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in Development of Coronavirus Vaccine
By Aryeh Savir, Tazpit News Agency - 3 Adar 5780 – February 27, 20200

Snippet:

This discovery was identified as a by-product of MIGAL’s development of a vaccine against IBV, a disease affecting poultry, which effectiveness has been proven in pre-clinical trials carried out at the Veterinary Institute.

MIGAL has made required genetic adjustments to adapt the vaccine to COVID-19, the human strain of Coronavirus, and is working to achieve the safety approvals that will enable preclinical testing, enable the initiation of production of a vaccine to counter the Coronavirus epidemic.

Research conducted at MIGAL has revealed that the poultry Coronavirus has high genetic similarity to the human COVID-19 and that it uses the same infection mechanism, a fact that increases the likelihood of achieving an effective human vaccine in a very short time.

Commenting on the news, David Zigdon, CEO of MIGAL, said that “given the urgent global need for a human Coronavirus vaccine, we are doing everything we can to accelerate development. Our goal is to produce the vaccine during the next 8-10 weeks, and to achieve safety approval in 90 days.”

https://www.jewishpress.com/news/science-and-tech/israeli-re...

another source:
https://www.zerohedge.com/geopolitical/israeli-scientists-sa...

I nibbled today just under 208
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By the time they have a vaccine out, 80% of the world population will have gone through the infection.
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All eyes on Remdesivir(Gilead) clinical trial underway in China.

WHO has said preliminary results from China will be announced in 3-4 weeks and final results by April end. This was a week ago.
If this works, it would be a game changer.

US also has started a trial.

https://www.pharmaceutical-technology.com/news/who-gilead-re...

Gilead Sciences antiviral drug remdesivir may be the best shot for treating the coronavirus, said an official from the World Health Organization (WHO).

Remdesivir, an experimental drug developed to fight Ebola virus, is currently undergoing clinical trial in coronavirus patients in China. WHO expects the trial data to be available within weeks.

At a press briefing in Beijing, WHO assistant director-general Bruce Aylward said: “There is only one drug right now that we think may have real efficacy and that’s remdesivir.”
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By the time they have a vaccine out, 80% of the world population will have gone through the infection.

Does this not depend more on politics? They might have an under-tested vaccine out soon to make quick fear profits and only if sales are good, complete testing on the final product.
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Does this not depend more on politics? They might have an under-tested vaccine out soon to make quick fear profits and only if sales are good, complete testing on the final product.

Doubtful. The original SARS vaccine was killing the rats by inducing a massive immune reaction when inoculated rats were exposed to the virus.
You don’t want to rush this too much.
Also, the speed at which this is spreading is astonishing. I read a study the other day estimating that in the absence of harsh quarantine measures, it was thought to double every 2.5 days.
If that is the case, it’ll take less than 3 months for most of the global population to be infected.
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I must say that I am frightened. I have asthma and a "normal" flu was very hard for me a few years ago.

It's hard to describe how bad it was and how hard to breathe.

Have cancelled a month visiting friends in Peru for March.

(Am using a Marjosse Bordeaux and Godiva dark chocolates as a preventative as we speak.)

As we discuss the financial aspects of this pandemic, let's remember those who are suffering as we speak and hope that the fewest people possible suffer with this flu.

I keep remembering a PBS show about 1918, and it's all too terrible.

damn it...
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I’ve been a bit dizzy (just very slightly) for maybe a week and I’ve been having a worsening headache for the past few days. Now I have diarrhea and I’m also feeling a bit under the weather.
I live in Manila in a development completely overrun by Chinese who are building a casino next door.
I’m worried for my parents who live in Germany, both into their high seventies.

I must say that I am frightened. I have asthma and a “normal” flu was very hard for me a few years ago.

It may still be possible to order an oxygen concentrator from Amazon:

https://www.amazon.com/s?k=oxygen+concentrator&ref=nb_sb...
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CNN talk about the markets and the flu.

https://youtu.be/0ApauTrulwc

Advocatus... thanks for the link.

We have raised more cash.

Hoping that we have been wrong to raise cashola and that the virus dies quickly and that the markets do not fall lower.

Hopefully we are all in a better position than 2008-2009.

If this is the time to back up a truck... well I cannot see it.

Better safe than sorry.

jan
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Also, the speed at which this is spreading is astonishing. I read a study the other day estimating that in the absence of harsh quarantine measures, it was thought to double every 2.5 days.
If that is the case, it’ll take less than 3 months for most of the global population to be infected.



Well, look at the swine flu in 2009. That infected about 60,000,000 people, just in the U.S. Yet influenza has an r-0 of about 1.3, meaning that on average each infected person infects 1.3 others. Covid-19, in contrast, appears to have an r-0 of roughly 3. But this is exponential: after just 5 rounds of spread, you would expect 3.7 cases of influenza...and 243 cases of Covid-19!

The case fatality rate of the swine flu in the U.S. was about 0.02 percent. Estimates of Covid-19 are about two orders of magnitude higher. Even if the estimates are off by one order of magnitude, Covid-19 will still be an order of magnitude more lethal than swine flu.

So even if we get really lucky and Covid-19 only spreads the same as swine flu (and if you don't think it will spread at least that much, what is your rationale?), that comes out to roughly a million deaths. And with about 20% (or 12,000,000 million) requiring critical care, that will outrageously overwhelm our chronically-strained health system (if you haven't had to wait many hours in an ER waiting room despite being quite ill, be thankful)...leading to a huge amount of morbidity and mortality from critical illnesses completely unrelated to Covid-19. Further overwhelming the emergency system will be all those who aren't even very sick, but in fear show up in the nation's ERs. Moreover, it is a near-certainty that a significant portion of our currently inadequate number of healthcare providers will be sick and/or die, further compounding the tragedy.

I don't even want to consider what it will be like if Covid-19 spreads far beyond what the swine flu did a decade ago...yet with it's much higher infectivity, that seems the more likely scenario.

Seems dismal, I know. But that seems to be the central expectation based on facts. If you see problems with the argument, please share...could use the cheering up.

The most optimistic scenario I can realistically envision is that we get a temporary reprieve in spread as we approach summer and kids out of school, and then in a wildly-optimistic scenario, there is a safe and effective vaccine available in massive quantity before next winter. But given that swine flu was spreading even in late summer/early fall, this is far from certain. And as far as vaccine goes, even with a great deal of experience and expertise, the flu vaccine each year only ends up being about 50% effective, though maybe with only one strain of this coronavirus it will be more efficacious...until the virus mutates. What about antiviral treatment? Well, despite years of research and need, we have nothing that does much against influenza (if you think Tamiflu helps, you might want to read the efficacy studies) nor the common cold (about a quarter of which is caused by other strains of...coronavirus); so, why should we think it likely that all of a sudden we can cure this virus?
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Yet influenza has an r-0 of about 1.3, meaning that on average each infected person infects 1.3 others. Covid-19, in contrast, appears to have an r-0 of roughly 3. But this is exponential: after just 5 rounds of spread, you would expect 3.7 cases of influenza...and 243 cases of Covid-19!


I believe the math is wrong...but the general point still holds. And it's late and I'm tired, so can't correct now. If there are any epidemiologists here, I would welcome your correction.
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And with about 20% (or 12,000,000 million) requiring critical care,

I think that’s a very high number. I think that’s the hospitalization rate. The critical care value is probably more like 5% of the infected (NOT of diagnosed cases, most cases are probably never diagnosed).
Still. Even a million people requiring critical care all at once will lead to some horrific scenes with stadiums as improvised wards filled with the dying.
The next months will be like a horror movie.
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Hoping that we have been wrong to raise cashola and that the virus dies quickly

You think it’s going to commit collective suicide maybe?
This is down to MATH now. I read a credible report recently that estimated (given the rapid spread obvious from the data outside of China) that the number of infected doubles every 2.5 days approximately.
Go ahead. Run the numbers.
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All eyes on Remdesivir(Gilead) clinical trial underway in China.

WHO has said preliminary results from China will be announced in 3-4 weeks and final results by April end. This was a week ago.
If this works, it would be a game changer.



