COVID-19 Knowledge
Article arguing that everyone should stay home from right now, as otherwise it will surely overwhelm the health systems: https://medium.com/@tomaspueyo/f4d3d9cd99ca
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html
"Inside China’s All-Out War on the Coronavirus". Basically the best article about what worke in China to beat the pandemic, free instructions for other countries to do the same. See: https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html
Global dashboard of the pathways of different countries:
https://ourworldindata.org/grapher/covid-confirmed-cases-since-100th-case
Dashboard for Germany, by province:
https://experience.arcgis.com/experience/478220a4c454480e823b17327b2bf1d4
Global dashboard of cases:
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
Global dashboard with the most up-to-date information, by John Hopkins University:
https://coronavirus.jhu.edu/map.html
"In one Italian town, we showed mass testing could eradicate the coronavirus", https://www.theguardian.com/commentisfree/2020/mar/20/eradicated-coronavirus-mass-testing-covid-19-italy-vo
"Erste Ergebnisse von deCode Genetics [beim Testen zufällig ausgewählter Personen in Island] zeigen, dass […] die Hälfte der bestätigen Fälle asymptomatisch ist", https://orf.at/stories/3159008
A U.S. map based on data from Internet connected fever thermometers, providing the earliest warning system about new cases: https://healthweather.us/?mode=Atypical
About the origins of the virus: "The Trail Leading Back to the Wuhan Labs", https://www.nationalreview.com/2020/04/coronavirus-china-trail-leading-back-to-wuhan-labs/ . Analyzes the hypothesis that the virus might have escaped from one of two labs in Wuhan studying bat coronaviruses.
Global forecast tool for the COVID-19 outbreak to predict total deaths and duration of the first wave of the epidemic in countries that implemented lockdowns:
https://bit.ly/2JgYCGo
https://kooplex-fiek.elte.hu/notebook/report-pkrisz5-covid19dashmodel---/report/
Based on this paper: "Predicting the ultimate outcome of the COVID-19 outbreak in Italy", https://arxiv.org/pdf/2003.07912.pdf . Preprint. Gives a logistic growth model of the lockdown.
prediction of maximum cases in Germany
Start of intervention: "On 16 March, the state of Bavaria declared a state of emergency for 14 days and introduced measures to limit public movement […]. Bavarian minister president Markus Söder ordered closures of all sports and leisure facilities starting on 17 March. […] non-essential shops are to be closed at all times. […] In the evening, Merkel announced measures similar to Bavaria for the entire country, agreed on by all federal states and the ruling coalition. This also includes a prohibition on travelling in coaches, attending religious meetings, visiting playgrounds or engaging in tourism. […] On 22 March, the government and the federal states agreed for at least two weeks to forbid gatherings of more than two people and require a minimum distance of 1.5 metres (4 ft 11 in) between people in public except for families, partners or people living in the same household. Restaurants and services like hairdressers were to be closed." (https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Germany#Reactions)
We can assume 2020-03-22 as the start of measures, given that people were not really following the earlier orders much and there were no distancing rules before. By 2020-03-22, they had however understood the severity of the situation and complied.
Using the example of China, "we can foresee that the cumulative curve of patients who are infected will peak 30 days [after the intervention measures]". ("COVID-19 and Italy: what next?", https://doi.org/10.1016/S0140-6736(20)30627-9 ).
That article also shows that the maximum number of cumulative cases is about 4 times what it was at the beginning of the measures. For Germany, there were 18610 cases on 2020-03-22. So for the best case scenario, roughly we can expect about 80 000 cases in total for this wave of the pandemic, with new infections coming to a near-standstill around 2020-04-22. That's an infection risk of about 1 in 1000 in Germany. Given that the German measures are less strict than those in China, realistically there could be 100 000 - 120 000 cases.
About 80% of transmissions during a lockdown are inside families, and probably similar if "only" social distancing measures are used instead of a full lockdown (see under "transmission" for sources). Due to this, the epidemic will spread for some time inside families, esp. if testing and case isolation is slower. It does nearly not spread in the community though if social distancing measures are in place. For the overall trend, this means that the reproductive number R will stay above 1 for some time, but it's already certain that it will go down to much less than 1 once the epidemic runs out of new people to infect in families.
"Scientists warn we may need to live with social distancing for a year or more", https://www.vox.com/science-and-health/2020/3/17/21181694
"COVID-19 and Italy: what next?", https://doi.org/10.1016/S0140-6736(20)30627-9 . Gives a prognosis for Italy based on an exponential function. Does not give a clear prediction for the impact of interventions.
"High Temperature and High Humidity Reduce the Transmission of COVID-19", 2020-03-09, https://arxiv.org/pdf/2003.05003.pdf . Includes world maps with predictions of R values for March and July 2020.
How to estimate the effective reproduction number R(t) over time: basically you do (agent based?) simulations until you find the R(t) values that can accurately model the observed day-by-day confirmed cases. You use a model for these confirmed cases though, probably to flatten the variations introduced by reporting etc.. See for an example: "Transmission potential and severity of COVID-19 in South Korea", https://www.ijidonline.com/article/S1201-9712(20)30150-8/fulltext
"The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection." And table 2 shows that:
These are the most probably, expected values. They vary within a confidence inerval. Source: "The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application", https://annals.org/aim/fullarticle/2762808 .
"We estimate the median incubation period of COVID-19 is 4.8 days (95%CI, 4.2, 5.4). 5% of the cases who develop symptoms will do so by 1.6 days (95% CI, 1.3, 2.0) after infection, and 95% by 14.0 days (12.2, 15.9)." (https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1.full.pdf+html , p. 13)
There is also a nice graph showing that relationship, see figure 2 (A). It means that even a 14-day-after-last-exposure quarantine is not fully safe.
"The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days."
https://www.worldometers.info/coronavirus/coronavirus-incubation-period/
"The most commonly reported clinical symptom in laboratory-confirmed cases is
fever (88%), followed by dry cough (68%), fatigue (38%), sputum production (33%), dyspnoea (19%), sore throat (14%), headache (14%) and myalgia or arthralgia (15%). Less common symptoms are diarrhoea (4%) and vomiting (5%)." Sputum production is basically wet cough.
