14 ms·

Coronavirus: 'Baffling' observations from the front line

234 points by sjcsjc 6y ago

nkkollaw 6y ago
This might be a rant, but it would be awesome if these new findings lead to laws that required doctors to give accurate cause of death for people that also test positive for COVID. At least in Italy, doctors were pressured to put "COVID" as cause of death of people that were given 10 days to live because of cancer and other diseases, but also tested positive. Newspapers went as far as saying that a policeman that was shot by a colleague by accident and had been on a coma for 3 months was the country's youngest COVID victim, because allegedly he tested positive (of course, they failed to mention he had been shot and in a coma, other journalists exposed that lie). From what I read and understood, since in the US hospitals get reimbursed by number of patients doctors came out saying that they were pressured to put "COVID" as cause of death even without testing, just because it was presumed to be COVID because the symptoms matched. Unfortunately, politicians want power and businesses want to make money—and other people have their own agenda. This pandemic and been spun out of proportion by people that gain from it, at the expense of workers and most importantly small businesses, and at the advantage of China (and perhaps Amazon)—who are the only ones who are actually making money. I wish the world was less corrupt—or at least people that are given positions of power in good faith.
- pjc50 6y ago
  Citation for the shot police officer's name? People seem to have chosen bad faith attack media and elected bad faith leaders. That's why the US, UK, and Brazil are doing particularly badly.
  - deleted 6y ago
    [deleted]
  - snovv_crash 6y ago
    > That's why the US, UK, and Brazil are doing particularly badly. And Russia.
    - kmlx 6y ago
      And Italy, Spain, France, Germany, Sweden, Turkey, Iran, etc etc Does anyone know of any large country that managed to: - not lockdown - keep the disease under control ?
      - ekianjo 6y ago
        Japan maybe but it's unclear why at this stage.
        bleuedejapan 6y ago
        One important aspect is that in Japan, there were no huge clusters in old folks homes. There are many others, but this is one of the most important.
        newsbinator 6y ago
        Naively, could a factor be that in Japan wearing masks all the time was already normal practice, long before this pandemic?
        asiachick 6y ago
        No, people did not wear masks "all the time" nor did even "most" people wear masks. Go to any image search. Find images before February. (Search Hardly a mask in sight. They are common enough no one finds them strange but they weren't remotely the norm either. https://www.google.com/search?q=tokyo+crowded+before:2019-12-31&source=lnms&tbm=isch https://www.google.com/search?q=tokyo+crowded+before:2019-12... https://www.google.com/search?q=tokyo+station+crowded+before:2019-12-31&source=lnms&tbm=isch https://www.google.com/search?q=tokyo+station+crowded+before...
        newsbinator 6y ago
        By "all the time", I mean take any given adult in Tokyo and there's a good chance they have experience wearing a mask for a couple days every year. In Japan it's not only the immunocompromised or healthcare workers who have ever donned a mask: it's nearly everybody. You'd be hard-pressed to ride the metro and not see a handful of mask-wearers on any given Tuesday in recent years. Whereas in countries like the United States you'd rarely see masks outside of a serious medical setting, and you wouldn't be able to buy masks for a dollar at literally every corner shop within 100 meters of your home.
  - black_puppydog 6y ago
    Yeah, seems like forming a national (or at least regional) consensus around basic facts like "this is dangerous and so we should really self-enforce some sort of social distancing" seems to be the main discriminating factor. Who'd have thought that being distracted with pointless discussions about what the weather was and where a shooting did or did not happen could be detrimental to your nation's (mental) health? <shrug>
  - fwn 6y ago
    > People seem to have chosen bad faith attack media and elected bad faith leaders. That's why the US, UK, and Brazil are doing particularly badly. This is something we tend to assume somewhat intuitively, but I'd love to see some actual research on it. The relationship between weakened trust in media and a societies pandemic response performance is not a trivial research question. I wouldn't even necessarily trust the premise that overall trust declined. Could as well be perception or based on publisher selection. ... and that didn't jet include seriously operationalizing or discussing the nebulous "bad faith leaders" term or their relationship to pandemic response performance.
  - nkkollaw 6y ago
    Sure, here it is: https://www.ilrestodelcarlino.it/bologna/cronaca/muore-di-covid-a-30-anni-%C3%A8-la-vittima-pi%C3%B9-giovane-1.5146701 https://www.ilrestodelcarlino.it/bologna/cronaca/muore-di-co... (this is the first result on Google, but it was all over the news). Title of the article: "Muore di Covid a 30 anni: è la vittima più giovane", which translates into "30-year-old dies of Covid, he's the youngest victim yet". Article starts with: "Dying younger than 30 for Coronavirus: a cruel fate, that of Michele Grauso, 29-year-old financier (he would have turned thirty in August)." Second paragraph, finally mentions the small detail that he had also been shot in the head and had been in a coma for 2 years: "He was hospitalized in a vegetative state in a private facility here in the city. A coma from which he had never come out since a partner in 2017 shot him in the head by mistake..." On TV, most news channels didn't even mention the coma. The family actually complained and it came out. Not sure if news want to be sensationalistic for clicks, or because they directly get paid to keep the level of panic high by whoever makes money from the emergency (which is many, many people in Italy). Probably both.