A vaccine that works would be a game changer for the epidemic. An antiviral would be a game changer for Gilead, but would not likely have much effect on the epidemic. For example, Gilead’s hugely successful oseltamivir (Tamiflu) saves lives and shortens symptoms of the flu by about a day, and so it slightly reduces transmission (so it is useful for protecting particularly vulnerable people who have had a known contact with a flu case), but doesn’t materially affect the circulation of the flu in the community nor the number of cases. Remdesivir, if it works on the coronavirus, is not likely to do better.

Dtb
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Yet influenza has an r-0 of about 1.3, meaning that on average each infected person infects 1.3 others. Covid-19, in contrast, appears to have an r-0 of roughly 3. But this is exponential: after just 5 rounds of spread, you would expect 3.7 cases of influenza...and 243 cases of Covid-19!


I believe the math is wrong...but the general point still holds. And it's late and I'm tired, so can't correct now. If there are any epidemiologists here, I would welcome your correction.



The basic idea is fine. After 5 rounds with an R-0 of 3.7, you would expect each case in round 1 to 3.7 cases in round 2, 3.7^2=13.7 cases in round 3, 3.7^3=50.7 cases in round 4, and 3.7^4=187.4 cases in round 5; the sum of all those cases is 256.4.

This calculation suggests we have a precise idea of what R-0 is, which we don’t, both because we have little experience with this new virus but also because the concept is not very well defined or rather, depends on how vulnerable the population is (notably the age distribution and presence of other illnesses), will vary among races, will depend on people’s behaviour (measures they take to reduce), etc.

More important than the rapidity of its spread is the number of people who are infectable. For the Spanish flu, a quarter of the world’s population may have been infected; for a typical seasonal flu epidemic, it is more like 10%. This winter, which is slightly worse than average already, the CDC estimates that the USA already has 29 million cases, almost 10%.

It’s early days for COVID-19, but the experience of the Diamond Princess, with 705 of its 3770 passengers and staff infected (18.6%) is not very encouraging. That natural experiment may also give us an idea about the virus’s lethality, at least among similar populations (relatively affluent, relatively old, but probably mostly in good health...), and they have had, so far, 4 deaths but 36 in critical condition. According to Yang’s Lancet paper based on experience with Wuhan patients (https://www.thelancet.com/journals/lanres/article/PIIS2213-2...), 32 of 51 patients in critical condition died, so we may see 22 more deaths on the DP, for a lethality of 26/705=3.7%, less than the Spanish flu or SARS-2002, but about 37 times as lethal as our usual annual flu.

If you combine this with twice as many people susceptible to the illness (18.6% instead of 10%), you get 69 times more deaths. An average year in the US is 36,000 deaths (2010-11 to 2018-19), with about 10 times as many hospitalizations, so if this scales to COVID-19, that would give us 2.5 million deaths. We are not going to be able to hospitalize 25 million people, so clearly hospitals will have to radically alter their criteria for hospitalization, either triaging for only the most severe cases, or, sensibly but radically, only the most likely to survive.

This may sound far-fetched, but I can’t see how this shouldn’t be the baseline scenario now.

Dtb
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The projected numbers of deaths in my last post 2.5 million deaths just in the USA, maybe 50 million in the world are pretty awful, but as for the flu, they are heavily skewed to older people and people who were sick already. From the China CDC article fro. February 17 (http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9...), we have the following lethality rates:


80+ years old ... 14.8%
70-79 years old... 8.0%
60-69 years old... 3.6%
50-59 years old... 1.3%
40-49 years old... 0.4%
30-39 years old... 0.2%
20-29 years old... 0.2%
10-19 years old... 0.2%
0-9 years old... no


Likewise, for pre-existing conditions:


Cardiovascular disease...... 10.5%
Diabetes.................... 7.3%
Chronic respiratory disease.. 6.3%
Hypertension................. 6.0%
Cancer....................... 5.6%
no pre-existing conditions... 0.9%



Finally, the death rate is 2.8% in men, and 1.7% in women, a difference they suggest might be due to the much higher rate of smoking in men in China.

If there’s anything people can do now to get prepared for what is coming, it is to stop smoking, along with getting lots of sleep and exercise, and losing some weight. Nothing new in that advice, but now we have some extra motivation!

Regards, DTB
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An antiviral would be a game changer for Gilead, but would not likely have much effect on the epidemic. For example, Gilead’s hugely successful oseltamivir (Tamiflu) saves lives and shortens symptoms of the flu by about a day, and so it slightly reduces transmission (so it is useful for protecting particularly vulnerable people who have had a known contact with a flu case), but doesn’t materially affect the circulation of the flu in the community nor the number of cases. Remdesivir, if it works on the coronavirus, is not likely to do better.


My understanding based on a review (Cochrane) of efficacy studies (including that of the manufacturer, who is likely to paint the rosiest picture) is that Tamiflu does not reduce deaths, hospitalizations, nor complications (pneumonia, ear infections). All it does is reduce the length of reported symptoms from 7 days to 6 days and 8 hours. Well, it also causes: 1) a fair amount of side effects, 2) a mint for the manufacturer, and 3) an enormous of wasted clinic and ED visits from people looking for treatment for uncomplicated flu.

While I certainly hope that we end up with an effective antiviral against Covid-
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An antiviral would be a game changer for Gilead, but would not likely have much effect on the epidemic. For example, Gilead’s hugely successful oseltamivir (Tamiflu) saves lives and shortens symptoms of the flu by about a day, and so it slightly reduces transmission (so it is useful for protecting particularly vulnerable people who have had a known contact with a flu case), but doesn’t materially affect the circulation of the flu in the community nor the number of cases. Remdesivir, if it works on the coronavirus, is not likely to do better.


My understanding based on a review (Cochrane) of efficacy studies (including that of the manufacturer, who is likely to paint the rosiest picture) is that Tamiflu does not reduce deaths, hospitalizations, nor complications (pneumonia, ear infections). All it does is reduce the length of reported symptoms from 7 days to 6 days and 8 hours. Well, it also causes: 1) a fair amount of side effects, 2) a mint for the manufacturer, and 3) an enormous of wasted clinic and ED visits from people looking for treatment for uncomplicated flu.

While I certainly hope that we end up with an effective antiviral against Covid-19, experience to date has shown us unable to come up with effective antiviral agents for influenza and basically all other respiratory viruses...so I would put this more in the realm of wishful thinking than a central expectation.
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DTB, in stark contrast to your numbers the "Robert-Koch-Institut", Germany's worldwide respected state Institut for the recognition and prevention of diseases, estimates the risk for Germany as "gering bis mäßig" = "small to a little".
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Since last 2 months, world wide cases are ~84k with ~3k deaths
(many were fearing millions infected with 500k+ deaths world wide by now)

Globally (outside China), total deaths are 79.

In China all trends are surprisingly positive.
Starbucks, Apple stores, Movie theaters, Factories are all slowly opening back again.

- Recoveries are up to 3500+ daily (sign that treatment and logistics are working).
- Deaths down to 20-50 daily and trending down from 100-500.
- New suspected cases are down to 2k from a high of 28k and going down.
- New cases are down to 350+ from a high of 5k and going down.
- Most importantly, severe cases are coming down 8k now down from 12k.

If this trend continues, China will not know what to do with the two huge hospitals it built by end of March.

Contrary to what media is saying, the cases in the world are NOT "now spreading".
They are "now being detected".
It has been spreading for over a month.

South Korea, Italy, Japan and Iran number are climbing from a small base but will start trending down in a week or so. They will pop some where else and cause another round of media excitement and financial markets down trend.

Mortality rate in China outside Hubei is 0.8% (104 deaths / 13,000). This is among people hospitalized. It is probably lower if asymptomatic or "sniffle" cases are counted.

The Remdesivir trial is key. We will know in next 2-3 weeks.

My guess is that if the trial results are positive, the market will quickly pop.
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In China all trends are surprisingly positive.
Starbucks, Apple stores, Movie theaters, Factories are all slowly opening back again.


Yes. And as a result, there will be a massive upsurge in cases again, but the Chinese government will do its level best to suppress information about it. At least 10 million Chinese will be dead by year’s end. I wonder what the official number will be.
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The Chinese have not defeated the virus; the return to “business as usual” is a declaration of surrender to the virus, the admission that it cannot be contained and that the Chinese economy would be dead long before the virus.
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Should we shut the world down next year when flu season starts? Over 600,000 people die of the flu worldwide annually.
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DTB, in stark contrast to your numbers the "Robert-Koch-Institut", Germany's worldwide respected state Institut for the recognition and prevention of diseases, estimates the risk for Germany as "gering bis mäßig" = "small to a little".