Source: "Novel coronavirus disease 2019 (COVID-19)pandemic: increased transmission in the EU/EEAand the UK–sixth update", 2020-03-12, https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf
Mild cases usually show as cold symptoms: "A yet-to-be published paper, also from German researchers, looked at nine of the country’s earliest confirmed Covid-19 patients. […] But, unlike much of the data from China to date — which suggests most people present with fever and a dry cough — symptoms for many people in this group resembled a cold. So only two of the nine had a fever and seven had a cough, but just as common were symptoms like stuffy nose, runny nose, and sneezing." (https://www.vox.com/2020/2/20/21143785)
So it may be that the Chinese hospitalized cases were the more severe ones, with may others with cold-like symptoms going undetected. The original paper notes these initial symptoms the patients were presenting with, by case:
Source: "Virological assessment of hospitalized cases of coronavirus disease 2019", PDF available for download at https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1
"Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection", https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html
"Coronavirus looks different in kids than in adults", https://www.washingtonpost.com/health/2020/03/17/coronavirus-looks-different-kids-than-adults/
"Angriff auf die Lunge – Bei den meisten Menschen bleibt eine Infektion mit dem Coronavirus ohne schwerwiegende Folgen, andere sterben daran: Welche Faktoren spielen eine Rolle?" (https://www.spiegel.de/wissenschaft/medizin/a-a-1de5d894-5672-43ff-a78b-bb3e6e402ed5). Tells that pneumonia does not develop in most of the cases – means, the virus can only take hold in the upper respiratory tract and is defeated there by the immune system.
From the head of the WHO mission to China: "Is the virus infecting almost everyone, as you would expect a novel flu to? – No. 75 to 80 percent of all clusters are in families. You get the odd ones in hospitals or restaurants or prisons, but the vast majority are in families. And only 5 to 15 percent of your close contacts develop disease. So they try to isolate you from your relatives as quickly as possible, and find everyone you had contact with in 48 hours before that."
(https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html)
"Date: February 24th, 2020 […] Dr. Liang Wannian, Head of Expert Panel of COVID-19 Resposne of China National Health Commission (NHC)[:] […] Good evening everyone! Let me begin with the main purposes and the major findings of the WHO-China Joint Mission on COVID-19. […] Familial clustering of COVID-19 has been identified, especially in Guangdong and Sichuan, where up to 78% - 85% of the confirmed cases were from familiar clusters. The familial clustering just reflected that the prevention and control measures in these two provinces are highly effective. Thanks to the these strict prevention and control measures, only the second-generation cases and clusters occurred inside families after the occurrence of imported cases. No continuous community spread was found. Thus, the relatively large number of clustered cases is not too bad." (https://www.who.int/docs/default-source/coronaviruse/transcripts/joint-mission-press-conference-script-english-final.pdf)
"[From an interview with the head of the] World Health Organization (WHO) mission to China, led by the agency’s assistant director general and veteran epidemiologist Bruce Aylward. […] The idea that the spread of this virus is driven mainly by families features prominently in your report. How do we know that? […] You look at the big, long lists of all the cases and identify those where you have clusterings in space and time and try to investigate what kind of clustering happened: Was it in a hospital, an old-age home, theaters, restaurants? We found it was predominantly in families. It’s not a big surprise; China had shut down a lot of the other ways people could gather. And family clusters are the closest, longest exposures [to the virus], and getting the virus is a function of whether someone’s got it, how long they’re exposed, and how much virus they are shedding." (https://www.vox.com/2020/3/2/21161067)
The overall secondary attack rate of a case among its close contacts was 7%, as per https://www.spiegel.de/wissenschaft/medizin/a-72e2a605-5865-4d23-81b1-c1c4f453d659 . This was not yet found in the original study, but conforms to the finding of that study, which says: the secondary attack rate (for cases then developing symptoms) among close contacts of a case was 6-8% for 0-59 years, 15% of 60-69 years, 10% for 70+ years. See: https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1.full.pdf+html , figure 1, page 12 .
"Household contacts and those travelling with a case where at higher risk of infection (ORs 6 and 7) than other close contacts. The household secondary attack rate was 15%" (https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1.full.pdf+html)
This means: the risk of infection by being a household contact is 600% higher and by being a travel partner 700% higher compared to being any other "close contact" of a case. On average 15% of household members get infected by a COVID-19 case in the household. Which of course can be zero a lot of times. This also means that 15%/6 = 2.5% (1 in 40) of non-household, non-travel-partner close contacts get infected by a case.
Note that this is from a study with contact tracing and intervention of isolating the infected cases. The proportions would be higher otherwise, as close contacts would be exposed for longer to the source without isolation. It does not change that the rate of transmission among non-close contacts (such as shoppers in the same supermarket etc.) will be way less than 2.5%.
The same and even lower numbers (2.5% as for non-family close contacts) can be expected in households when practicing isolation of all sick individuals in the household, even those who have simple cold symptoms. Together with social distancing in the household to deal with the 48 hour period of pre-symptomatic infectiousness, this should bring the household secondary attack rate close to zero.
"Der Hauptübertragungsweg scheint die Tröpfcheninfektion zu sein. Theoretisch möglich sind auch Schmierinfektion […].
Tröpfcheninfektion: Es kann davon ausgegangen werden, dass die hauptsächliche Übertragung über Tröpfchen erfolgt. Epidemiologische Studien, die dies untermauern, konnten noch nicht identifiziert werden.
Aerosol: keine Evidenz
Schmierinfektion: Eine Übertragung durch Schmierinfektion ist prinzipiell nicht ausgeschlossen, vermutlich spielt dies jedoch nur eine untergeordnete Rolle, da häufig Infektionsketten identifiziert werden konnten, die eher für eine direkte Übertragung, z. B. durch Tröpfchen, sprechen."
(https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html)
There is no evidence of fecal-oral transmission. From a detailed study of nine patients: "Infectious virus was readily isolated from throat- and lung-derived samples, but not from stool samples in spite of high virus RNA concentration. […] Further studies should therefore address whether SARS-CoV-2 shed in stool is rendered non-infectious through contact with the gut environment. Our initial results suggest that measures to contain viral spread should aim at droplet-, rather than fomite-based transmission.", https://www.medrxiv.org/content/10.1101/2020.03.05.20030502v1
"[T]he method adopted in China [… included] basic hygiene measures, including constant emphasis on the importance of frequent hand washing to the public. As we all know in hygiene, 30% of infectious diseases of the respiratory tract are caused by hands touching the mucosa of the respiratory tract." (https://www.who.int/docs/default-source/coronaviruse/transcripts/joint-mission-press-conference-script-english-final.pdf)
Discussion of other possibilities how the virus might spread: "How does the new coronavirus spread? These new studies offer clues.", https://www.vox.com/2020/2/20/21143785
In buses with A/C and other actively ventilated closed spaces, the virus can infect people up to 4.5 m away by droplets. Masks seem to prevent such infections. Source: a study from China, shown in "Coronavirus can travel twice as far as official ‘safe distance’ and stay in air for 30 minutes, Chinese study finds", https://www.scmp.com/news/china/science/article/3074351/coronavirus-can-travel-twice-far-official-safe-distance-and-stay
"So the main way of disease transmission is by respiratory droplet. But the fact that health workers, NYPD officers (currently over 500) and others are getting infected wearing masks points to surface contamination as the second main mode of infection, or, possibly lack of training in wearing the masks and/or poor hand washing, or, that aerosol transmission is indeed important." ("What is the main way COVID-19 spreads?", https://medicalsciences.stackexchange.com/q/22796)
"Experts tell White House coronavirus can spread through talking or even just breathing", https://edition.cnn.com/2020/04/02/health/aerosol-coronavirus-spread-white-house-letter/index.html . Does not provide definitive evidence, so to be researched more.