    - atentaten 6y ago
      There is no doubt fear mongering about this topic exists in the media. This shouldn't be surprising. The death coding is surprising, at least to me. This idea of coding deaths in this way is not limited to Italy, but is happening in many countries including the U.S. Dr. Deborah Brix replied to a reporter asking questions about death coding methods by saying that the U.S. was using liberal methods. In this article Professor Walter Riaccardi (scientific adviser to Italy’s minister of health), complains about such coding methods: https://www.telegraph.co.uk/global-health/science-and-disease/have-many-coronavirus-patients-died-italy/ https://www.telegraph.co.uk/global-health/science-and-diseas...
    - pjc50 6y ago
      So he'd been alive for two years in a coma? And presumably "stable"? And then contracts coronavirus and dies? It does sound like he'd have still been alive if he'd not contracted the virus.
      - nkkollaw 6y ago
- DanBC 6y ago
  > This might be a rant, but it would be awesome if these new findings lead to laws that required doctors to give accurate cause of death for people that also test positive for COVID. In England that law already exists. It's called the Coroners and Justice Act. http://www.legislation.gov.uk/ukpga/2009/25/contents http://www.legislation.gov.uk/ukpga/2009/25/contents You want to read about the reforms which arose out of the Shipman and Mid Staffs scandals (the Shipman Inquiry and the Francis Inquiry). You can read about those here: https://www.gov.uk/government/publications/changes-to-the-death-certification-process/an-overview-of-the-death-certification-reforms https://www.gov.uk/government/publications/changes-to-the-de...
  - kmlx 6y ago
    Yes, in England there is no such thing as dying from old age. But this is still considered an official reason in Italy for example.
  - iso947 6y ago
    There are three level of excess deaths in E+W Those that are defiantly covid Those that mention covid on the certificate Those in excess of level of normal deaths over last 5 years That puts covid deaths at between 40k and 70k. With an IFR across the country of between 1 and 2% based on the latest antibody tests. That’s disastrous and we can only hope that either the most vulnerable have been disproportionately exposed or the antibody tests are massively overreading false negatives.
    - jansan 6y ago
      Doesn't the third level also include those who died from the side effects caused by the lockdown?
      - iso947 6y ago
        Yes, hence the large gap in death estimation
  - nkkollaw 6y ago
unityByFreedom 6y ago
clickbait..
- nkkollaw 6y ago
  It's called "journalism", nowadays.
  - andybak 6y ago
    Clickbait when it contradicts your belief. Solid journalism when it confirms them.
    - nkkollaw 6y ago
      My comment has nothing to do with the content of the article. I meant that most of the headlines I see nowadays are clickbaity. This trend started 5 years ago or so, and it hasn't stopped. I guess it's just me.
- codeisawesome 6y ago
  Maybe the details of suffering they want to write are more graphic, but standards and the need to prevent public anxiety means that they write in a measured clinical-technical detail.
  - api 6y ago
    Sticky blood, thrombosis, brain inflammation... not hard to read past the clinical language.
- Jonnax 6y ago
  Why is it clickbait? This article has quotes form doctors saying that the symptoms of COVID have been unexpected. ""We still don't really know why some patients feel OK to begin with, even though they have incredibly low levels of oxygen in their blood," says Prof Hugh Montgomery, a consultant in critical care at the Whittington Hospital in north London." " ""The volume of this is, of course, unprecedented in the era of modern medicine," says Ron Daniels, an intensive care consultant at hospitals in Birmingham. "But it's also the type of illness which is so distinct, and the way it's really different from almost every other patient that we've ever seen before."" "The main protein in the blood which forms blood clots is called fibrinogen. "Normally," says Beverley Hunt, "it's somewhere between two and four grams per litre in your blood. It goes up a bit in pregnancy, but what we're getting with Covid is as high as 10 to 14 grams per litre. I've never seen that in all my years as a doctor."" Honestly with this kind of detail and information, why is this clickbait?
akkawwakka 6y ago
The pathology of COVID-19 is really interesting. As the article describes, the viral pneumonia is well-described, but there are a lot of knock-on effects from infection of epithelial cells. Namely, virus binding to ACE2 receptors causes oxidative stress which can give rise to disease and cardiovascular events. MedCram did a really great video talking through some papers on this subject. [1] If you want to learn more, also check out This Week in Virology, a podcast that has been covering COVID-19 in great detail the last few months. It features a panel of virologists and other folks in the scientific field (immunologists, etc) plus a doctor reporting about the situation at a clinical level. [1]: https://youtu.be/Aj2vB_VITXQ https://youtu.be/Aj2vB_VITXQ