Yes, but they are only talking about the immediate risk of infection in Germany this week (Monday), from the 3 known clusters, not the risk from the global pandemic I think is inevitable.

I don’t have the transcript, but in the same press conference, the speaker mentions that we may only be detecting 10% of all cases, so that the true lethality is more like null komma drei prozent (0.3%). That would be wonderful, and would mean we just get a starke Grippewelle (a strong wave of flu) this year, but it is hard to square with the Diamond Princess experience, unless those people are very old. It would be interesting to know more about them: I presume the passengers are quite old, but almost a third of the people on the boat were staff.

dtb
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Advocatus,

I do understand. The MATH is correct.

Hate this virus.

:^(
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In my experience, Tamiflu did nothing not just for me, but for my normally healthy husband Dave.

Expensive and pointless, IN MY HUMBLE OPINION!

:^(
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My understanding based on a review (Cochrane) of efficacy studies (including that of the manufacturer, who is likely to paint the rosiest picture) is that Tamiflu does not reduce deaths, hospitalizations, nor complications (pneumonia, ear infections). All it does is reduce the length of reported symptoms from 7 days to 6 days and 8 hours. Well, it also causes: 1) a fair amount of side effects, 2) a mint for the manufacturer, and 3) an enormous of wasted clinic and ED visits from people looking for treatment for uncomplicated flu.



You are obviously well-informed about the controversy, and this is the skeptics' conclusion, but it is not mine.

If you speak to infectious disease specialists, they will tell you that oseltamivir (Tamiflu) has a dramatic effect on people who are very sick with the flu, often almost Lazarus-like. They would qualify that enthusiams by saying that it has to really be flu (with a positive test, now usually done with a quick nucleic acid amplification test, or NAAT), and the really dramatic effects are when it is given within 48h of the beginning of symptoms.

Then you read the Cochrane reviews, that say that there is no evidence that it saves lives, and that it only shortens the duration of illness by about 1/2 to 1 day. This has been taken up in the popular press, where government stockpiling of oseltamivir is called the Tamiflu Debacle, and of course the producer of this medication is accused of manipulating the evidence so they can sell the drug.

When there is such a chasm between what the clinical experts think and what these systematic reviews say, there are at least 3 ways to resolve the discrepancy; they may not be talking about the same question, there may be biases involved (industry trials sponsored by the drugmaker, professional biases, etc.) or the scientific evidence may be of poor quality. I think here that it is a combination of the first and third explanations.

In the first case, all the trial evidence comes from clinics where oseltamivir was given to people presenting to doctors' offices or emergency departments with a influenza like illness (ILI). There are dozens of trials and there are nuances with each one, but the bottom line is that in many of these trials, patients with ILI were not tested for influenza, either because the tests were not very reliable before the recent NAA tests, or because people outside hospitals were just treated on spec, meaning with a presumptive diagnosis. Most of these people would not have had influenza, they would have had some other condition like RSV or a coronavirus or adenovirus or parapertussis bacteria or any of the myriad other conditions that have symptoms that overlap with the flu. In addition, many of these patients had symptoms for many days, so that oseltamivir treatment would have been too late, even for the subset that had influenza. And for non-hospitalized patients, flu is not usually fatal, so outpatient trials are underpowered to detect a difference in mortality rates.

Giving oseltamivir to people with ILI, even after 48h, does not necessarily represent bad practice: it may have been justifiable to give a cheap drug to patients based on a possible diagnosis of flu, particularly when the test was unreliable, and for very sick flu patients, even with symptoms present for more than 48h, oseltamivir may still help a little. But when you do a study this way, as most of them were done (perhaps all of them, I can't remember), it is not surprising that the effect actually measured is quite small.

(Aside: my field in public health is cancer screening; there are parallels to screening trials. For instance, in the 10 major mammography trials, 1/3 of patients that are invited to screening never participate, another 10-20% only participate occasionally, and then they are given a few years of screening, which can only start reducing mortality after about 5-6 years, and they are followed up for about 11 years, total, so the effect is massively diluted. A screening exam which probably reduces mortality by more than 50% (in my opinion) ends up 'only' showing a 20% reduction, and that number is universally quoted by groups like the Cochrane collaboration, ignoring the problems with the trials and their analysis.)

Back to oseltamivir: here is a good recent review, mentioning the controversy, and giving some of the above explanation, if you are interested: https://wwwnc.cdc.gov/eid/article/22/6/15-1037_article. Of course, you could find plenty of learned reviews coming to the opposite conclusion, and reasonable people could come to different conclusions. The debate will probably continue until there is a proper trial in the modern era with confirmed flu diagnosis and recent symptoms. Unfortunately, such trials are expensive, and not likely to be financed by the Gilead/Roche. Why would they? The product sells well based on observational studies and clinical opinion, so a trial that confirmed the drug's usefulness will probably not increase sales, and of course a failure would be even worse!


Anyways, my main point was that Gilead' new antiviral, remdesivir, is unlikely to dramatically altar the course of the epidemic, even if it turns out to be a worthwhile drug for patients that are very ill. My example of oseltamivir was meant only to illustrate that even (what I believe to be) an effective drug is not thought by anyone to be helpful in controlling the epidemic. So even if remdesivir works for this novel coronavirus, it is not going to stop the pandemic, only perhaps lower the number of deaths by a small percentage. If someone thinks that oseltamivir is a useless drug, then these arguments apply all the more to remdesivir!

Regards, DTB
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In my experience, Tamiflu did nothing not just for me, but for my normally healthy husband Dave.

Expensive and pointless, IN MY HUMBLE OPINION!



Did you have lab-confirmed flu? Did you start treatment within 2 days of symptoms? These are the two conditions of success, often not met in trials.

dtb
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Tamiflu seems to have worked for me. I say "seems to have worked" because my family has gotten the flu but I haven't gotten it during the last several flu seasons. I've been doing chemo (the pills kind) for stage 4 cancer a few years now. So I'm an old dude. IV chemo failed. My immune system sucks as do my WBC, RBC etc blood counts. I'm exposed daily to my 3rd grader grandson, his mom and of course my wife (a second grade teacher) all of whom work in "germ factories" and live with me. I always have a fresh supply of Tamiflu on hand and take it immediately prophylactically if me or anyone near me exhibits flu symptoms. I always get flu shots and keep my pneumonia shots up to date. I know Covid 19 is way different so far but most of us will get through it just fine.

BTW, Jansen Pharm (now owned by JNJ) charges me a discounted $35/mo. Their new, specialty med isn't covered by my wife's insurance or Medicare and might otherwise cost about $22k/mo. Thanks JNJ!

To my fellow BRK investors, keep your chin up, chill, smile and be happy. I am and I'm slowly averaging down. Also, pay attention to Chompin aka Dealraker. He's a very good, successful, long-term investor and has been around a looong time. We've both experienced BRK's price being cut in half and we're still happily here.

This too shall pass...lots of fear, let's be greedy!
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Hang in there Tairbear00. I’m rooting for you to get better soon.
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DTB,

Yes... we had lab confirmed flu... started treatment quickly. And Tamiflu did nothing for either one of us.

Glad Tairbear has good luck taking it whenever he is around someone sick.

Good luck to Tairbair!

jan
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Should we shut the world down next year when flu season starts? Over 600,000 people die of the flu worldwide annually.

Well, this year it’ll be 60 million+ (more of a base-case scenario).
And, no we can’t shut down the world. That’s the problem.
I’m not saying the Chinese are doing the wrong thing. They’re doing the only thing they can.
They try to slow down the spread through fairly comprehensive, intrusive measures, but on the other hand also try to restore economic activity as much as possible.

The problem is that the virus is SO infectious that with only limited measures, there’s bound to be dozens of millions of infected Chinese by April.
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The case fatality rate of the swine flu in the U.S. was about 0.02 percent. Estimates of Covid-19 are about two orders of magnitude higher. Even if the estimates are off by one order of magnitude, Covid-19 will still be an order of magnitude more lethal than swine flu.