"These Coronavirus Exposures Might Be the Most Dangerous – As with any other poison, viruses are usually deadlier in larger amounts.", https://www.nytimes.com/2020/04/01/opinion/coronavirus-viral-dose.html
Full article available as: ~/Projects/Body_Development/COVID-19_Pandemic/Literature.These_Coronavirus_Exposures_Might_Be_the_Most_Dangerous.pdf
"The importance of viral dose is being overlooked in discussions of the coronavirus. As with any other poison, viruses are usually more dangerous in larger amounts. Small initial exposures tend to lead to mild or asymptomatic infections, while larger doses can be lethal. […] Both small and large amounts of virus can replicate within our cells and cause severe disease in vulnerable individuals such as the immunocompromised. In healthy people, however, immune systems respond as soon as they sense a virus growing inside. Recovery depends on which wins the race: viral spread or immune activation. […] Dose sensitivity has been observed for every common acute viral infection that has been studied in lab animals, including coronaviruses. […] Low-dose infections can even engender immunity, protecting against high-dose exposures in the future. […] People should take particular care against high-dose exposures, which are most likely to occur in close in-person interactions — such as coffee meetings, crowded bars and quiet time in a room with Grandma — and from touching our faces after getting substantial amounts of virus on our hands. In-person interactions are more dangerous in enclosed spaces and at short distances, with dose escalating with exposure time. For transient interactions that violate the rule of maintaining six feet between you and others, such as paying a cashier at the grocery store, keep them brief — aim for “within six feet, only six seconds.” Because dose matters, medical personnel face an extreme risk, since they deal with the sickest, highest-viral-load patients. We must prioritize protective gear for them. For everyone else, the importance of social distancing, mask-wearing and good hygiene is only greater, since these practices not only decrease infectious spread but also tend to decrease dose and thus the lethalness of infections that do occur. While preventing viral spread is a societal good, avoiding high-dose infections is a personal imperative, even for young healthy people. At the same time, we need to avoid a panicked overreaction to low-dose exposures. Clothing and food packaging that have been exposed to someone with the virus seem to present a low risk. Healthy people who are together in the grocery store or workplace experience a tolerable risk — so long as they take precautions like wearing surgical masks and spacing themselves out."
"In addition to case reports, pre-symptomatic transmission has been inferred through modelling, and the proportion of pre-symptomatic transmission was estimated to be around 48% and 62%. Pre-symptomatic transmission was deemed likely based on a shorter serial interval of COVID-19 (4.0 to 4.6 days) than the mean incubation period (five days) with the authors indicating that many secondary transmissions would have already occurred at the time when symptomatic cases are detected and isolated. Major uncertainties remain in assessing the influence of pre-symptomatic transmission on the overall transmission dynamics of the pandemic."
Source: "Novel coronavirus disease 2019 (COVID-19)pandemic: increased transmission in the EU/EEAand the UK–sixth update", 2020-03-12, https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf
"Further, transmission in the first 3-5 days of illness, or potentially pre-symptomatic transmission –transmission of the virus before the appearance of symptoms –is a major driver of transmission for influenza. In contrast, while we are learning that there are people who can shed COVID-19 virus 24-48 hours prior to symptom onset, at present, this does not appear to be a major driver of transmission." (https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf#page=2)
"Mit der Entscheidung […] berufen sich Mediziner und Landkreis nach eigenen Angaben auf die Richtlinien des Robert Koch-Instituts, wonach eine Ansteckungsgefahr ab zwei Tage vor den ersten Symptomen bestehe." (https://www.morgenpost.de/vermischtes/article228605257/Coronavirus-Corona-News-Ticker-Lufthansa-streicht-Haelfte-Fluege-Suedtirol-Risikogebiet.html)
"There’s this big panic in the West over asymptomatic cases. Many people are asymptomatic when tested, but develop symptoms within a day or two.
In Guangdong, they went back and retested 320,000 samples originally taken for influenza surveillance and other screening. Less than 0.5 percent came up positive, which is about the same number as the 1,500 known Covid cases in the province. […]
There is no evidence that we’re seeing only the tip of a grand iceberg, with nine-tenths of it made up of hidden zombies shedding virus. What we’re seeing is a pyramid: most of it is aboveground."
(https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html)
There are several reports about pre-symptomatic transmission, such as this: " 15.46 Uhr: Auf einem Kreuzfahrtschiff auf dem Nil sind nach offiziellen Angaben zwölf Menschen positiv auf das Coronavirus getestet worden. Es handele sich um Ägypter, die auf dem Schiff arbeiteten, teilte das Gesundheitsministerium mit. Sie seien zwar positiv getestet worden, zeigten aber keine Symptome. Die Behörden hätten die Tests angeordnet, nachdem das Virus bei einer Touristin aus Taiwan nach ihrer Rückkehr festgestellt worden sei." (https://www.morgenpost.de/vermischtes/article228605257/Coronavirus-Corona-News-Ticker-Lufthansa-streicht-Haelfte-Fluege-Suedtirol-Risikogebiet.html)
Asymptomatic cases: "Etwa zeitgleich erschienene systematische Studien aus Island und über die Betroffenen des italienischen Ortes Vo über das Kreuzfahrtschiff Diamond Princess und weitere Studien zeigen, dass die Hälfte der Fälle oder etwas weniger gänzlich symptomlos verläuft. Symptomlose Fälle werden jedoch nach den Testkriterien in Deutschland aktuell nicht mehr erfasst." (https://de.wikipedia.org/wiki/COVID-19-Pandemie_in_Deutschland#Dunkelziffer)
"Based on Chinese data, the international WHO mission report indicates that up to 75% of initially asymptomatic cases will progress to clinical disease, making the true asymptomatic infection rather rare (estimated at 1-3%)."
https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf
"Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China.", https://www.ncbi.nlm.nih.gov/pubmed/32146694 . Shows that completely asymptomatic carriers (who never develop symptoms) are young, with a median age of 14.0 years. Others did eventually develop symptoms of sickness. So anyone much older (say, ≥30 years) can be assumed with high probability (>98%, but that's a guess) to not become a truly asymptomatic carrier. If they catch the infection, they will develop symptoms.
