; an antibody test could help clarify our own narratives.
  • If you test positive, you can also apply to donate plasma.
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    Recommended by Dr. Michael Kurisu D.O. 4/15/2020 Good summary. Not scientific or too detailed but good overall big picture view
Dennis OConnor

Apple and Google have a clever way of encouraging people to install contact-tracing app... - 0 views

  • Apple and Google surprised us with an announcement that the companies are spinning up a system to enable widespread contact tracing in an effort to contain the COVID-19 pandemic.
  • The basic idea is that as jurisdictions flatten the curve of infection and begin to consider re-opening parts of society, they need to implement a comprehensive “test and trace” scheme.
  • First, the companies said that by phase two of their effort, when contact tracing is enabled at the level of the operating system, they will notify people who have opted in to their potential exposure to COVID-19 even if they have not downloaded the relevant app from their public health authority.
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  • Apple and Google said they recognized the importance of not allowing people to trigger alerts based on unverified claims of a COVID-19 infection. Instead, they said, people who are diagnosed will be given a one-time code by the public health agency, which the newly diagnosed will have to enter to trigger the alert.
  • Google said it would distribute the operating system update through Google Play services, a part of Android controlled by the company that allows it to reach the majority of active devices.
  • Singapore saw only 12 percent adoption of its national contact-tracing app. Putting notifications at the system level represents a major step forward for this effort, even if still requires people to opt in.
  • the companies promised to use the system only for contact tracing, and to dismantle the network when it becomes appropriate.
Dennis OConnor

Free Webinar: How to Be a Statistical Detective - 0 views

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    This is an on-demand webinar. "Statistical errors are all too common in medical literature, and contribute to the reproducibility crisis currently plaguing science. Fortunately, you don't need a degree in statistics to catch these errors. While some errors are impossible to spot without access to the underlying dataset, many are detectable just by reviewing the information available in the paper. In many cases nothing more than common sense and simple arithmetic is required. In addition, there is an ever-increasing number of free, easy-to-use online statistical tools that facilitate error detection."
Dennis OConnor

American Gut by American Gut Project (UC San Diego) - 0 views

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    "The Microsetta Initiative and its subsidiaries, including the American Gut Project, have pivoted to COVID-19 research, and are revising our kits to support this effort. We are working as hard as we can, but please be patient as these changes have required a complete overhaul of our infrastructure. Please check back soon: we are setting up a form to gather information about people who are interested in receiving a kit when they are ready."
Dennis OConnor

Testing ramps up in California - 0 views

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    Source: LA Times 4/8/2020 As of Tuesday, California said it had results for 143,172 tests - or 362 per 100,000 people. That's a sharp increase from two weeks ago when just 39 of every 100,000 residents had been tested. Yet for all its deep sources of innovation, the state is behind the national average of 596 tests per 100,000, according to the COVID Tracking Project. In New York, which has far more people hospitalized with severe symptoms, testing has reached 1,748 of every 100,000.
Dennis OConnor

COVID-19/Coronavirus Real Time Updates With Credible Sources in US and Canada | 1Point3... - 2 views

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    Dr. Michael Kurisu D.O. "This is from a former student at CalIt2 that has a GREAT site connecting people. It has all great interactive data coming in from national sites about COVID Cases. As it says on top... Made with love by first-generation Chinese Americans.. Also has a 'matching' program for hospital that need PPEs and quantity of them AND.. has a matching program for grocery store chains and what they have in stock etc... AND has a 'job posting' arena trying to get people matched up where jobs are available. AWESOME citizen-run project by computer programmers and students… Why oh WHY is our government not running something like this??
Dennis OConnor

Coronavirus Treatment: Hundreds of Scientists Scramble to Find One - The New York Times - 0 views

  • Working at a breakneck pace, a team of hundreds of scientists has identified 50 drugs that may be effective treatments for people infected with the coronavirus.
  • Quantitative Biosciences Institute Coronavirus Research Group
  • Mount Sinai Hospital in New York and at the Pasteur Institute in Paris
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  • no antiviral drug proven to be effective against the virus
  • If the research effort succeeds, it will be a significant scientific achievement: an antiviral identified in just months to treat a virus that no one knew existed until January.
  • Roche Pharma Research and Early Development
  • Quantitative Biosciences Institute
  • Global Health and Emerging Pathogens Institute at the Icahn School of Medicine at Mount Sinai Hospital.
  • Pasteur Institute in Paris
  • In February, a team of researchers found that remdesivir could eliminate the coronavirus from infected cells. Since then, five clinical trials have begun to see if the drug will be safe and effective against Covid-19 in people.
  • On Saturday, Stanford University researchers reported using the gene-editing technology Crispr to destroy coronavirus genes in infected cells.
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    Recommended by DeAunne Denmark, MD, PhD - Magnificent resource
Dennis OConnor