So even if we get really lucky and Covid-19 only spreads the same as swine flu (and if you don't think it will spread at least that much, what is your rationale?), that comes out to roughly a million deaths. And with about 20% (or 12,000,000 million) requiring critical care, that will outrageously overwhelm our chronically-strained health system (if you haven't had to wait many hours in an ER waiting room despite being quite ill, be thankful)...leading to a huge amount of morbidity and mortality from critical illnesses completely unrelated to Covid-19. Further overwhelming the emergency system will be all those who aren't even very sick, but in fear show up in the nation's ERs. Moreover, it is a near-certainty that a significant portion of our currently inadequate number of healthcare providers will be sick and/or die, further compounding the tragedy.

I don't even want to consider what it will be like if Covid-19 spreads far beyond what the swine flu did a decade ago...yet with it's much higher infectivity, that seems the more likely scenario.


So China which is the epicenter, has much higher density of population, people living closely,
bad air and much higher pollution issues has less than 3k deaths.

And your best case scenario for US is 1 million deaths
and 12 million critical patients ?

No wonder I get to buy BRK at 1.17 PBV.
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So China which is the epicenter, has much higher density of population, people living closely, bad air and much higher pollution issues has less than 3k deaths.

The Chinese are lying, unfortunately. We don’t know by how much they’re understating the number of infected and dead, we just know that they are.
From the scattered reports we get from inside China, it appears to be much worse.

https://www.barrons.com/articles/chinas-economic-data-have-a...

In addition, the Chinese government has done things that the US cannot do. It has quarantined entire cities and literally welded people into their condo towers. And it still failed at containing the virus and has given up on its attempts.


https://twitter.com/howroute/status/1226213258614497281

Read the comments
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Heartbreaking twitter thread.

...
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It's coming...

...three completely separate cases of community spread of Covid-19. Two in California, and one in Oregon (and the Oregon patient has recently spent time in a local elementary school).

While this is only three, there are obviously many more out there, and now the wildfire spread begins.
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Interesting example of what nonsense the officially reported numbers of Covid-19 are: Egypt is reporting only one patient in their country. Yet yesterday a man in Ontario, Canada tested positive, after travelling to Egypt, and wearing a mask the whole time (no contact with anyone traveling from China or Iran). That's sure some bad luck to visit a country of millions, and happen to come in close contact with the sole Covid-19 patient.
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Well, a few hours gone by, and there's yet another report of community (untraceable) spread in the U.S., this time in the Seattle area.

The horses have definitely broke loose from the stable.

Will be interesting to see how the market responds to all of this new U.S. community transmission.

But while there is nothing wrong with trying to negotiate the markets intelligently, I think the times we'll be going through will help emphasize that most of the really important things of life don't involve money.
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"So China which is the epicenter, has much higher density of population, people living closely,
bad air and much higher pollution issues has less than 3k deaths.

And your best case scenario for US is 1 million deaths
and 12 million critical patients ? "


That is a rather dishonest interpretation of what he said. Care to try again?

You are comparing current (and ongoing) results in China with what he thinks might be the final result in the U.S.
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"I’m not saying the Chinese are doing the wrong thing. They’re doing the only thing they can."

Yep.

I don't think they Chinese are getting enough credit. They took a huge short to medium term hit to their economy in order to give the rest of the world a chance at dealing with this in a somewhat orderly manner. They threw themselves on a grenade.

Suppose China's response was similar to what Iran is doing (deny, obfuscate, and do nothing). With so much of the world's supply chain going through China the virus could have infected millions worldwide by now.
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Suppose China’s response was similar to what Iran is doing (deny, obfuscate, and do nothing).


The Chinese certainly did something, but they also denied and obfuscated. And they still are doing that.
The numbers they give are obviously fake; and all the early modelling was done on the basis of those fake numbers.
If you look at the early predictions about R0 and doubling rate, it was 2 - 3 and 7 - 8 days, respectively, based on bull**** data.
Based on the numbers we see from the international spread, it’s more like R0 = 5 and the doubling rate is 2.5 days (or less).
This is an entirely different ballgame. The lies of the Chinese government have cost us dearly.
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Just read

Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)

Released this week.

Was impressed and surprised by how good and thorough China's response has been.
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Was impressed and surprised by how good and thorough China’s response has been.

According to the Chinese
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Well, a few hours gone by, and there's yet another report of community (untraceable) spread in the U.S., this time in the Seattle area.

The horses have definitely broke loose from the stable.


Take a dep breath. Relax. The drip drip media and online monitoring will make you sick, not the virus.

I am not trivializing this but the world is blowing this out of proportions
and people are using scientific calculators too much.

CDC has just started to get its act together on detection kits and is now sending them around.
In the US, over the next few weeks, you will hear many more cases, clusters and yes some deaths.

But, this will subside by April.
Sun will shine and early detection kits, treatments and training will quickly evolve
and we all will be arguing about too many TSLA posts on this board.

Italy is already beginning to reopen their schools and museums.
China is slowly reopening its cafes, theaters and factories - just within 4 weeks after it looked like end of the world there.

Buy BRK at 1.1x PBV on Monday and enjoy. I am.
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The horses have definitely broke loose from the stable.
...
I think the times we'll be going through will help emphasize that most of the really important things of life don't involve money


Jeez.. Relax. Every year we add (births minus death) roughly 80 m people to this planet. Even if 10 or 20 million people die, which I think is highly unlikely, only we are slowing down the growth rate.

The reason I say is to not trivialize human loss, but put the deaths in context. Of course I was bit freaking out earlier, and sold some, sold short some puts, etc, but I have already started buying back. Because the market reaction seems disproportionate to the threat so far.
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But, this will subside by April.
Sun will shine and early detection kits, treatments and training will quickly evolve
and we all will be arguing about too many TSLA posts on this board.



Is this President Trump using an alias??

Given that the virus is already spreading in warm, sunny places, what makes April so magical?

Also, why did swine flu spread during late August/early September?

What season is April in the Southern Hemisphere?

What good are test kits going to do to stop the spread? Ditto "training".

Instead of some mindless dismissal like this, why not share your rationale for the scenario you see as most likely?
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Jeez.. Relax. Every year we add (births minus death) roughly 80 m people to this planet. Even if 10 or 20 million people die, which I think is highly unlikely, only we are slowing down the growth rate.

The reason I say is to not trivialize human loss, but put the deaths in context. Of course I was bit freaking out earlier, and sold some, sold short some puts, etc, but I have already started buying back. Because the market reaction seems disproportionate to the threat so far.



You clearly have no understanding of human nature. When death can be transmitted through a sneeze or dirty doorknob, people react...with fear. Full stop.

They do not care if someone explains that statistically this is not important (though indeed it is shaping up to be very important).

This fear will interrupt supply chains, shut down much or normal society and travel, and cause an enormous shift away from risk assets. Quite the opposite of an overreaction so far, the market is just starting to react to this.

Of course, this too will end (though likely not for at least 18-24 months, when a good vaccine is widely available). But again, this is irrelevant to human psychology.
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You clearly have no understanding of human nature. When death can be transmitted through a sneeze or dirty doorknob, people react...with fear. Full stop...
Of course, this too will end (though likely not for at least 18-24 months


First of all the world has seen pandemic and millions of people dying, clearly this is not that scenario. While we may not have a cure, clearly still only 2% of people who are infected are dead. I am not saying you should not exercise caution, but don't panic.

Separately, humans while over-react to small things, have also shown enormous resilience and calm in the face of major calamity. The life is not stopping, I just booked an Air travel for work on 3rd week of March. Am I bit scared, of course. I am going to take some pre-caution but life doesn't stop.
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Is this President Trump using an alias??

Yes, People think I only use twitter but Melania and I often hang around these BRK boards.
Its Obama's fault.
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Melania and I often hang around these BRK boards

OK. So, dividends20, you have an eye on Melania!!
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You clearly have no understanding of human nature

You are absolutely correct. So here is a story of a reporter checking Costco to see what people are stocking up and she found a guy stocking up on condoms, 16 boxes or 928 condom's. LOL

https://twitter.com/jillreports/status/1233870486670495745
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An interesting example of how fear is more relevant than "reality" in issues like the Covid-19 pandemic: we decided to stock up on some hand sanitizer. Looked online: almost every place we looked was simply sold out. Amazon has it for obscene prices only: about $2/once was the cheapest. Fortunately, we found some at a local OfficeMax and Aldi's for a tiny fraction of that price. And good luck (or large fortune) if you hope to find an N95 mask.