There are rumors citing leaked documents that 18-33% of all cases (40,000 in the case of China) are true asymptomatic cases: https://www.reuters.com/article/idUSKBN21C0P2
"We monitored SARS-CoV-2 viral loads in upper respiratory specimens obtained from 18 patients […] in Zhuhai, Guangdong, China, including 4 patients with secondary infections (1 of whom never had symptoms) within two family clusters […] The viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients."
Source: "SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients", https://www.nejm.org/doi/full/10.1056/NEJMc2001737
Children get infected as often as adults, but show no or little symptoms. They shed the virus longer than adults, though. This makes it possible that the virus spreads in schools without being detected, and that children could be multipliers of the disease. See: https://www.spiegel.de/wissenschaft/medizin/a-72e2a605-5865-4d23-81b1-c1c4f453d659
"Dauer der Infektiosität: Es liegen bislang keine publizierten Daten dazu vor, bis zu welchem Zeitpunkt nach Erkrankungsbeginn vermehrungsfähige Viren im oberen Atemwegstrakt gefunden werden. […] Eine Studie mit 17 Patienten hat die Ausscheidungsdynamik in den oberen Atemwegen untersucht. […] Ein Nachweis von Virus-RNA war etwa bis zum Tag 7–9 nach Erkrankungsbeginn möglich. In einer weiteren Studie wurde die Dauer von Erkrankungsbeginn bis zu dem Zeitpunkt, bis keine virale RNA mehr nachweisbar war – abhängig vom Schweregrad der Erkrankung – auf 13–18 Tage angegeben." (https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html)
Measures that apply to Germany.
Source: https://www.rlp.de/fileadmin/rlp-stk/pdf-Dateien/Corona/2020-03-23_3._CoBeLVO.pdf#page=4
§4
(1) Der Aufenthalt im öffentlichen Raum ist nur alleine oder mit einer weiteren nicht im Haushalt lebenden Person und im Kreis der Angehörigen des eigenen Hausstands zulässig. Zu anderen als den in Satz 1 genannten Personen ist in der Öffentlichkeit, wo immer möglich, ein Mindestabstand von 1,5 Metern einzuhalten. […]
(2) Jede übrige, über Absatz 1 Satz 1 hinausgehende Ansammlung von Personen (Ansammlung) ist […] […] untersagt. Ausgenommen sind Ansammlungen, die der Aufrechterhaltung der öffentlichen Sicherheit und Ordnung oder Daseinsvorsorge zu dienen bestimmt sind.
§7 (2) Eine kurzzeitige Anwesenheit in einem Risikogebiet,beispielsweise im Rahmen einer Durchreise, gilt nicht als Aufenthalt nach Absatz1, selbst wenn es dabei etwa bei einem Tankvorgang, einer Kaffeepause oder einem Toilettengang zu einem kurzzeitigen Kontakt mit der dortigen Bevölkerung gekommen ist.
"How can I protect myself? The WHO says:
Don't get too close to people coughing, sneezing or with a fever - they can propel small droplets containing the virus into the air - ideally, keep 1m (3ft) away" (https://www.bbc.com/news/health-51048366)
Strict hygiene measures are needed even in households because of the danger of pre-symptomatic transmission (up to 48 hours before symptom onset). So the person doing the shopping could infect others if strict measures are not taken.
"Im stark von Corona-Fällen betroffenen Kreis Heinsberg haben Prof. Streeck und sein Team diverse Oberflächen getestet und kein aktives Virus nachweisen können […] Die bisherige Forschung zeige: Vor allem große Menschenmengen mit viel Kontakt seien eine Gefahr, also beispielsweise Partys und Fußballspiele." (https://www.youtube.com/watch?v=VP7La2bkOMo)
"COVID-19: Optionen für Maßnahmen zur Kontaktreduzierung in Gebieten, in denen vermehrt Fälle bekannt wurden", https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Kontaktreduzierung.html
Shutting down public gatherings was enough in many Chinese cities to suppress the case levels to the low daily counts (~40) we're seeing as of 2020-03-10. So it may not be needed to enforce complete lockdowns in Europe, if other measures are taken early enough.
From the head of the WHO mission to China: "You said different cities responded differently. How?
It depended on whether they had zero cases, sporadic ones, clusters or widespread transmission.
First, you have to make sure everyone knows the basics: hand-washing, masks, not shaking hands, what the symptoms are. Then, to find sporadic cases, they do fever checks everywhere, even stopping cars on highways to check everyone.
As soon as you find clusters, you shut schools, theaters, restaurants. Only Wuhan and the cities near it went into total lockdown.
[…]
In Wuhan, in the beginning, it was 15 days from getting sick to hospitalization. They got it down to two days from symptoms to isolation. That meant a lot fewer infected."
(https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html)
"Respiratory Pathogen Emission Dynamics"
video: https://edhub.ama-assn.org/jn-learning/video-player/18357411
article: https://edhub.ama-assn.org/jn-learning/module/2763852
This argues that sneezes can transport pathogens for 7-8 m away. So keeping a distance of 1.5 m would not be enough in that case.