N-OF-1 RESOURCES Guides, Papers, and Posts on N-of-1 - 0 views

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    DeAunne Denmark, MD, PhD - Magnificent resource N-of-1 guide An interactive explainer on what N-of-1 is and it's purpose.
Dennis OConnor

INGH Institute for Next Generation Healthcare - 0 views

  • We offer an inspirational ecosystem for healthcare professionals, patients, scientists and entrepreneurs determined to close the gap between health and care at a time when the failures of the current healthcare system call for an innovation movement to bring transformational change.
  • All our innovations will have the human experience at heart
  • The Institute for Next Generation Healthcare at Mount Sinai launched an ambitious project called LymeMIND
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    DeAunne Denmark, MD, PhD - OUR CORE PREMISE: To improve health, we must close the gap between what we know and what we do. "INGH has a new facility and venture that is the best I've seen anywhere to get a whole slew of high-resolution data collected in one shot. And supposedly, it is "not that expensive"...
Dennis OConnor

Eric Topol M.D. (@EricTopol) / Twitter - 2 views

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    Recommended by DeAunne Denmark, MD, PhD. Eric Topol's professional background: Gary & Mary West Endowed Chair of Innovative Medicine, Scripps Research Executive VP, Scripps Research Professor, Molecular Medicine, Scripps Research Director & Founder, Scripps Research Translational Institute Department of Molecular Medicine California Campus
Dennis OConnor

The Coronavirus Conundrum: ACE2 and Hypertension Edition - NephJC - 0 views

  • Hypertension and COVID19
  • Are patients with hypertension more likely to get COVID19?For this, we need a well-designed cohort study with incidence rates of COVID19 in patients with hypertension (HT) and those without HT, in which exposure history is able to be carefully accounted for.
  • Amongst the patients with COVID19, it seems the prevalence of prior h/o HT is higher in those who develop severe disease than those who do not.
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  • Hypertension does seem to be a common comorbidity, even more so than diabetes - but these are all data from one country, so one should be careful before generalization.
  • Why might there be a link between high blood pressure and COVID19?As you can read so far, we are not convinced the data show a strong, robust link. However, the virus uses the renin-angiotensin system - hence all the speculation. Read about the science behind the speculation below.
  • Can ARB/ACEi use (and potentially increased ACE2) actually be beneficial in coronavirus and other viral pneumonias?This is an interesting question and has been looked at in both animal model and human studies (retrospective). This study looked at patients (humans) with viral pneumonia and demonstrated an association with improved outcomes in patients with continued ACEi use during viral pneumonia. However, you could argue that patients with viral pneumonia who had continued use of ACEi while hospitalized were not “as sick” as patients in which it was discontinued. 
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    Recommended by DeAunne Denmark, MD, PhD: "... this excellent international society and expert consensus site regarding anti-hypertensives and ACE2, the protein used by both SARS for host cell.
Dennis OConnor

A serological assay to detect SARS-CoV-2 seroconversion in humans | medRxiv - 0 views

  • While molecular assays to directly detect the viral genetic material are available for the diagnosis of acute infection, we currently lack serological assays suitable to specifically detect SARS-CoV-2 antibodies.
  • Methods: Here we describe serological enzyme-linked immunosorbent assays (ELISA) that we developed using recombinant antigens derived from the spike protein of SARS-CoV-2.
  • Conclusion: Serological assays are of critical importance to determine seroprevalence in a given population, define previous exposure and identify highly reactive human donors for the generation of convalescent serum as therapeutic.
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    Recommended by DeAunne Denmark, MD, PhD: This study is under peer review. Published via the medRxiv preprint server for health sciences.
Dennis OConnor

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

  • 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.
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  • 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.
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    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.
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    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."
Dennis OConnor