For better or worse, that is human nature.

And all the people who buy and sell stocks are human, so the same thing--but kind of in reverse--is going to happen in the equities markets over the next few weeks as people wake up and realize that this isn't just a China problem, but any random person in the U.S. can get it as well. I wish I could have bought far-out-of-the-money options on Purell two weeks ago.
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Just to disabuse people of the nonsensical view that Covid-19 is basically like SARS: just look at the number of cases reported in South Korea (which inevitably is far lower than actual cases). The first few cases were reported IIRC about two weeks ago. Now they have reported more than 3500...which is roughly half of the total cases of SARS globally over nine months. One small island country. Italy and Iran seem to be following the trail laid down by South Korea (and, of course, China). So you can guess how this unfolds in the U.S.

Unless "it's different this time"...of which there seem to be many believers lately.
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This fear will interrupt supply chains, shut down much or normal society and travel, and cause an enormous shift away from risk assets. Quite the opposite of an overreaction so far, the market is just starting to react to this.


As I like to say - all that is required to melt down the economy is that a sufficient number of people decide to do the same thing at the same time.
In this case, that would be “stay home”. “Don’t go to a restaurant”. “Don’t take that trip”. “Don’t spend that money”.

People look at the massive 20 trillion dollar US economy and see it as this invincible block of granite.
But it’s really just a shifting emphemeral entity made up out of countless of individual decisions. If a sufficient number of those decisions change because of fear, then that invincibly looking block can start to crumble fast than you can say “OMG I didn’t realize that’s how economics works”.
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One small island country. Italy and Iran seem to be following the trail laid down by South Korea (and, of course, China).

Iran is probably heading the pack. According to BBC sources, they already have over 200 dead. Depending on the model you’re using, that means that they already have somewhere been 100k and 1 million infected.

https://www.bbc.com/news/world-middle-east-51673053
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An interesting example of how fear is more relevant than "reality" in issues like the Covid-19 pandemic

This is different than your emphatic assertion of
"best case US scenario is 1 million deaths and 12 million critical care hospitalizations"
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So now, CEO of Invitation Homes Announces Cancellation of Participation in Citi's 2020 Global Property CEO Conference because of abundance of caution!!!

At this rate, the anxiety may kill more people than corona virus.
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It is quite amazing to me how otherwise smart people have such a hard time applying basic math and logic to this situation.
Or just listen to the bloody experts. During the last week, have you heard any epidemiologist say that it’s probably going to be contained? I haven’t haven’t. It’s all “brace for the pandemic” and such. Well, guys, assume there’s a pandemic and imagine what the implications are.

People here seem to think that we have no real comparable experience to draw upon - but there’s the Spanish Flu pandemic from 1918-1920, which most people apparently don’t know about.
Sure, maybe the virus is going to diminish in the summer months…that also happened during the Spanish Flu epidemic, but then the virus came back in winter and killed even more people.

It is completely obvious to me that there will be a massive, nightmarish global pandemic, PARTICULARLY in the US, because here people don’t go to the doctor if they can possibly avoid it, and they go to work as long as they can because they don’t want to use up their sick days (if they have any).

It is also obvious that this will completely f*** the economy. I don’t know exactly how bad it’s going to be, but I’m pretty sure it’s going to be “bad enough for a severe recession”, especially given the fact that the supply chain will already be massively disrupted once the container ships arriving from China will take their 1+ month break. This will start happening right about now.

I guess I can see this because I read so much history, and I can thus imagine a range of outcomes that people who haven’t, can’t.
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Hate this virus.

Vitamin D seems to have a large impact on cold virus infections. If you’re not already supplementing it, you should. People in the northern hemisphere very often have a deficiency, in particular at the end of winter.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949172/
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Hey AD, you posted earlier that you were in the Philippines and were sick, implying you maybe had COVID-19. How's that going?
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Hey AD, you posted earlier that you were in the Philippines and were sick, implying you maybe had COVID-19. How’s that going?

I’m feeling substantially better than I did 2 days ago.
The persistent headache is gone, but I still have a little dizziness now and then, in particular while walking around.
2 days ago, I could hardly concentrate on my work, and when I walked the stairs, I got tired really quick. I’m still not quite ok, though.
It didn’t feel like a flu, though. No sore throat or anything. It felt like nothing I’d ever encountered before.
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Absolutely correct to ask, "AD.... how are you feeling?"

Hope you are drinking lots of water or gatorade...

Enough fear to make us prepare for the worst and hope for the best, is an ok thing.

Thank you for sharing your observations...

......

I just watched a video about how to wash your hands properly.

It seems I need to get a nail brush...

......

Focusing on what we can do even if it's a small thing like a nail brush, is smart.

I feel for friends who fly long distances in the US and abroad every week for large corporations. Somehow, they must believe in their own preparations, their own vigor and pure luck to function with the obvious risks.

Glad that we don't have bosses owning our time during this pandemic.

AD, be safe... some of us believe you and thank you for the warnings.

Be ok.

jan
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Hey AD,

Am not a doctor, but the dizziness and fatigue are worrying.

It's easy to say this, and it is meant very respectfully, but can you be seen by a doctor?

Have you been able to sleep?

Take care, and keep us posted.

Wishing you a good night's rest and no more fatigue & dizziness.

Sincerely,

jan
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https://youtu.be/u7qS-CjZfYY

Harvard MD discusses this problem
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It’s easy to say this, and it is meant very respectfully, but can you be seen by a doctor?


I could, but that wouldn’t do anything. The symptoms are totally non-specific and mild.
The fatigue is mostly gone, and the dizziness is really subtle, not like I’m stumbling around or anything. Most of the time I don’t feel it.
I feel better than yesterday, and yesterday I felt better than the day before.

I can sleep quite well, which is usually the case when I am sick.
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ok.... get better soon.
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"An interesting example of how fear is more relevant than "reality" in issues like the Covid-19 pandemic: we decided to stock up on some hand sanitizer. Looked online: almost every place we looked was simply sold out. Amazon has it for obscene prices only: about $2/once was the cheapest. Fortunately, we found some at a local OfficeMax and Aldi's for a tiny fraction of that price. And good luck (or large fortune) if you hope to find an N95 mask."

I saw a local news report on how the army surplus stores are doing incredibly well and are running out of MREs, industrial grade room air filters, and other prepper end of the world stuff.

That is just crazy. This virus is going to kill a lot of people and it is going to get a lot of people sick, but it isn't going to change the dead into mutant zombies leading to an apocalypse and a breakdown of society.
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feel good story

[Wuhan # 98-year-old critically ill patients with new coronary pneumonia discharged # ! ]
On the morning of March 1, Hu Hanying, a 98-year-old elderly patient who was currently the most critically ill patient
with new coronary pneumonia in China, was cured and discharged from Wuhan Lei Shenshan Hospital.


https://m.weibo.cn/status/4477735164044944?
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This virus is going to kill a lot of people and it is going to get a lot of people sick,

We've heard this all before. Multiple times. The name of the disease or tragedy is always different, but the same "We'e all going to die!!!!" narrative is the same.

Some people just enjoy the rush of being scared.

Reading all over the internets about this, I've come to some conclusions:
1) Most Americans treat it as noise. Slightly increase precautions -- no handshaking, no hugging except for immediate family, etc. -- but that's it.

2) Of the (minority) of American people who closely watch this and have an excited opinion about it:
2a) half are sure this is the apocalypse and we're going to have a die-off.
2b) half think that it's just the same cohort that predicted the end of the world due to Y2K, ebola, etc. getting all wrought up about nothing.

FWIW: My favorite travel agent who puts together very atttractively-priced cruise packages just came out with an Alaska land/sea cruise, 3 dates this summer. About 200 cabins available for each of the 3 dates.
He sold out all 3 sailing in 2 days.
These must be paid for fully at the time of booking and no refunds or cancellations allowed. If you book it and decide to not go, you don't get any of your money back.