How to wash your hands: https://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf
How to produce hand disinfectant:
"Aktualisierte Fragen und Antworten des BfR vom 30. März 2020 […] Ist es in der gegenwärtigen Situation sinnvoll, Desinfektionsmittel auch im Privathaushalt einzusetzen? Das BfR sieht auch in der aktuellen Situation keine Notwendigkeit für gesunde Menschen, im Alltag Desinfektionsmittel anzuwenden. Die Empfehlungen zum Einsatz von bioziden Stoffen im Privathaushalt sind in FAQs zum Thema dargelegt (https://www.bfr.bund.de/de/fragen_und_antworten_zu_nutzen_und_risiken_von_desinfektionsmitteln_im_privathaushalt-190275.html). Welche Desinfektionsmaßnahmen durchzuführen sind, wenn ein Infizierter unter Quarantäne im Haushalt lebt, ist mit dem zuständigen Gesundheitsamt oder dem betreuenden Arzt bzw. der betreuenden Ärztin abzusprechen." (https://www.bfr.bund.de/de/-244062.html)
"Im stark von Corona-Fällen betroffenen Kreis Heinsberg haben Prof. Streeck und sein Team diverse Oberflächen getestet und kein aktives Virus nachweisen können: Weder auf Handys, Türklinken, Waschbecken noch Katzen, selbst bei hoch infektiösen Familien. Er betont daher, es gebe stand jetzt keine Gefahr, beim Einkaufen, jemand anderen zu infizieren. Die bisherige Forschung zeige: Vor allem große Menschenmengen mit viel Kontakt seien eine Gefahr, also beispielsweise Partys und Fußballspiele. Prof. Hendrik Streeck ist Direktor des Instituts für Virologie und HIV-Forschung an der Universität Bonn." (https://www.youtube.com/watch?v=VP7La2bkOMo)
"Aktualisierte Fragen und Antworten des BfR vom 30. März 2020 […] Können Coronaviren außerhalb menschlicher oder tierischer Organismen auf festen und trockenen Oberflächen überleben und infektiös bleiben? Die Stabilität von Coronaviren in der Umwelt hängt von vielen Faktoren wie Temperatur, Luftfeuchtigkeit und Beschaffenheit der Oberfläche sowie vom speziellen Virusstamm und der Virusmenge ab. Im Allgemeinen sind humane Coronaviren nicht besonders stabil auf trockenen Oberflächen. In der Regel erfolgt die Inaktivierung in getrocknetem Zustand innerhalb von Stunden bis einigen Tagen. Für das neuartige Coronavirus SARS-CoV-2 zeigen erste Laboruntersuchungen einer amerikanischen Arbeitsgruppe, dass es nach starker Kontamination bis zu 3 Stunden als Aerosol, bis zu 4 Stunden auf Kupferoberflächen, bis zu 24 Stunden auf Karton und bis zu 2-3 Tagen auf Edelstahl und Plastik infektiös bleiben kann.
https://www.nejm.org/doi/full/10.1056/NEJMc2004973?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed
"
(https://www.bfr.bund.de/de/-244062.html)
"SARS-CoV-2: Wie lange das Virus in der Luft und auf Oberflächen nachweisbar bleibt", https://www.aerzteblatt.de/nachrichten/111039 . The interesting point here is that the decay of the virus particles is exponential, i.e. it has a half-life (https://en.wikipedia.org/wiki/Exponential_decay).
"Kann das neuartige Coronavirus über Lebensmittel und Gegenstände übertragen werden?", https://www.bfr.bund.de/de/-244062.html
"How to Clean and Disinfect Yourself, Your Home, and Your Stuff", https://www.wired.com/story/coronavirus-disinfectant-cleaning-guide . Among others, it includes the following tips:
"Daily clean and disinfect surfaces that are frequently touched in the room where the [COVID19] patient is being cared for, such as bedside tables, bedframes, and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1% sodium hypochlorite (i.e. equivalent to 1000 ppm) should be applied."
Source: "Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts", https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
"Surfaces that may become damaged by sodium hypochlorite may be cleaned with a neutral detergent followed by a 70% concentration of ethanol" (https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf)
"Gloves and protective clothing (e.g. plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.1% sodium hypochlorite solution. Single-use gloves (e.g. nitrile or latex) should be discarded after each use. Perform hand hygiene before putting on and after removing gloves."
(So this shows that it is not necessary to wear a mask when cleaning surfaces, or a respirator mask for that matter, as there will be no infectious levels of airborne viruses.)
Source: "Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts", https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
"Auch ohne Symptome sinnvoll: RKI ändert Einschätzung zu Mundschutz", https://m.focus.de/gesundheit/news/a_id_11843714.html
"Experts Increasingly Question Advice Against Widespread Use of Face Masks", https://slate.com/news-and-politics/2020/03/experts-question-advice-against-face-mask-use-coronavirus.html
"A cluster randomised trial of cloth masks compared with medical masks in healthcare workers", https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/ .
The results are not simple to interpret, as there is only one statistically significant result: that cloth masks increase risk of influenza-like illness by a factor of 13.25 (95% CI 1.74 to 100.97). Maybe that means that cloth masks somehow do harm when it comes to influenza virus, maybe by humidity retention? And maybe that is something that can be fixed?
This did not compare cloth masks to no mask use, but shows that cloth masks are subpar compared with medical masks. Strictly speaking, it does not prove that medical masks are better than no masks, as cloth masks could also perhaps do harm compared to no masks.
About the type of masks: "Masks used in the study were locally manufactured medical (three layer, made of non-woven material) or cloth masks (two layer, made of cotton) commonly used in Vietnamese hospitals. […] Laboratory tests showed the penetration of particles through the cloth masks to be very high (97%) compared with medical masks (44%) (used in trial) and 3M 9320 N95 (<0.01%), 3M Vflex 9105 N95 (0.1%)."
How to reuse N95 masks:
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
https://mp.weixin.qq.com/s/3QYVWO4kj5qwuSHnhcM9uQ
https://sci-hub.tw/10.1371/journal.pone.0186217 (comparison of disinfection treatments)
Mask recommendations by a mask manufacturer: https://www.blsgroup.it/news1/436-coronavirus-2019-ncov-en.html
A Lancet article, arguing for compulsory masking: "Mass masking in the COVID-19 epidemic: people need guidance", https://doi.org/10.1016/S0140-6736(20)30520-1
A study showing that any use of masks (even home-made ones) has the capacity to slow and help end the pandemic: "Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population", https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/
There is no need for gloves. They can hardly be re-used.
More knowledge about gas masks and their filters:
https://de.wikipedia.org/wiki/Atemschutzmaske
https://de.wikipedia.org/wiki/Atemschutzfilter
https://en.wikipedia.org/wiki/CBRN_defense
"Astronauts know how to handle isolation: Here are tips from Scott Kelly, Peggy Whitson and more", https://www.space.com/astronaut-tips-for-handling-isolation-coronavirus.html
"Online-Supermärkte in der Übersicht: Wer jetzt noch zeitnah liefert", https://t3n.de/news/a-1264762/
"ACE2 and HYPERTENSION", http://www.nephjc.com/news/covidace2 . The article gives a lot of background. To be studied in more detail.
Main file downloaded and available at: ./Literature/Interactions_with_Experimental_COVID-19_Therapies.2020-03-12.pdf
Review of experimental drugs against SARS-CoV-2: "Coronavirus SARS-CoV-2: Antivirale Wirkstoffe auf dem Prüfstand", https://www.aerzteblatt.de/archiv/213027
"[Quoting prof. Raoult, who did the study about chloroquine use in Europe:] the IHU Méditerrannée-Infection (like others) has long been advising that antibiotics be prescribed concomitantly for respiratory viral infections "because they are mainly complicated by lung disease. So all people who had clinical signs susceptible of evolving into a bacterial complication of pulmonary disease were given Azithromycin. There is proof that this lowers risk in people with viral infections. The other reason is that laboratory testing shows Azithromycin to be effective against a great many viruses, although it is an antibiotic. So if we were to choose an antibiotic, it was preferable to administer one that was effective against viruses. And when you look at the comparative percentage of positive carriers with the combination of hydroxychloroquine and Azithromycin, you find an absolutely dramatic decrease in the number of positive carriers."