Norman Doidge: Placebo Possibilities - YouTube - 0 views

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    Interview with Dr. Norman Doige, part of a series of interviews on Brain Plasticity, Healing and "The Brain That Changes Itself".
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    Dr. Michael Kurisu D.O. recommended Doidge's book, "The Brain That Changes Itself" to me several years ago. Reading the rich and detailed case studies in his book opened me to so many intriguing ideas. In particular, his explanations of how the placebo effect relates to neuroplasticity.
Dennis OConnor

Anthony S. Fauci, M.D., NIAID Director | NIH: National Institute of Allergy and Infecti... - 0 views

  • Dr. Fauci was appointed Director of NIAID in 1984.
  • Dr. Fauci has advised six Presidents on HIV/AIDS and many other domestic and global health issues.
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    DeAunne Denmark, MD, PhD - Recommends Dr. Anthony Fauci as a highly credible source of information.
Dennis OConnor

What We Know So Far About SARS-CoV-2 - The Atlantic - 0 views

  • March 20, 2020
  • One of the few mercies during this crisis is that, by their nature, individual coronaviruses are easily destroyed.
  • These viruses don’t endure in the world. They need bodies.
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  • To be clear, SARS-CoV-2 is not the flu. It causes a disease with different symptoms, spreads and kills more readily,
  • his family, the coronaviruses, includes just six other members that infect humans
  • OC43, HKU1, NL63, and 229E—have been gently annoying humans for more than a century, causing a third of common colds
  • MERS and SARS (or “SARS-classic,” as some virologists have started calling it)—both cause far more severe disease.
  • hy was this seventh coronavirus the one to go pandemic?
  • The structure of the virus provides some clues about its success. In shape, it’s essentially a spiky ball. Those spikes recognize and stick to a protein called ACE2
  • This is the first step to an infection
  • he exact contours of SARS-CoV-2’s spikes allow it to stick far more strongly to ACE2 than SARS-classic did
  • But in SARS-CoV-2, the bridge that connects the two halves can be easily cut by an enzyme called furin, which is made by human cells and—crucially—is found across many tissues. “This is probably important for some of the really unusual things we see in this virus,” says Kristian Andersen of Scripps Research Translational Institute.
  • SARS-CoV-2 seems to infect both upper and lower airways,
  • his double whammy could also conceivably explain why the virus can spread between people before symptoms show up
  • All of this is plausible but totally hypothetical; the virus was only discovered in January, and most of its biology is still a mystery.
  • The closest wild relative of SARS-CoV-2 is found in bats, which suggests it originated in a bat, then jumped to humans either directly or through another species.
  • Another coronavirus found in wild pangolins also resembles SARS-CoV-2
  • Indeed, why some coronaviruses are deadly and some are not is unclear. “There’s really no understanding at all of why SARS or SARS-CoV-2 are so bad but OC43 just gives you a runny nose,” Frieman says.
  • Once in the body, it likely attacks the ACE2-bearing cells that line our airways.
  • The immune system fights back and attacks the virus; this is what causes inflammation and fever
  • in extreme cases, the immune system goes berserk
  • These damaging overreactions are called cytokine storms.
  • they’re probably behind the most severe cases of COVID-19.
  • During a cytokine storm, the immune system isn’t just going berserk but is also generally off its game, attacking at will without hitting the right targets.
  • But why do some people with COVID-19 get incredibly sick, while others escape with mild or nonexistent symptoms
  • Age is a factor.
  • other factors—a person’s genes, the vagaries of their immune system, the amount of virus they’re exposed to, the other microbes in their bodies
  • “it’s a mystery why some people have mild disease, even within the same age group,”
  • Coronaviruses, much like influenza, tend to be winter viruses.
  • In the heat and humidity of summer, both trends reverse, and respiratory viruses struggle to get a foothold.
  • irus is tearing through a world of immunologically naive people, and that vulnerability is likely to swamp any seasonal variations.
  • And one recent modeling study concluded that “SARS-CoV-2 can proliferate at any time of year.
  • Unless people can slow the spread of the virus by sticking to physical-distancing recommendations, the summer alone won’t save us.
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    Dr. Michael Kurisu D.O.: We've known about SARS-CoV-2 for only three months, but scientists can make some educated guesses about where it came from and why it's behaving in such an extreme way.
Dennis OConnor

Coronavirus Pandemic Update 37: The ACE-2 Receptor - The Doorway to COVID-19 (ACE Inhib... - 0 views