So there are a lot of people in categories 1 and 2b.
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This virus is going to kill a lot of people and it is going to get a lot of people sick, but it isn’t going to change the dead into mutant zombies leading to an apocalypse and a breakdown of society.

You don’t know that. If you had played Plague, Inc., you would know that the virus could evolve Cytopathic Reanimation at any time.

https://plagueinc.fandom.com/wiki/Cytopathic_Reanimation
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This virus is going to kill a lot of people and it is going to get a lot of people sick, but it isn't going to change the dead into mutant zombies leading to an apocalypse and a breakdown of society.

Indeed.
On the first point, latest estimate by some epidemiologists on death rate is still a wide range, but best guest now sitting at 0.9%.
Varying wildly with sex, more by age, and especially by health beforehand.
A female under 50 without a major health condition should work hard to avoid catching it, but perhaps primarily because she might then spread it to old sick guys.

So, how bad is reasonably plausible?
The big bummer is that it's extremely contagious. It seems pretty likely to be a pandemic soon by most definitions.
If 20% of world population eventually got it, and the 0.9% figure were correct and remained so, that would be about 14 million additional deaths spread over the time frame of the epidemic.
Technically "early" deaths I suppose...it's one per customer either way.
For a sense of scale, if it all happened in one year the total number of global deaths that year would be about 20-25% above normal.
Nothing in that comment is to minimize it. I merely like to have a sense of scale for big scary numbers.

Time to read up on HI, CSV, MATW, SCI...

Jim
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The demographic patterns of the viral mortality rate are quite interesting. I think most of us on this board are at the greatest risk of a fatal infection (I presume we're a bunch of middle aged to old white guys, but I could be wrong). A pandemic in the US might impact the election outcome in November if these demographic trends in mortality rates continue.

PP
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I'm not sure if the hypothesis will hold up, but the increased fatality for males may be due to heavier smoking.
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A pandemic in the US might impact the election outcome in November if these demographic trends in mortality rates continue.

How many old white guys are going to die to swing the election, Seriously? Economy may be the biggest threat for Trump's re-election.
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If 20% of world population eventually got it, and the 0.9% figure were correct and remained so, that would be about 14 million additional deaths spread over the time frame of the epidemic.

No epidemiologist appears to believe that it will be limited to 20%. The most recent estimates I’ve heard were 60-80%.
This is NOT the flu. The flu is much less transmissible, and there’s always a large part of the population that is immune or at least partially immune. With regard to Covid, everyone appears to be “immunologically naive”.

You also have A LOT of hospitalization (20%, according to the Chinese data). If only 5% of the infected have to be hospitalized, that’s something like 10 million people that will need hospital beds for weeks. Generally with oxygen supply (if available).

The Spanish Flu killed only approximately half a percent of the US population (although way more locally), and it traumatized the entire country deeply.
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No epidemiologist appears to believe that it will be limited to 20%

AD, here are the simple facts. Find below a research report based on "epidemiological data". If you look at the age-group graph at the below, you will see the risk increases with age. Outside of developed world, countries in Asia, particularly SE Asia, significant population (about 50%) are below 35 years. It is a different story how fertile this group and how much kids they will have and population increase, but they are lesser risk. For context that number is far higher than developed world population.

So worldwide 20% people catching this really looks like worst case scenario.

https://www.thelancet.com/journals/landig/article/PIIS2589-7...
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I should have put a winky eye in there. I'm joking. The level of paranoia on this board, and elsewhere, would suggest that several million old white guys like me will be dead by November. It's just math after all.

<insert winky eye here>

PP
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No epidemiologist appears to believe that it will be limited to 20%. The most recent estimates I’ve heard were 60-80%.
This is NOT the flu. The flu is much less transmissible, and there’s always a large part of the population that is immune or at least partially immune. With regard to Covid, everyone appears to be “immunologically naive”.

You also have A LOT of hospitalization (20%, according to the Chinese data). If only 5% of the infected have to be hospitalized, that’s something like 10 million people that will need hospital beds for weeks. Generally with oxygen supply (if available).

The Spanish Flu killed only approximately half a percent of the US population (although way more locally), and it traumatized the entire country deeply.


AD is example #1 of the kind of shrieking paranoia that is evident on this board.

Hey, AD, were you a Y2K prepper?

PP
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AD is example #1 of the kind of shrieking paranoia that is evident on this board.


He provided a well-reasoned argument, as did I. Now one may disagree with the rationale, but it's nonsense to say it's just emotional paranoia.

Interestingly, you and others with a condescending dismissal do not give any specific rationale for your stance, nor do you state specific reasons why you disagree with specific points we make.

Listen, I'm all for getting the best possible understanding of the situation as our limited knowledge allows; that's the whole point of having discussion boards.

But "hey, this is just like the last four global infectious diseases" is just stupid (as whatever this turns out to be, it's clearly completely different than SARS or MERS or Ebola). And simply saying "the flu is worse" is either ignorance or unintelligent wishful thinking.
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Interestingly, you and others with a condescending dismissal do not give any specific rationale for your stance

I am not sure you can generalize. I don't think anyone is condescending. You can discuss the impact, even worst case scenario, but 20% of world population is currently not supported by the data.
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I don't think anyone is condescending.


"AD is example #1 of the kind of shrieking paranoia that is evident on this board."

I think that would qualify.




20% of world population is currently not supported by the data.


What data are you referring to?? Of course, 20% are not involved now. So all we can do is use what we know in general about the transmission patterns of past infectious diseases and apply it to this, based on the transmission patterns to date--which is very early in the outbreak.

1) This is clearly significantly more easily spread than seasonal influenza. Whether the R-0 is 2 or 5, that's far higher than common flu.
2) When novel influenza strains come on the scene (best modern example is swine flu in 2009), they tend to spread extensively; 20% is certainly within the range of historical precedent.
3) The fact that this has spread to every corner of the Earth in roughly 90 days from the index case is completely different than recent diseases such as SARS and MERS. In that short of a period, it's already spread well over 10X the total SARS epidemic.
4) It very likely has a case fatality ratio an order of magnitude higher than typical seasonal influenza. Ditto for the number of cases which will require hospitalization and intensive care.
5) With this pattern of transmission and current global reach, this virus will not simply go away. Doesn't work like that. It will spread until the substantial majority of the globe has contracted it or receives an effective vaccine (though the annual flu vaccine is usually only roughly 50% effective...and it's almost a certainty that one will not be widely available for a year).
6) So, if this spreads about as widely as even the seasonal flu, and it has a case fatality ratio an order of magnitude higher, this will be far worse than the seasonal flu...which, by the way, causes plenty of misery on it's own, and significantly taxes the healthcare system.
7) When human beings are faced with new diseases which they can contract by from a doorknob or wayward sneeze, and for which the fatality rate is not trivial, they react with fear. Widespread fear affects society, and affects the economy.
8) Lower interest rates by central banks has no affect on points 1-7.

Again, if someone has scientific knowledge to counter any of those specific points, please share. Truly, I want to understand the situation as best as possible.
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Please see the link I posted from lantus, that is the latest research on the spread, age group impacted, etc. For your scenario of 20% of world population to get infected you are looking at more than 50% of people over 40 should get infected.

We don't know how bad it will be. But, at this time the available data doesn't support 20% assertion. The best anyone can do is stay calm. Especially those who are too worried, please switch off your TV, unplug yourself and enjoy something that relaxes you, whether it is meditation or a glass of wine. All your freaking out is not going to chance anything and you will work yourself to frenzy. Stay calm.
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But, at this time the available data doesn't support 20% assertion.


Again, what data are you referring to that would say that 20% transmission in not a reasonably likely scenario?? Last I saw, this was spreading like wildfire. Generally a virus with these characteristics doesn't just disappear; that's not about "data" or some report you can link to; it's basic infectious disease science. I believe I was wrong, though, on one of my points: it will not necessarily spread until everyone has had it; rather, it will likely spread until a sufficient percentage of the population has immunity to it, either through exposure or effective immunization. But "a sufficient percentage" is quite high...likely at least 20%, but probably much more. It's basically the concept of herd immunity; herd immunity typically requires in the neighborhood of 90% immunity.


All your freaking out is not going to chance anything and you will work yourself to frenzy. Stay calm.