- sradman 6y ago
  Oxidative stress, why? I’m really confused at why we don’t think of the mechanics of this disease in terms of the cell and tissue types that express ACE2 receptors. ACE and ACE2 receptors regulate fluid pressure. ACE increases pressure by constricting tissue and ACE2 decreases pressure by dilating tissue. ACE2 receptors are found in the lungs, blood vessels, heart, kidneys, and gastrointestinal system. This makes sense and matches the pathogenesis of SARS-CoV. SARS-CoV-2 also infects the epithelial cells of the upper respiratory tract, like the cold-like HCoV-NL63. All the symptoms seem to match the spread of the virus to new tissue types. The timing matches too, with each new tissue type having an independent incubation period. Am I missing something? Children only seem to be susceptible to gastrointestinal infection which looks like Kawasaki’s disease when it spreads to adjoining blood vessels.
  - droopyEyelids 6y ago
    Thats a lot of disputin' for not having clicked the attached explanation links.
- pdkl95 6y ago
  > MedCram did a really great video I also recommend the followup videos that continue looking into the theory he discussed in episode 63 (your [1]). In particular, episode 69's discussion[2] of glutathione in existing research related to oxidative stress is very interesting. Comparisons are made to acetaminophen (tylenol) toxicity. A very plausible hypothesis is presented that high dose NAC (N-Acetylcysteine) might be a treatment for (some of) COVID-19's worst effects. NAC is obviously interesting as an antioxidant, but MedCram found a few papers that suggest it might also be important as a way to break the disulfide bonds cross-lining von Willebrand factor that seems to be causing a strokes and other thrombosis-related problems in the worst COVID-19 patients. Obviously this is all very speculative an turning these hypothesis into something practically useful will require a lot of work. However, as someone with multiple of the serious risk factors[3] for COVID-19, the last few months has mostly been hoping I can avoid dying from the virus before a vaccine is available. The ACE2/glutathione/NAC hypothesis is the first time 3rd option - an effective treatment - has seemed... plausible. [2] https://www.youtube.com/watch?v=Dr_6w-WPr0w https://www.youtube.com/watch?v=Dr_6w-WPr0w [3] diabetes, heart failure and cardiomyopathy from too many years of high-BP and bad sleep apnea (AHI=148)
OJFord 6y ago
Naïvely I would think factor v Leiden defect (prone to clotting, DVTs) would be a risk factor, but I understand it's most prevalent in white Europeans and Americans, which is somewhat the opposite of covid's (suspected vitamin D related) bias. Has anyone seen any studies mention it, or otherwise know that it's a silly suggestion that wouldn't be worth studying? On second thoughts I think it raises the clotting risk particularly in the event of severe blood loss, so maybe that's it. Covid patients are clotting but for unrelated reasons?
- deleted 6y ago
  [deleted]
- robbiep 6y ago
  You’re choosing a narrow band of the population. Undoubtedly there are thousands of groups out there who, by way of genotype, phenotype or lifestyle, are at higher risk. Teasing these all out is going to be the work of the next decade. It’s all in the last paragraph - (to paraphrase) ‘we’re having to learn in months what we’ve had hundreds of years to learn about other diseases’ When I was at Med school I naively thought ‘there will be no new pathophysiology’ - we knew all the continents and had mapped most of the interiors, in varying levels of detail. This is an entirely new continent. (So was vaping associated lung injury actually) It’s fascinating
  - OJFord 6y ago
    It's not that narrow among aforementioned populations though - 15% iirc. Enough that (again, as a naïve layman) I'd have thought it would be noticed or considered when discussing clotting and DVT/PEs? And enough to have an counteracting impact on the opposite African/Caucasian divide that's actually being seen - not to say that they couldn't coexist, but that if so it'd make the latter even more dramatic.
    - robbiep 6y ago
      From UpToDate: In the general population without a personal history of VTE, a study involving 1690 unrelated individuals from Europe found a prevalence of FVL of approximately 4 percent, and a study involving 356 individuals from Canada found an incidence of approximately 5 percent [47,48]. In a series of 4047 men and women participating in the Physicians' Health Study and the Women's Health Study (both in the United States), the following frequencies for FVL heterozygosity were found [49]: ●Caucasians – 5.3 percent ●Hispanic Americans – 2.2 percent ●Native Americans – 1.2 percent ●African Americans – 1.2 percent ●Asian Americans – 0.45 percent A higher prevalence of FVL (12 to 14 percent) has been reported in populations in parts of Greece, Sweden, and Lebanon Compared to a more likely cause for thrombophilia in the patient population, ie inflammatory response, endothelial damage, up regulation of clotting factors; I think focusing on factor V Leiden (and I’m speaking just as a clinician, not as someone who has had to work with covid patients, we’ve had relatively SFA here in Australia thankfully) is a footnote. And any patient who is admitted is going to be on anticoagulants anyway, nullifying most of any procoagulant effect of FVL in hospitalised patients. It might show up in the data, it might be a footnote, but treatment would be covered under normal VTE prophylaxis (and seems like many protocols are now stepping up fairly significantly the prophylaxis regime)