( "Covid-19: The game is over?!", http://jdmichel.blog.tdg.ch/archive/2020/03/24/covid-19-the-game-is-over-305275.html )
"treatment with a combination of hydroxychloroquine (200 mg x 3 per day for 10 days) + Azithromycin (500 mg on the first day then 250 mg per day for 5 more days), as part of the precautions for use of this combination (with in particular an electrocardiogram on D0 and D2), and outside the MA. In cases of severe pneumonia, a broad-spectrum antibiotic is also associated." (http://jdmichel.blog.tdg.ch/archive/2020/03/24/covid-19-the-game-is-over-305275.html)
The reason why an antibiotic treatment helps is: "many people who are now infected with corona (sars-cov-2) in Italy probably do not die from the virus itself, but rather from secondary bacterial infections caused by resistant microbes. It is a known case that respiratory infections of viruses generally weaken the immune system, allowing bacteria to attack more easily. This is also common for viruses that cause flu or colds. Between 10 and 30 per cent of patients admitted to hospitals with a virus-based respiratory infection subsequently receive a secondary bacterial infection, figures from the UK Antibiotic Center show. […] In a study published in acclaimed The Lancet this month, researchers found that over half of patients who died of the Wuhan virus in China had sustained a secondary bacterial infection before they died." (English translation of "Derfor tar koronaviruset så mange liv i Italia", https://www.aftenposten.no/meninger/kronikk/i/awEP27/a )
Since infection with antibiotics resistant bacteria happen often in hospitals, it would make sense to do the COVID-19 therapy at home if at all possible. That should work well using HCQ and azithromycin, as the antibiotics can do their job if no resistant bacteria are present.
This has not been studied yet, but it makes complete sense as CQ and HCQ are basically interchangeable and the combination is safe.
Study about the safety of chloroquine, also in combination with azithromycin: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Chico-2011.-Azithromycin-plus-chloroquine-combination-therapy-for-protection-against-malaria-and-STD-infections-in-pregnancy.pdf
"Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro", https://www.nature.com/articles/s41421-020-0156-0
"600 mg HCQ per day after 6 days, 90% of patients tested COVID-19 negative. 96% of control group tested positive after 6 days." (https://twitter.com/RiganoESQ/status/1239780304082124800)
There is also this ongoing study evaluating the effectiveness of hydroxychloroquine for prophylaxis: https://www.covidtrial.io/
Chloroquine was confirmed to be effective in a clinical study:
Other sources about this study:
"Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro", https://www.nature.com/articles/s41422-020-0282-0 . That study shows that in vitro, chloroquine works even better (!) than remdesivir to inhibit the virus, at concentrations that are achievable in vivo.
"Covid-19: The game is over?!", http://jdmichel.blog.tdg.ch/archive/2020/03/24/covid-19-the-game-is-over-305275.html . The article contains very interesting information about the political backgrounds around the struggle if chloroquine should be used or not against COVID-19.
"Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial", https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2 . The strength of their findings has to be reviewed still …
"Chloroquine seems to need a higher concentration than remdesivir, but it's within the feasible range, and if it really works as well as the published in vitro results, it would be quite promising […]
I would suggest a cocktail of drugs that target different stages of replication," Reiss said. "This virus is probably going to be like a number of other viruses, and it will undergo mutation and selection, so if you use only one antiviral drug, you are going to ultimately select for resistance.
What's more, the treatment will be most effective when given to a patient early on, perhaps even before symptoms develop, she said. "Taken very early in the course of exposure, the antiviral drugs could have a real impact," she said. After someone is already in the hospital in respiratory distress and a high fever, "it is much harder to treat the infection, people are more likely to treat the disease.""
(https://www.livescience.com/possible-treatments-new-coronavirus.html)
Chloroquine and hydroxychloroquine seem to be quite equal (at least in vitro) regarding their effect for treatment of COVID-19, but hydroxychloroquine is superior (at least in vitro) for prophylaxis. See: https://twitter.com/elonmusk/status/1239776019856461824 [TODO: add the original sources.]
"if you look at the data as presented, at least in vitro, it seems like chloroquine can be used as an early-stage drug […] Chloroquine is a synthetic form of quinine, a compound found in the bark of cinchona trees native to Peru and used for centuries to treat malaria. […] The biggest question regarding chloroquine he said, is at how many days into an infection it can be effectively administered to someone sick with the new coronavirus. As an analogy, Tamiflu works very well against susceptible influenza A virus strains as long as you take it early enough,” he said. “And that's what we have to determine with chloroquine, whether it can be used when somebody has been sick for more than a few days. But the indication so far, based on this paper and past work with SARS, is that it might be a useful drug." (https://www.asbmb.org/asbmb-today/science/020620/could-an-old-malaria-drug-help-fight-the-new-coron)
" Forscher: Malaria-Mittel wirkt womöglich auch gegen Coronavirus. Ein herkömmliches Malaria-Mittel wirkt womöglich auch gegen das neuartige Coronavirus. Das Mittel Chloroquin, das in Deutschland unter dem Handelsnamen Resochin bekannt ist, habe sich in einer klinischen Studie in China als wirksam gezeigt, sagte der Leiter des Instituts für Infektionskrankheiten in Marseille, Didier Raoult, der Nachrichtenagentur AFP. Das französische Gesundheitsministerium warnte dagegen vor Euphorie." ( https://www.tagesschau.de/newsticker/liveblog-coronavirus-101.html#Forscher-Malaria-Mittel-wirkt-womoeglich-auch-gegen-Coronavirus )
"Ein Forscher in Marseille hatte zuvor eine erste klinische Studie mit 24 infizierten Patienten durchgeführt. Bei drei Vierteln von ihnen war das Virus sechs Tage nach Beginn der Einnahme nicht mehr nachweisbar, wie der Leiter des Instituts für Infektionskrankheiten, Didier Raoult, mitteilte." (https://www.handelszeitung.ch/news/vielversprechend-sanofi-setzt-auf-malaria-medikament-gegen-corona)
"In the Chinese study, which was conducted by researchers from the department of infection and immunity at the Shanghai Public Health Clinical Center, the 15 patients who didn’t get hydroxychloroquine were treated with conventional care. This includes bed rest, oxgen inhalation, and the use of anti-viral drugs recommended in China’s treatment guidelines like lopinavir and ritonavir, and antibiotics when necessary."
So this rather proves that chloroquine is as good as those other antiviral drugs.