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    "Dr. Michael Kurisu D.O." called this video "molecurlar biology 101" It is from the Youtube Channel: MedCram - Medical Lectures Explained CLEARLY
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    Forwarded to the Project Apollo listserve by "Dr. Michael Kurisu D.O." from Christina Mnatzaganian. This is from the UCSD Family Medicine Faculty Listserve. Hi Deepa, The statement below is from ACC/HFSA/AHA on March 17th. Essentially, there is no human data yet and data is evolving. See below, particularly the red area: *The following joint statement from the ACC, American Heart Association and Heart Failure Society of America was posted online on March 17 and addresses using renin angiotensin aldosterone system (RAAS) antagonists in COVID-19. "The continued highest standard of care for cardiovascular disease patients diagnosed with COVID-19 is top priority, but there are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients using ACE-I or ARB medications," said Richard J. Kovacs, MD, FACC. "We urge urgent, additional research that can guide us to optimal care for the millions of people worldwide with cardiovascular disease and who may contract COVID-19. These recommendations will be adjusted as needed to correspond with the latest research." Patients with underlying cardiovascular diseases appear to have an increased risk for adverse outcomes with coronavirus disease 2019 (COVID-19). Although the clinical manifestations of COVID-19 are dominated by respiratory symptoms, some patients also may have severe cardiovascular damage. Angiotensin converting enzyme 2 (ACE2) receptors have been shown to be the entry point into human cells for SARS-CoV-2, the virus that causes COVID-19. In a few experimental studies with animal models, both angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to upregulate ACE2 expression in the heart. Though these have not been shown in human studies, or in the setting of COVID-19, such potential upregulation of ACE2 by ACE inhibitors or ARBs has resulted in a speculation of potential increased risk for COVID-19 infection in patients with
Dennis OConnor

Doctors on the Frontlines of the Coronavirus Fight - The Atlantic - 0 views

  • Yui had always counted herself lucky to be among a family of doctors. Now the family is facing the greatest challenge of their lives as they wrestle with the dilemma of caring for their patients even though this risks exposing their loved one
  • Will her family survive the crisis intact?
  • Doctors across America are facing similar predicaments, made all the more acute by the government’s failure to protect them—to warn the public, to provide tests, and to supply enough protective equipment.
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  • When it comes to us being doctors, I worry about [family members] Stephanie and Alex and Jennifer and Pam—about their health, and about the eventual burnout due to everything that’s going on,”
  • As a primary-care physician, she’s the first point of contact with the medical system for many patients.
  • Pam recommended a hospital visit to be tested. “It was already too late for me and my family,” Pamela told me—she had been potentially exposed. Her patient got tested on March 12, and is still waiting for results. “My patient’s test was sent from Baltimore to a lab in Utah, then due to a reagent shortage [a substance needed to process the tests] sent from Utah to Arizona, Arizona back to a lab in North Carolina,” she said.
  • This is a mirror of the dysfunction and delays surrounding the country’s testing crisis, a major factor hamstringing the fight against the virus.
  • Meanwhile, she started feeling sick on Tuesday, and took the test herself. Self-quarantined at home, she thinks it’s only a matter of time, if she does have the virus, before she infects her two children—totally isolating from them would be all but impossible.
  • As a health-care provider, if I test positive, it has big implications for my office, my staff, and all the patients,”
  • Emergency-room doctors, he noted, are among those most at risk.
  • Her emergency room has been seeing more and more patients who have symptoms
  • She wears protective equipment but knows that the hospital could run out.
  • It’s not lost on Koo and her family that medical professionals worldwide have been dying fighting the coronavirus.
  • the main dilemma they’re grappling with is not so much getting sick themselves but spreading the virus to their families, their patients, and the public.
  • his might be the greatest fear of doctors across the country—that they’ll move from being part of the solution to part of the problem.
  • should. It weighs heavily on people.”Yui, for her part, told me she’d never let her fears over the virus stop her from doing her job.
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    Dr. Michael Kurisu D.O.: Another article capturing the dialogue that i hear from a lot of my colleagues and others. We have doctors as well In my family : -My sister is Neuro ICU and director of stroke at Tri city hospital in Oceanside -Her husband is ER doc -My little sister is the PhD in sociology. (She specializes in education programs for the incarcerated and has interest on health access for prisons - which is a frightful place during this pandemic)
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    We are in a war against this virus. First responders are the first line of defense. There is a lack of supplies and central leadership. However, there is no shortagage of courage. When you meet a first responder, say, "Thank you for your service."
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