Xcelerate 6y ago
Anyone know the SNPs for ACE2 expression? Curious which variant I have...
- rogerkirkness 6y ago
  More complex than having "more" or "less" because while the presence of certain SNPs would mean more expression by default, the presence of the virus downregulates them, which means you could tolerate "more" virus. SNPs: rs4646127, rs1996225, rs2158082, rs4830974. Source: https://selfdecode.com/blog/article/ACE2-coronavirus-128 https://selfdecode.com/blog/article/ACE2-coronavirus-128
lorsting 6y ago
Every anti-opinion in the comments was [flagged]. I guess this is done by algorithms. Only the anti-anti-opinion comments survived. That above is the main issue with this disease.
- pjc50 6y ago
  No, the situation is that everyone is fed up with contrarians and downvotes them on sight. Cautious well evidenced dissent should still get through.
phyzome 6y ago
Doctors often want to keep pneumonia patients "dry", that is, somewhat dehydrated. (That's maybe contributing to the kidney failure.) To what extent could this also be resulting in increased clotting?
- nickthemagicman 6y ago
  Yes something is off here. Corona is totally respiratory virus.
  - JoeAltmaier 6y ago
    That seems untrue. Corona attacks almost every organ.
    - nickthemagicman 6y ago
      You should totally check out Wikipedia or some factual scientific source instead of listening to the news. Science is a candle in the dark.
      - JoeAltmaier 6y ago
        I gotta think this is a bot or troll response? So obviously wrong and argumentative.
        nickthemagicman 6y ago
        I'm not wrong you should open up your mind to the fact that you're wrong. There's hundreds of coronavirus and they're all respiratory viruses. Arrogant ignorance is no way to go through life son.
        DanBC 6y ago
        > There's hundreds of coronavirus and they're all respiratory viruses. How many coronaviruses can infect humans?
mrfusion 6y ago
These articles can certainly be scary. It might be good to keep the risks in mind too. “for people 49 and under, the agency [CDC] estimated that 0.05% of symptomatic people will die.” https://www.cnn.com/2020/05/22/health/cdc-coronavirus-estimates-symptoms-deaths/index.html https://www.cnn.com/2020/05/22/health/cdc-coronavirus-estima...
- PragmaticPulp 6y ago
  > for people 49 and under It’s always easy to downplay the risks if you start excluding the most vulnerable.
  - glofish 6y ago
    vice versa, it is just as easy to exaggerate the risks if you report and extrapolate from the subset of the worst cases,
- droopyEyelids 6y ago
  That would be comforting if the outcomes were limited to 'death' or 'full recovery'!
  - mrfusion 6y ago
    Do you have a source on the amount of other outcomes for the 0-49 group? I haven’t come across that data. I’d be curious.
    - rogerkirkness 6y ago
      ARDS is limited at this point almost exclusively to those over 75 with critical cases who happen to recover.
      - spaced-out 6y ago
        source?
seemslegit 6y ago
When your per-capita covid19 mortality rates are almost 200% of the US and almost 600% of Germany you need all the bafflement your citizens can buy.
rapjr9 6y ago
Personalized medicine has been a big deal lately, which makes me wonder if perhaps the "weirdness" of COVID-19 is only due to the fact that this disease is being studied at large scale, across the country and the world. It's already known that not everyone reacts to drugs the same way, why would we expect everyone to react to a disease the same way? Western medicine focused on it's successes with a one disease, one drug model, but just like it's obvious one drug doesn't always work for everyone, one disease could affect different people in different ways and could in fact manifest as several different diseases. Possibly if we had studied flu and colds at scale in the population we would have found a wide variety of reactions that would also surprise us. I also wonder why we seem to never have even tried to cure the flu and colds (there seem to be only a few tiny research groups studying either). We thought mapping the genome was impossible till we tried it. The variety of viruses causing flus and colds caused medicine to make the same claim, impossible to solve because it's so complex, but is it really that complex? We have 100 candidates for a vaccine for what is essentially a cold virus after a few months work. What if we'd started working on colds and flu seriously a few decades ago? Cold and flu cost society tens of billions each year, why have we lived with this disease burden for so long? I'm not an expert but the complexity seems less than that of decoding DNA. Is the fact that colds and flu only kill a few tens of thousands of people a year really a good reason not to eradicate them? The cost/benefit ratio here seems skewed because the benefit seems really high and the cost not so high. For one thing, it could have saved us from this, previous, and future pandemics which have enormous costs.
- Discombulator 6y ago
  I do not have answers or facts to offer, but I suspect they are similar in nature to those for the question of “why haven’t we solved security critical bugs? Why haven’t we just heavily invested in software verification? Etc.”