Again, condescension. I'm giving facts and rational arguments, though clearly any argument may have flaws. You're the one who is operating on an emotional or non-rational level. I'm not trying to be an optimist, nor a pessimist; I'm trying to understand the situation based on the information we have at hand.
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Again, what data are you referring to

Read the post 248239 and the link.

Again, condescension. I'm giving facts and rational arguments

Wrong and Wrong. My point was take it easy, stay calm, how is that condescension?

BTW, you have provided no facts and no rational arguments either. Just because you thought something that doesn't make it a fact or rational argument. Here is the timeline...

Officially China announced WHO on corona virus on Dec 31st. probably they had it at least one month. Now, it is fully 3 months in China, there infected population is not 20%. Let that sink. Between then and now, we have grown more cautious and our ability to defend ourselves are increasing.

So 20% is still a wild ass theory and not based on facts.
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cc, dtb, ad - you guys should get together and see who can paint the most dire scenario using your exponential calculators.

In the mean time, here are the number of increases in cases for the top countries by day

Case increase daily
-------------------
Italy: 17, 42, 93, 74, 93, 131, 202, 233, 240, 566, 335

South Korea: 73, 100, 229, 169, 144, 284, 505, 571, 813, 586, 599

Hubei: 105,212,297,365,2131,0,1349,903,1347,4024,2345,3156,2987,2447,2841,2147,2531,2097,1638,14840,6200,1843,1933,1807,1693,349,411,220,1422,203,499,401,409,318,423,570,196

You don't even know that R0 is not a constant.
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using your exponential calculators
...
You don't even know that R0 is not a constant.


Dang divi.
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https://earthobservatory.nasa.gov/images/146362/airborne-nit...

NASA report shows lack of pollution over China, which may give an indication of current economic activity.

jan
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"The best anyone can do is stay calm. Especially those who are too worried, please switch off your TV, unplug yourself and enjoy something that relaxes you, whether it is meditation or a glass of wine. All your freaking out is not going to chance anything and you will work yourself to frenzy. Stay calm. "

Making up false motivations and emotions for your opponent's is not a credible form of argument.
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DTB, in stark contrast to your numbers the "Robert-Koch-Institut", Germany's worldwide respected state Institut for the recognition and prevention of diseases, estimates the risk for Germany as "gering bis mäßig" = "small to a little".

Three days later, RKI says "The risk to the health of the population is currently assessed as moderate in Germany" (according to the Google translation, anyway). Any bets on next week?

https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus...
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The demographic patterns of the viral mortality rate are quite interesting. I think most of us on this board are at the greatest risk of a fatal infection (I presume we're a bunch of middle aged to old white guys, but I could be wrong).

I'd have assumed that too. But then one night I went to an Oakland 24 Hour Fitness for a late night workout and walked by two young, Black guys wearing hoodies and chatting about... Berkshire Hathaway.
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6) So, if this spreads about as widely as even the seasonal flu, and it has a case fatality ratio an order of magnitude higher, this will be far worse than the seasonal flu...which, by the way, causes plenty of misery on it's own, and significantly taxes the healthcare system.


This may be true, and if it is, then the epidemic will be a big deal as you have outlined. But it is also the point where the virus and its disease are least well known, and it is still possible that the virus’s lethality (or case fatality ratio) is lower than the 1-2% that is often quoted.

On the one hand, we have deaths in China (2945) compared to cases (80,152), 3.7%, and this could still go higher as the cases from the last couple of weeks evolve. On the other hand, it seems more and more clear that the virus can cause asymptotic infection, and that we may be severely underestimating how widely it has spread. If there are 10 times as many cases, for instance, then we only have a lethality rate of 0.37, and obviously if there are 40 times as many cases, then we are right back down to the average mortality rate of the flu, 0.1%.

I think we have to be quite cautious with the Chinese data: if the epidemic’s course in Europe and Iran, and now the USA, is any guide, they are just making stuff up in China. We will soon have data from countries like France, Germany and the USA which are less likely to be falsified. And in the meantime, there is the Diamond Princess, our natural experiment.

2666 passengers, 1045 crew, 3709 in total, with 706 infected, 7 deaths, 36 in critical condition. I don’t know whether they were all tested or not but many have tested negative, although some have turned out to be infected once they got home. I assume the latter are included in the 705, but we may be missing some. The point is, there are just too many deaths to seriously sustain the idea that this new coronavirus is just like a bad flu. We are likely to end up with at least 20 deaths, and whether the denominator ends up being 706 infected or 1000 or 2000, the lethality is still 1-2%.

Now if these unfortunate cruise travellers were 80 years old, or most of them were, this might still be just a really bad flu - mortality rates in 80 year olds are about 1%, but that includes sick 80 year olds that are not likely to take a cruise, and it’s the rate for a whole year, not a 10 day cruise with a one-month extension. Also, there seem to have been lots of younger passengers, and of course nearly a third of these people were staff.

In addition, it is anecdotal, but there seem to be too many anecdotes of young doctors, nurses, and even health ministers (Iran) dying of this bug.

My best guess right now is that we will get a higher percentage of people infected, maybe 30-50%, maybe higher, but with much lower lethality, maybe 1%, maybe less, and as usual, most of the deaths will be among older, sicker people. That would still be several times the impact of the regular flu, on top of the flu of course, and with a ton of social disruption - but possibly not quite as bad as my initial estimates. Finally, if the China data, at least on deaths, does turn out to be accurate (although I doubt it), it would be far less devastating, really more on par with the seasonal flu, but I think that is far-fetched, an outlier compared to the rest of the evidence.

Dtb
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A few days ago, they said ‘gering bis mässig’ (slight to moderate), now it’s just ‘mässig’. I don’t know what the next word will be? Bedeutlich? Beachtenswert? Erheblich? Working our way up the scale...
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South Korea seems to have more reliable coronavirus data. And they are testing many more citizens, not just those showing symptoms. IIRC they even have "drive through" screenings set up.

But the truth is no one has precise knowledge at this time.

It seems like it will take time for the absolute truth about this virus to emerge.

jan
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I assume the latter are included in the 705, but we may be missing some. The point is, there are just too many deaths to seriously sustain the idea that this new coronavirus is just like a bad flu. We are likely to end up with at least 20 deaths, and whether the denominator ends up being 706 infected or 1000 or 2000, the lethality is still 1-2%.

We can’t really say anything until we know the age profile of the infected DP population. So far, I believe all deaths have been 79+.
If we apply Chinese lethality ratios, and the death rate among the 80-year-old DP population ends up being 4%, then that would imply a lethality rate for the entire population of around 0.5%. Except, of course, that the 80-year-old population of a cruiseship is going to be more healthy, also for socio-economic reasons, than the average 80-year-old. So that’s a caveat.

In addition, the DP population has access to ventilators and ECMO. In the event of a widespread epidemic in the US, that will not be the case for a large majority of patients.
According to reports, the US has about 0.02 ventilators for every 100 people, and most of those are in use already.

In addition, it is anecdotal, but there seem to be too many anecdotes of young doctors, nurses, and even health ministers (Iran) dying of this bug.

I’m not sure you can draw too many conclusions from a high mortality rate among doctors, as they are likely to be exposed to much higher virus concentrations than most other people.
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Bedeutlich? Beachtenswert? Erheblich? Working our way up the scale…

Deutlich, not bedeutlich (in this context).
My guess would be “erheblich”.
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We can’t really say anything until we know the age profile of the infected DP population. So far, I believe all deaths have been 79+.
If we apply Chinese lethality ratios, and the death rate among the 80-year-old DP population ends up being 4%, then that would imply a lethality rate for the entire population of around 0.5%. Except, of course, that the 80-year-old population of a cruiseship is going to be more healthy, also for socio-economic reasons, than the average 80-year-old. So that’s a caveat.


Yes, the age distribution of the cruise ship would be very helpful. If all 7 deaths really were in people 80+, that would be very reassuring (at least, for those of us that are younger...). However, don't forget there are 36 people in critical condition. If they are using the same definition of 'critical' as the Chinese, then we can expect about half of these people to die, and they may not all be 80 and over. Also, while I am sure that cruise ship populations skew old, almost a third of the occupants were staff: waiters, janitors, pilots, engine mechanics, cleaning staff, etc. They probably are fairly representative of the working age population, say 20-60. AT least 150 of the 705 people infected were crew members, and as far as I have heard, none of them have died, so that is somewhat reassuring for that age group.