See: "Malaria Drug Chloroquine No Better Than Regular Coronavirus Care, Study Finds", https://www.bloomberg.com/news/articles/2020-03-25/hydroxychloroquine-no-better-than-regular-covid-19-care-in-study .
"However, if patients are old or have underlying conditions with serious symptoms, physicians should consider an antiviral treatment. If they decide to use the antiviral therapy, they should start the administration as soon as possible, the task force noted.
For the antiviral treatment, the doctors recommended lopinavir 400mg/ritonavir 100mg (Kaletra two tablets, twice a day) or chloroquine 500mg orally per day.
As chloroquine is not available in Korea, doctors could consider hydroxychloroquine 400mg orally per day, they said. […]
The antiviral treatment for the new coronavirus will be most suitable for seven to 10 days. Still, the period could be shortened or extended depending on clinical progress, the doctors said."
("Physicians work out treatment guidelines for coronavirus", http://www.koreabiomed.com/news/articleView.html?idxno=7428 )
"FDA authorizes widespread use of unproven drugs to treat coronavirus, saying possible benefit outweighs risk", https://www.washingtonpost.com/business/2020/03/30/coronavirus-drugs-hydroxychloroquin-chloroquine/ . Contains good information about what kind of medical screening is needed to prevent serious side effects of chloroquine (heart arrythmia), which otherwise would happen in about 1% of cases.
Study about the safety of chloroquine, also in combination with azithromycin: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Chico-2011.-Azithromycin-plus-chloroquine-combination-therapy-for-protection-against-malaria-and-STD-infections-in-pregnancy.pdf
Report of a couple in the U.S.A. who took chloroquine sold for fish. One of them died, the other had to be treated in the hospital. Also with a report that three people in Nigeria had overdosed on chloroquine after Trump endorsed it as a potential treatment for COVID-19: https://edition.cnn.com/2020/03/23/health/arizona-coronavirus-chloroquine-death/index.html . The report did not give a reason why the person in the USA died from chloroquine. It could simply be an overdose, which is easily possible with chloroquine.
"Covid-19: The bitter truth about using hydroxychloroquine as a preventive drug", https://www.indiatoday.in/india-today-insight/story/covid-19-the-bitter-truth-about-using-hydroxychloroquine-as-a-preventive-drug-1659116-2020-03-24
"Chloroquine May Fight Covid-19—and Silicon Valley’s Into It", https://www.wired.com/story/an-old-malaria-drug-may-fight-covid-19-and-silicon-valleys-into-it/
"A New Study Questions the Effectiveness of a Potential “Game Changer” Against the Coronavirus", https://www.newyorker.com/news/daily-comment/a-new-study-questions-the-effectiveness-of-a-potential-game-changer-against-the-coronavirus
The results can also be seen as just proving that late intervention with CQ / HCQ does not help. Early intervention could still help against the disease progressing.
Chloroquine treatment information by WHO, including about overdose: https://apps.who.int/medicinedocs/en/d/Jh2922e/2.5.1.html
Chloroquine is also used for treatment of fish, and might be possible to purchase via that route if necessary. See: https://www.reef2reef.com/threads/chloroquine-phosphate.192309/
"It is available as a generic medication.[1] The wholesale cost in the developing world is about US$0.04 [per dose.]" (https://en.wikipedia.org/wiki/Chloroquine)
When ordering Chloroquine, tell that it's needed for traveling to India, Central America or the Caribbean, because:
The uncertainty about the use of chloroquine but its established safety for preventative treatment (over weeks and months) might mean that it's best to use chloroquine for prevention of COVID-19 infection. That is, get a larger stockpile of it and use it once the pandemic has spread enough to present a real danger. Only one person per household would use it and be the one to go shopping when needed, while the others would all just stay home.
But note that for prophylaxis, hydroxychloroquine seems to be superior (see https://twitter.com/elonmusk/status/1239776019856461824 ; link to the original source needed). Also note, there is a certain lifetime dose of chloroquine that should not be exceeded or one might suffer eye damage.
On 2020-02-14, chloroquine phosphate did cost about 50 EUR for 20 tablets of 250 mg each. On 2020-03-07, it did cost 74-79 EUR for the same amount, at the same sources (namely dokteronline.com).
There are two equivalent variants of chloroquine available in medications: chloroquine phosphate and chloroquine sulphate. See: "tablet 100 mg, 150 mg, 300 mg base (as phosphate or sulfate) […] chloroquine base 150 mg is equivalent to chloroquine sulfate 200 mg or Chloroquine phosphate 250 mg" (https://apps.who.int/medicinedocs/en/d/Jh2922e/2.5.1.html).
Both are used against malaria, just the dosage is different (malaria prophylaxis: for phosphate, 1 × 250 mg once weekly, for sulphate 2 × 400 mg once weekly). Only the phosphate variant increased in price in 2020-02 / -03, probably because it was the easiest to find and buy online. At 2020-03-07, the sulphate variant was three times cheaper!
Interest in chloroquine spiked a lot compared to the baseline: https://trends.google.com/trends/explore?date=today%205-y&q=chloroquine,remdesivir
In Germany and generally in Europe, chloroquine for malaria prophylaxis seems to be available online with a prescription handed out in response to an online inquiry.
Chloroquine phosphate.
Probably a scam site, as per:
Chloroquine sulphate.
Chloroquine phosphate for fish.
More research options.
"Ein Team des University of Queensland Centre for Clinical Research verkündete […] man habe vielleicht eine Therapie gegen das neue Coronavirus gefunden: Ende März soll ein landesweiter Test anlaufen. […] Offenbar setzen die Infektiologen aus Queensland eine Kombination ein – erstens Remdesivir […]; zweitens Resochin (Chloroquin) […].
Die ersten Einsätze bei Covid-19-Patienten in Australien hätten bereits zur vollständigen Erholung und zum «Verschwinden des Virus» geführt, sagte Paterson […].
[…]
Nun beginnt ein grosser Test, an dem sich 50 Spitäler in ganz Australien beteiligen: Geprüft wird, in welcher Mischung die beiden Heilmittel die stärkste Kraft gegen das tückische Virus entfalten."
(https://www.handelszeitung.ch/panorama/forscher-gegen-das-coronavirus-spannende-entwicklungen-des-tages)
"Die Forscher identifizierten ein zelluläres Protein, das für das Eindringen des neuartigen Coronavirus` in Zellen wichtig ist. „Unsere Ergebnisse zeigen, dass SARS-CoV-2 die im menschlichen Körper vorhandene Protease TMPRSS2 benötigt, um in die Wirtszelle einzudringen“, sagte Stefan Pöhlmann, Leiter der Abteilung Infektionsbiologie am Deutschen Primatenzentrum laut Mitteilung. „Damit haben wir einen Ansatzpunkt zur Bekämpfung des Virus gefunden.“
Coronavirus: Forscher wollen Medikament testen
Sie verweisen auch auf ein bereits existierendes Medikament, das diese Funktion erfüllen könnte: Camostat Mesilate ist ein in Japan zugelassenes Medikament, das bei Entzündungen der Bauchspeicheldrüse eingesetzt wird.