234 points by sjcsjc 6y ago

This might be a rant, but it would be awesome if these new findings lead to laws that required doctors to give accurate cause of death for people that also test positive for COVID. At least in Italy, doctors were pressured to put "COVID" as cause of death of people that were given 10 days to live because of cancer and other diseases, but also tested positive. Newspapers went as far as saying that a policeman that was shot by a colleague by accident and had been on a coma for 3 months was the country's youngest COVID victim, because allegedly he tested positive (of course, they failed to mention he had been shot and in a coma, other journalists exposed that lie). From what I read and understood, since in the US hospitals get reimbursed by number of patients doctors came out saying that they were pressured to put "COVID" as cause of death even without testing, just because it was presumed to be COVID because the symptoms matched. Unfortunately, politicians want power and businesses want to make money—and other people have their own agenda. This pandemic and been spun out of proportion by people that gain from it, at the expense of workers and most importantly small businesses, and at the advantage of China (and perhaps Amazon)—who are the only ones who are actually making money. I wish the world was less corrupt—or at least people that are given positions of power in good faith.

pjc50 6y ago
Citation for the shot police officer's name? People seem to have chosen bad faith attack media and elected bad faith leaders. That's why the US, UK, and Brazil are doing particularly badly.
- deleted 6y ago
  [deleted]
- snovv_crash 6y ago
  > That's why the US, UK, and Brazil are doing particularly badly. And Russia.
  - kmlx 6y ago
    And Italy, Spain, France, Germany, Sweden, Turkey, Iran, etc etc Does anyone know of any large country that managed to: - not lockdown - keep the disease under control ?
    - ekianjo 6y ago
      Japan maybe but it's unclear why at this stage.
      - bleuedejapan 6y ago
        One important aspect is that in Japan, there were no huge clusters in old folks homes. There are many others, but this is one of the most important.
      - newsbinator 6y ago
        Naively, could a factor be that in Japan wearing masks all the time was already normal practice, long before this pandemic?
        asiachick 6y ago
        No, people did not wear masks "all the time" nor did even "most" people wear masks. Go to any image search. Find images before February. (Search Hardly a mask in sight. They are common enough no one finds them strange but they weren't remotely the norm either. https://www.google.com/search?q=tokyo+crowded+before:2019-12-31&source=lnms&tbm=isch https://www.google.com/search?q=tokyo+crowded+before:2019-12... https://www.google.com/search?q=tokyo+station+crowded+before:2019-12-31&source=lnms&tbm=isch https://www.google.com/search?q=tokyo+station+crowded+before...
        newsbinator 6y ago
        By "all the time", I mean take any given adult in Tokyo and there's a good chance they have experience wearing a mask for a couple days every year. In Japan it's not only the immunocompromised or healthcare workers who have ever donned a mask: it's nearly everybody. You'd be hard-pressed to ride the metro and not see a handful of mask-wearers on any given Tuesday in recent years. Whereas in countries like the United States you'd rarely see masks outside of a serious medical setting, and you wouldn't be able to buy masks for a dollar at literally every corner shop within 100 meters of your home.
- black_puppydog 6y ago
  Yeah, seems like forming a national (or at least regional) consensus around basic facts like "this is dangerous and so we should really self-enforce some sort of social distancing" seems to be the main discriminating factor. Who'd have thought that being distracted with pointless discussions about what the weather was and where a shooting did or did not happen could be detrimental to your nation's (mental) health? <shrug>
- fwn 6y ago
  > People seem to have chosen bad faith attack media and elected bad faith leaders. That's why the US, UK, and Brazil are doing particularly badly. This is something we tend to assume somewhat intuitively, but I'd love to see some actual research on it. The relationship between weakened trust in media and a societies pandemic response performance is not a trivial research question. I wouldn't even necessarily trust the premise that overall trust declined. Could as well be perception or based on publisher selection. ... and that didn't jet include seriously operationalizing or discussing the nebulous "bad faith leaders" term or their relationship to pandemic response performance.
- nkkollaw 6y ago
  Sure, here it is: https://www.ilrestodelcarlino.it/bologna/cronaca/muore-di-covid-a-30-anni-%C3%A8-la-vittima-pi%C3%B9-giovane-1.5146701 https://www.ilrestodelcarlino.it/bologna/cronaca/muore-di-co... (this is the first result on Google, but it was all over the news). Title of the article: "Muore di Covid a 30 anni: è la vittima più giovane", which translates into "30-year-old dies of Covid, he's the youngest victim yet". Article starts with: "Dying younger than 30 for Coronavirus: a cruel fate, that of Michele Grauso, 29-year-old financier (he would have turned thirty in August)." Second paragraph, finally mentions the small detail that he had also been shot in the head and had been in a coma for 2 years: "He was hospitalized in a vegetative state in a private facility here in the city. A coma from which he had never come out since a partner in 2017 shot him in the head by mistake..." On TV, most news channels didn't even mention the coma. The family actually complained and it came out. Not sure if news want to be sensationalistic for clicks, or because they directly get paid to keep the level of panic high by whoever makes money from the emergency (which is many, many people in Italy). Probably both.
  - atentaten 6y ago
    There is no doubt fear mongering about this topic exists in the media. This shouldn't be surprising. The death coding is surprising, at least to me. This idea of coding deaths in this way is not limited to Italy, but is happening in many countries including the U.S. Dr. Deborah Brix replied to a reporter asking questions about death coding methods by saying that the U.S. was using liberal methods. In this article Professor Walter Riaccardi (scientific adviser to Italy’s minister of health), complains about such coding methods: https://www.telegraph.co.uk/global-health/science-and-disease/have-many-coronavirus-patients-died-italy/ https://www.telegraph.co.uk/global-health/science-and-diseas...
  - pjc50 6y ago
    So he'd been alive for two years in a coma? And presumably "stable"? And then contracts coronavirus and dies? It does sound like he'd have still been alive if he'd not contracted the virus.
    - nkkollaw 6y ago
DanBC 6y ago
> This might be a rant, but it would be awesome if these new findings lead to laws that required doctors to give accurate cause of death for people that also test positive for COVID. In England that law already exists. It's called the Coroners and Justice Act. http://www.legislation.gov.uk/ukpga/2009/25/contents http://www.legislation.gov.uk/ukpga/2009/25/contents You want to read about the reforms which arose out of the Shipman and Mid Staffs scandals (the Shipman Inquiry and the Francis Inquiry). You can read about those here: https://www.gov.uk/government/publications/changes-to-the-death-certification-process/an-overview-of-the-death-certification-reforms https://www.gov.uk/government/publications/changes-to-the-de...
- kmlx 6y ago
  Yes, in England there is no such thing as dying from old age. But this is still considered an official reason in Italy for example.
- iso947 6y ago
  There are three level of excess deaths in E+W Those that are defiantly covid Those that mention covid on the certificate Those in excess of level of normal deaths over last 5 years That puts covid deaths at between 40k and 70k. With an IFR across the country of between 1 and 2% based on the latest antibody tests. That’s disastrous and we can only hope that either the most vulnerable have been disproportionately exposed or the antibody tests are massively overreading false negatives.
  - jansan 6y ago
    Doesn't the third level also include those who died from the side effects caused by the lockdown?
    - iso947 6y ago
      Yes, hence the large gap in death estimation
- nkkollaw 6y ago