In addition, it is anecdotal, but there seem to be too many anecdotes of young doctors, nurses, and even health ministers (Iran) dying of this bug.
==========
I’m not sure you can draw too many conclusions from a high mortality rate among doctors, as they are likely to be exposed to much higher virus concentrations than most other people.



That shouldn't be relevant - you are either infected or you are not infected. A higher exposure to the virus would be expected to result in higher rates of infection, but not a higher percentage of infected people who go on to die.

dtb
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Bedeutlich? Beachtenswert? Erheblich? Working our way up the scale…
===============
Deutlich, not bedeutlich (in this context).
My guess would be “erheblich”.



Doch, erheblich - oder deutlich. Danke schön!

Here is what the Robert Koch Institute said yesterday:

Auf globaler Ebene handelt es sich um eine sich sehr dynamisch entwickelnde und ernst zu nehmende Situation. Bei einem Teil der Fälle sind die Krankheitsverläufe schwer, auch tödliche Krankheitsverläufe kommen vor. Mit weiteren Fällen, Infektionsketten und Ausbrüchen muss in Deutschland gerechnet werden. Die Gefahr für die Gesundheit der Bevölkerung wird in Deutschland aktuell als mäßig eingeschätzt. Eine weltweite Ausbreitung des Erregers ist zu erwarten.


My rough translation: the risk is moderate now (mässig), but that is for Germany right now (aktuell). However, on a global level (auf globaler Ebene) the situation is developing very dynamically and has to be taken seriously. In Germany, one should expect more cases, chains of infection and outbreaks. A worldwide expansion of the pathogen (Erreger) is to be expected.

So their evaluation of 'moderate risk' only concerns the immediate situation in Germany, not the expected future of the epidemic.

dtb
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If all 7 deaths really were in people 80+, that would be very reassuring (


In related news, the official death tally on the Diamond Princess has now gone from 7 to ... 6! We just saved a million people from a horrible death, if the death rate went down by 14%! Sorry to kid around about what may be a pretty tragic business for many people. Also, 35 in serious or critical condition, instead of 36, indicating another correction or perhaps a new recovery (212 now recovered out of 705 infected). https://www.worldometers.info/coronavirus/

In the not so good news department, today the case count in India has gone from 7 to 28...

dtb
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That is correct.
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They probably are fairly representative of the working age population, say 20-60. AT least 150 of the 705 people infected were crew members, and as far as I have heard, none of them have died, so that is somewhat reassuring for that age group.

Well, on a group of 150 below 60-year-olds, which most likely skews significantly to below 40, and is most likely in above-average good health given their physical occupation, we don’t really expect more than 0.2 deaths or so anyway.
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In related news, the official death tally on the Diamond Princess has now gone from 7 to … 6!

That’s weird. These cases were all reported individually in the media. Either a person rose from the dead, turned out not to have died from Covid-19, or this is a data error. I assume it’s a data error.

https://en.wikipedia.org/wiki/2020_coronavirus_outbreak_on_c...
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Two passengers died on 20 February[44] and a third on 23 February, all three Japanese citizens in their 80s.[45] A fourth passenger, an elderly Japanese man, was reported on 25 February to have died.[46] The sixth fatality, a British national, died on 28 February.[47] An Australian national, who was evacuated from the ship, died on 1 March in Australia.[48]


Interesting that the Wikipedia article is also missing one: they seem to skip from 4 to 6! Perhaps the article was revised, removing the fifth? Also, 3 Japanese in their eighties, a fourth ‘elderly’ Japanese man, a Briton with no age mentioned, and an Australian who was 78.

Dtb
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They probably are fairly representative of the working age population, say 20-60. AT least 150 of the 705 people infected were crew members, and as far as I have heard, none of them have died, so that is somewhat reassuring for that age group.
===
Well, on a group of 150 below 60-year-olds, which most likely skews significantly to below 40, and is most likely in above-average good health given their physical occupation, we don’t really expect more than 0.2 deaths or so anyway.


This is a good point; if rates are
50-59 years old: 1.3%
40-49 years old: 0.4%
30-39 years old: 0.2%
20-29 years old: 0.2%,

as reported by the China CDC, Feb 27th (http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9...)

So if we very roughly assumed that the 150 sick Diamond Princess employees were equally distributed in these 4 age groups, the expected number of cases would be 0.8, so clearly zero observed cases doesn't contradict the estimated case fatality rates. In addition, as you point out, these employees will be much less likely to have chronic diseases which are also an important risk factor for COVID-19 death. Death rates overall are 2.3% according to that report, and they are 0.9% in the absence of pre-existing conditions, so if the risk factors are multiplicative, assuming the employees didn't have pre-existing conditions (diabetes, heart disease, chronic respiratory disease, hypertension, cancer) we might expect 0.8*(0.9/2.3)=0.3 cases, in line with your estimate.

dtb
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I'm not sure how all these numbers work out but:
“Globally, about 3.4% of reported Covid-19 cases [the technical term for the novel coronavirus strain responsible for the outbreak] have died,” WHO director-general Tedros Adhanom Ghebreyesus said at a press conference on Tuesday.

The previous death rate had been given as an estimated 2% after the initial explosion of cases begin in China.

https://www.theguardian.com/world/2020/mar/05/trump-coronavi...


Sounds much higher than the 0.2% rates you are showing. And certainly much higher than any recent flu strain.



Rich
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. Globally, about 3.4% of reported Covid-19 cases [the technical term for the novel coronavirus strain responsible for the outbreak] have died,” WHO director-general Tedros Adhanom Ghebreyesus said at a press conference on Tuesday.
...
Sounds much higher than the 0.2% rates you are showing. And certainly much higher than any recent flu strain.


I actually said 2.3%, based on a China CDC report. Even on the Diamond Princess, with its somewhat elderly clientele, the rate is not likely to get over 2%.

I’m not sure which 0.2% rate you are referring to, but I did say that in 20-39 year olds, that was the rate, and I estimated it might be 0.9% among people with no underlying illness. On the other hand, rates can be 10% and higher in the elderly, or people with serious per-existing illness, and higher still in people that are both old and sick.

By way of comparison, typical flu lethality is about 1 in 1000 or 1 in 2000, i.e. 0.05% to 0.1%, which is also an average of much lower rates in young, healthy people and much higher rates in old & sick. So the coronavirus is about 20-40 times worse, probably about that same 20-40 ratio at every age group.

dtb
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By way of comparison, typical flu lethality is about 1 in 1000 or 1 in 2000, i.e. 0.05% to 0.1%, which is also an average of much lower rates in young, healthy people and much higher rates in old & sick. So the coronavirus is about 20-40 times worse, probably about that same 20-40 ratio at every age group.

To a man with a gasoline can, everything looks like a fire.
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Here is the data

-------------------------------------
Country		Cases	Death	Rate
-------------------------------------
China		80,556	3042	3.7
 China-Hubei	67,592	2931	4.3
 China-NonHubei	12,964	111	0.85	
SouthKorea	6593	40	0.6
Iran		4747	124	2.6
Italy		3858	148	3.8
Germany		577	0	0
US		233	14	6.0
-------------------------------------

China NonHubei 0.85% is the most valid number. Good sample size and enough time has passed. 
However, there are 149 severe/critical cases remaining (down from 1000+ two weeks ago) 
outside Hubei which can drive the mortality rate up. 
They are doing a good job of curing those, about 20-30 per day. 

I am expecting this rate(0.85%) to go down by April end as the clinical trial results are published
and hopefully some therapeutics (remdesivir ?) are approved.
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US data on affected cases is highly suspect. I think the actual number of people who are affected are far higher and because of the pathetic healthcare system we have, we don't even have a good count of these folks.
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https://news.cgtn.com/news/2020-03-06/InterviewClinical-drug...

Cao noted that the trial for kaletra has finished, and the team has shared the results with the Chinese Ministry of Health. "During the last two months, we have successfully treated 199 cases," said Cao.

Cao pointed out that according to the test results, remdesivir shows stronger activity against coronavirus compared with kaletra. "If we have the positive results of kaletra, maybe we will have even better clinical and virologic outcomes of the remdesivir," Cao added.
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