„Unsere Ergebnisse legen nahe, dass Camostat Mesilate auch vor der Krankheit Covid-19 schützen könnte“, sagte der Infektionsforscher Markus Hoffmann." (https://www.morgenpost.de/vermischtes/article228625595/Coronavirus-Deutsche-Forscher-wollen-Medikament-testen.html)
"Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts", https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
"Intensivmediziner veröffentlichen Empfehlungen zur Therapie von COVID-19-Patienten", https://www.aerzteblatt.de/nachrichten/111046
"The Open-Air Treatment of PANDEMIC INFLUENZA", https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/
AmboVent, a "medically tested" open source ventilator developed by an Israeli team, using the same principle as the MIT mechanical ambu bag ventilator: https://github.com/AmboVent/AmboVent
"MIT-based team works on rapid deployment of open-source, low-cost ventilator", http://news.mit.edu/2020/ventilator-covid-deployment-open-source-low-cost-0326 . This is the device to manufacture, if any. All information about it is available open source at https://e-vent.mit.edu/ .
Ininnova non-invasive respirator mask made from scuba-diving gear, see https://www.isinnova.it/easy-covid19-eng/
To be researched further.
The original source is just some text that was copied&pasted around in Facebook: "POTENTIALLY LIFESAVING ADVICE by Lauren Hebert your local Dr’s of Physical Therapy
If you end up with pulmonary symptoms of corona virus pneumonia... there can be lethal damage from effusion (mucous filling lungs) or cytokine storm (body over-reacts with more effusion.)
This kills people... ESPECIALLY when the number of patients is greater than the number of ICU beds or ventilators. You will be left to drown in your mucous. That mucous can also be infected by other germs during your struggle. That is happening in Italy where there are 5x more patients than they have hospital beds. And the USA has far FEWER beds per population than does Italy.
Many years ago, physical therapists have successfully treated this with POSTURAL DRAINAGE... where the patient is tipped over a wedge to tilt the lungs and bronchial tubes upside down... to allow the mucous to flow out, where it can be coughed out.
Google it. It is EASY to do for yourself and family members. Simply get in position and let it flow, helping it along with breathing techniques that emphasize full, prolonged exhale, while puffing your cheeks and you blow out long and steady.
Start as soon as you feel lungs getting filled. Don’t wait until you are too sick to bother. 3-5 minutes several times per day.
I did this inside a nursing home in VT during the 1976 flu epidemic for resident patients. We did not lose anyone, while other nursing homes lost dozens. It is an old PT technique that has faded away since we have ventilators and related machines. BUT this time, we will NOT have nearly enough ventilators, not the ICU beds where they are provided.
One easy way to get into position is to lie over an EXERCISE BALL."
( https://www.facebook.com/prwithlipqin/photos/a.745823322124203/3017284738311372 )
There is substance to it, though: https://en.wikipedia.org/wiki/Postural_drainage . And there are some studies that show it helps with pneumonia.
From the head of the WHO mission to China: "The real case fatality rate is probably what it is outside Hubei Province, somewhere between 1 and 2 percent." (https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html)
Which means that the data from Hubei province alone can be assumed to be incomplete, hiding a good number of cases that never presented to a hospital.
For the population average, seemingly 1-3% or less, perhaps as low as 0.16% with sufficient care (according to data from outside China, but that might also be because few older people caught the virus outside China). As of 2020-02-14, there was so far no way to make a good estimate.
Lethality risk depends a lot on age. Based on data from China:
See: https://en.wikipedia.org/wiki/Coronavirus_disease_2019#Prognosis . Similar but even more skewed data is available for Italy: https://de.wikipedia.org/wiki/COVID-19-Epidemie_in_Italien#Einfluss_von_Alter,_Geschlecht_und_Vorerkrankungen_auf_Sterblichkeit
In addition, lethality risk is increased for people with pre-existing conditions. See also: https://de.wikipedia.org/wiki/COVID-19-Epidemie_in_Italien#Einfluss_von_Alter,_Geschlecht_und_Vorerkrankungen_auf_Sterblichkeit
"Wenn man sich die Daten aus China anschaut, sind die Männer, die rauchen und eine COPD haben, die am allermeisten gefährdete Patientengruppe." Einmal mit dem Erreger Sars-CoV-2 infiziert, liege die Sterblichkeit diesen Zahlen zufolge bei 58 Prozent. "Wir reden sonst so von zwischen einem und maximal acht Prozent."
(https://www.spiegel.de/auto/a-a-46196d09-4aa4-4041-97e3-1fd1ff094c3f)
"Die Daten außerhalb von China deuteten Drosten zufolge darauf hin, dass sich die Wahrscheinlichkeit, an der Viruserkrankung zu sterben, eher im Bereich von 0,2 Prozent bewege. Das sei ähnlich den typischen Influenza-Pandemien von 1957 oder 1968." (https://www.tagesspiegel.de/wissen/25547964.html)
"How deadly is the coronavirus? Based on data from 17,000 patients with this coronavirus, the WHO says: 82% develop mild symptoms, 15% develop severe symptoms, 3% become critically ill. The proportion dying from the disease, which has been named Covid-19, appears low (between 1% and 2%) - but the figures are unreliable." (https://www.bbc.com/news/health-51048366)
"Sekundärinfektionen (meistens bakteriell) habe einen grossen Anteil an den Todesfällen bei covid-19. Das Virus selbst greift des Immunsystem an, das sich dann nicht mehr gegen zusätzliche Bakterien wehren kann. Im Normalfall behandelt man das mit Antibiotika und die Sache ist gegessen.
Nur hat Italien ein grosses Problem mit antibiotikaresistenten Bakterien (~11000 tote pro Jahr vs 69 in Norwegen), wh. geschuldet durch den hohen Antibiotikaanteil im Zuchtfleisch. Anscheinend ist die Lombardei ein Zentrum für die Schinkenproduktion und deshalb arg betroffen. Ähnliches gilt für Spanien." (https://blog.fefe.de/?ts=a0873c37)
The theory was originally published in Norwegian here: https://www.aftenposten.no/meninger/kronikk/i/awEP27/derfor-tar-koronaviruset-saa-mange-liv-i-italia-erik-martiniussen .