unityByFreedom 6y ago

clickbait..

nkkollaw 6y ago
It's called "journalism", nowadays.
- andybak 6y ago
  Clickbait when it contradicts your belief. Solid journalism when it confirms them.
  - nkkollaw 6y ago
    My comment has nothing to do with the content of the article. I meant that most of the headlines I see nowadays are clickbaity. This trend started 5 years ago or so, and it hasn't stopped. I guess it's just me.
codeisawesome 6y ago
Maybe the details of suffering they want to write are more graphic, but standards and the need to prevent public anxiety means that they write in a measured clinical-technical detail.
- api 6y ago
  Sticky blood, thrombosis, brain inflammation... not hard to read past the clinical language.
Jonnax 6y ago
Why is it clickbait? This article has quotes form doctors saying that the symptoms of COVID have been unexpected. ""We still don't really know why some patients feel OK to begin with, even though they have incredibly low levels of oxygen in their blood," says Prof Hugh Montgomery, a consultant in critical care at the Whittington Hospital in north London." " ""The volume of this is, of course, unprecedented in the era of modern medicine," says Ron Daniels, an intensive care consultant at hospitals in Birmingham. "But it's also the type of illness which is so distinct, and the way it's really different from almost every other patient that we've ever seen before."" "The main protein in the blood which forms blood clots is called fibrinogen. "Normally," says Beverley Hunt, "it's somewhere between two and four grams per litre in your blood. It goes up a bit in pregnancy, but what we're getting with Covid is as high as 10 to 14 grams per litre. I've never seen that in all my years as a doctor."" Honestly with this kind of detail and information, why is this clickbait?

akkawwakka 6y ago

The pathology of COVID-19 is really interesting. As the article describes, the viral pneumonia is well-described, but there are a lot of knock-on effects from infection of epithelial cells. Namely, virus binding to ACE2 receptors causes oxidative stress which can give rise to disease and cardiovascular events. MedCram did a really great video talking through some papers on this subject. [1] If you want to learn more, also check out This Week in Virology, a podcast that has been covering COVID-19 in great detail the last few months. It features a panel of virologists and other folks in the scientific field (immunologists, etc) plus a doctor reporting about the situation at a clinical level. [1]: https://youtu.be/Aj2vB_VITXQ https://youtu.be/Aj2vB_VITXQ

sradman 6y ago
Oxidative stress, why? I’m really confused at why we don’t think of the mechanics of this disease in terms of the cell and tissue types that express ACE2 receptors. ACE and ACE2 receptors regulate fluid pressure. ACE increases pressure by constricting tissue and ACE2 decreases pressure by dilating tissue. ACE2 receptors are found in the lungs, blood vessels, heart, kidneys, and gastrointestinal system. This makes sense and matches the pathogenesis of SARS-CoV. SARS-CoV-2 also infects the epithelial cells of the upper respiratory tract, like the cold-like HCoV-NL63. All the symptoms seem to match the spread of the virus to new tissue types. The timing matches too, with each new tissue type having an independent incubation period. Am I missing something? Children only seem to be susceptible to gastrointestinal infection which looks like Kawasaki’s disease when it spreads to adjoining blood vessels.
- droopyEyelids 6y ago
  Thats a lot of disputin' for not having clicked the attached explanation links.
pdkl95 6y ago
> MedCram did a really great video I also recommend the followup videos that continue looking into the theory he discussed in episode 63 (your [1]). In particular, episode 69's discussion[2] of glutathione in existing research related to oxidative stress is very interesting. Comparisons are made to acetaminophen (tylenol) toxicity. A very plausible hypothesis is presented that high dose NAC (N-Acetylcysteine) might be a treatment for (some of) COVID-19's worst effects. NAC is obviously interesting as an antioxidant, but MedCram found a few papers that suggest it might also be important as a way to break the disulfide bonds cross-lining von Willebrand factor that seems to be causing a strokes and other thrombosis-related problems in the worst COVID-19 patients. Obviously this is all very speculative an turning these hypothesis into something practically useful will require a lot of work. However, as someone with multiple of the serious risk factors[3] for COVID-19, the last few months has mostly been hoping I can avoid dying from the virus before a vaccine is available. The ACE2/glutathione/NAC hypothesis is the first time 3rd option - an effective treatment - has seemed... plausible. [2] https://www.youtube.com/watch?v=Dr_6w-WPr0w https://www.youtube.com/watch?v=Dr_6w-WPr0w [3] diabetes, heart failure and cardiomyopathy from too many years of high-BP and bad sleep apnea (AHI=148)

OJFord 6y ago

Naïvely I would think factor v Leiden defect (prone to clotting, DVTs) would be a risk factor, but I understand it's most prevalent in white Europeans and Americans, which is somewhat the opposite of covid's (suspected vitamin D related) bias. Has anyone seen any studies mention it, or otherwise know that it's a silly suggestion that wouldn't be worth studying? On second thoughts I think it raises the clotting risk particularly in the event of severe blood loss, so maybe that's it. Covid patients are clotting but for unrelated reasons?

deleted 6y ago
[deleted]
robbiep 6y ago
You’re choosing a narrow band of the population. Undoubtedly there are thousands of groups out there who, by way of genotype, phenotype or lifestyle, are at higher risk. Teasing these all out is going to be the work of the next decade. It’s all in the last paragraph - (to paraphrase) ‘we’re having to learn in months what we’ve had hundreds of years to learn about other diseases’ When I was at Med school I naively thought ‘there will be no new pathophysiology’ - we knew all the continents and had mapped most of the interiors, in varying levels of detail. This is an entirely new continent. (So was vaping associated lung injury actually) It’s fascinating
- OJFord 6y ago
  It's not that narrow among aforementioned populations though - 15% iirc. Enough that (again, as a naïve layman) I'd have thought it would be noticed or considered when discussing clotting and DVT/PEs? And enough to have an counteracting impact on the opposite African/Caucasian divide that's actually being seen - not to say that they couldn't coexist, but that if so it'd make the latter even more dramatic.
  - robbiep 6y ago
    From UpToDate: In the general population without a personal history of VTE, a study involving 1690 unrelated individuals from Europe found a prevalence of FVL of approximately 4 percent, and a study involving 356 individuals from Canada found an incidence of approximately 5 percent [47,48]. In a series of 4047 men and women participating in the Physicians' Health Study and the Women's Health Study (both in the United States), the following frequencies for FVL heterozygosity were found [49]: ●Caucasians – 5.3 percent ●Hispanic Americans – 2.2 percent ●Native Americans – 1.2 percent ●African Americans – 1.2 percent ●Asian Americans – 0.45 percent A higher prevalence of FVL (12 to 14 percent) has been reported in populations in parts of Greece, Sweden, and Lebanon Compared to a more likely cause for thrombophilia in the patient population, ie inflammatory response, endothelial damage, up regulation of clotting factors; I think focusing on factor V Leiden (and I’m speaking just as a clinician, not as someone who has had to work with covid patients, we’ve had relatively SFA here in Australia thankfully) is a footnote. And any patient who is admitted is going to be on anticoagulants anyway, nullifying most of any procoagulant effect of FVL in hospitalised patients. It might show up in the data, it might be a footnote, but treatment would be covered under normal VTE prophylaxis (and seems like many protocols are now stepping up fairly significantly the prophylaxis regime)

Xcelerate 6y ago

Anyone know the SNPs for ACE2 expression? Curious which variant I have...

rogerkirkness 6y ago
More complex than having "more" or "less" because while the presence of certain SNPs would mean more expression by default, the presence of the virus downregulates them, which means you could tolerate "more" virus. SNPs: rs4646127, rs1996225, rs2158082, rs4830974. Source: https://selfdecode.com/blog/article/ACE2-coronavirus-128 https://selfdecode.com/blog/article/ACE2-coronavirus-128

lorsting 6y ago

Every anti-opinion in the comments was [flagged]. I guess this is done by algorithms. Only the anti-anti-opinion comments survived. That above is the main issue with this disease.

pjc50 6y ago
No, the situation is that everyone is fed up with contrarians and downvotes them on sight. Cautious well evidenced dissent should still get through.

phyzome 6y ago

Doctors often want to keep pneumonia patients "dry", that is, somewhat dehydrated. (That's maybe contributing to the kidney failure.) To what extent could this also be resulting in increased clotting?

nickthemagicman 6y ago
Yes something is off here. Corona is totally respiratory virus.
- JoeAltmaier 6y ago
  That seems untrue. Corona attacks almost every organ.
  - nickthemagicman 6y ago
    You should totally check out Wikipedia or some factual scientific source instead of listening to the news. Science is a candle in the dark.
    - JoeAltmaier 6y ago
      I gotta think this is a bot or troll response? So obviously wrong and argumentative.
      - nickthemagicman 6y ago
        I'm not wrong you should open up your mind to the fact that you're wrong. There's hundreds of coronavirus and they're all respiratory viruses. Arrogant ignorance is no way to go through life son.
        DanBC 6y ago
        > There's hundreds of coronavirus and they're all respiratory viruses. How many coronaviruses can infect humans?

mrfusion 6y ago

These articles can certainly be scary. It might be good to keep the risks in mind too. “for people 49 and under, the agency [CDC] estimated that 0.05% of symptomatic people will die.” https://www.cnn.com/2020/05/22/health/cdc-coronavirus-estimates-symptoms-deaths/index.html https://www.cnn.com/2020/05/22/health/cdc-coronavirus-estima...

PragmaticPulp 6y ago
> for people 49 and under It’s always easy to downplay the risks if you start excluding the most vulnerable.
- glofish 6y ago
  vice versa, it is just as easy to exaggerate the risks if you report and extrapolate from the subset of the worst cases,
droopyEyelids 6y ago
That would be comforting if the outcomes were limited to 'death' or 'full recovery'!
- mrfusion 6y ago
  Do you have a source on the amount of other outcomes for the 0-49 group? I haven’t come across that data. I’d be curious.
  - rogerkirkness 6y ago
    ARDS is limited at this point almost exclusively to those over 75 with critical cases who happen to recover.
    - spaced-out 6y ago
      source?

seemslegit 6y ago

When your per-capita covid19 mortality rates are almost 200% of the US and almost 600% of Germany you need all the bafflement your citizens can buy.

rapjr9 6y ago

Personalized medicine has been a big deal lately, which makes me wonder if perhaps the "weirdness" of COVID-19 is only due to the fact that this disease is being studied at large scale, across the country and the world. It's already known that not everyone reacts to drugs the same way, why would we expect everyone to react to a disease the same way? Western medicine focused on it's successes with a one disease, one drug model, but just like it's obvious one drug doesn't always work for everyone, one disease could affect different people in different ways and could in fact manifest as several different diseases. Possibly if we had studied flu and colds at scale in the population we would have found a wide variety of reactions that would also surprise us. I also wonder why we seem to never have even tried to cure the flu and colds (there seem to be only a few tiny research groups studying either). We thought mapping the genome was impossible till we tried it. The variety of viruses causing flus and colds caused medicine to make the same claim, impossible to solve because it's so complex, but is it really that complex? We have 100 candidates for a vaccine for what is essentially a cold virus after a few months work. What if we'd started working on colds and flu seriously a few decades ago? Cold and flu cost society tens of billions each year, why have we lived with this disease burden for so long? I'm not an expert but the complexity seems less than that of decoding DNA. Is the fact that colds and flu only kill a few tens of thousands of people a year really a good reason not to eradicate them? The cost/benefit ratio here seems skewed because the benefit seems really high and the cost not so high. For one thing, it could have saved us from this, previous, and future pandemics which have enormous costs.

Discombulator 6y ago
I do not have answers or facts to offer, but I suspect they are similar in nature to those for the question of “why haven’t we solved security critical bugs? Why haven’t we just heavily invested in software verification? Etc.”