Thread by @hussmanjp

THREAD: Pinning prior #COVIDー19 updates & adding below. If they're helpful, PLEASE RETWEET.

What would you do if you if you reasonably expected ~30 days grace for acute health system preparedness, including staffing, production of supplies, and primary/secondary medications?

https://twitter.com/hussmanjp/status/1235906203886157824

One way some dismiss #SARSCov2 (#COVIDー19) risk is by arguing about the "true" fatality rate. Stop it. Even two weeks of exponential growth overwhelms the effect of any plausible ascertainment ratio between actual/reported cases. We're losing time for health system readiness.

An interim approach for #SARSCoV2 (#COVIDー19) testing when PCR is not available: antibody response. "Seroconversion (antibody presence) sequentially appeared for total Ab, IgM, then IgG at 11, 12 and 14 days, rapidly increasing between 7-15 days of onset" researchgate.net/publication/33…

I'm generally "pro-vaccine" but careful testing is needed before rolling one out for #SARSCoV2 (#COVID2019) where antibody-dependent enhancement (ADE) can increase viral entry via Fc receptors on subsequent challenge. Interim alternatives remain critical. ncbi.nlm.nih.gov/pubmed/25073113

Sharing updated notes and references for the #COVIDー19 research community. "SARS" may not be specific to #SARSCov2. Prospective interventions are only suggestive until supported by controlled trials. As in other conditions, it's important to nail down the molecular pathways.

This is what leadership looks like.

https://twitter.com/gatesfoundation/status/1237227970802008064

1) At the current rate of expansion, even two weeks of case growth overwhelm any debate about ascertainment rates.
2) Containment can help, but we need more focus on health-system preparedness (primary/secondary meds, triage prep, public information, acute care). See thread.

What we need is outcome data & rapid, controlled clinical trials of interventions that may be helpful against late-stage respiratory failure. Sufficient statistical power in new cases. Posting my updated research observations on potential points of #SARSCoV2 pathway intervention.

Oh [expletive deleted].

Posted this on March 5th as an out-of-sample test. Distressed that the growth/fatality assumptions were too conservative.

Two weeks of growth makes question of "true" case fatality rates moot. Need health-system preparedness.

https://twitter.com/hussmanjp/status/1235756698402516992

Here's what's going on. As new cases are reported, matched fatalities haven't come in yet. So rapid growth of new cases tends to understate the CFR. Clearly, underreporting cases has the opposite effect and overstates the "true" CFR. The rate below still applies to reported cases

Look. Containment efforts remain important. PCR testing remains important. But with >300 distinct nodes, the genie is out of the bottle.

We have ~30 days for health care system preparedness (primary/secondary meds, ventilators, triage planning, accurate public info). See thread.

Plausible approach along ACE2 axis of #SARSCoV2 disease pathway (see research notes earlier in this thread). Need rapid, controlled trials for any proposed therapeutics. Key phrase in this study: cell.com/cell/fulltext/…
"inhibited but not abrograted."

medicalxpress.com/news/2020-03-s…

An observation on #SARSCoV2 (#COVIDー19)

The mortality rate of a SARSCoV2 case, the moment it's reported, regardless of severity, is already nearly half the mortality rate of a seasonal flu case that's already been admitted to the hospital (CDC).

This is not the flu. Stop it.

An excerpt from an email shared with me by one of the most brilliant global health experts I know. Advice to his own family, and now yours. Containment, health-system preparedness, and accurate public guidance (e.g. self-care, self-report, self-quarantine for nonemerg) are vital.

Brief Report: Hospital Emergency Management Planning During the #COVIDー19 Epidemic - useful considerations involving online triage, initial examination and classification, case separation, risk prioritization, and minimizing potential cross-infection. onlinelibrary.wiley.com/doi/epdf/10.11…

Estimated incubation period of #SARSCoV2 (#COVIDー19) ~ 5 days. 97.5% of those who develop symptoms do so within 11.5 days. Only ~1% develop symptoms after 14 days of active monitoring or quarantine.
ncbi.nlm.nih.gov/pubmed/32150748

Fever (91.7%), cough (75.0%), fatigue (75.0%), and gastrointestinal (39.6%) were the most common clinical manifestations in #SARSCoV2 (#COVIDー19). Hypertension (30.0%) and diabetes (12.1%) were the most common co-presenting conditions. ncbi.nlm.nih.gov/pubmed/32077115

This is just outstanding.

https://twitter.com/politvidchannel/status/1238151184340271104

Morning research correspondence. For anyone who imagines I take joy in the current environment, this is what I'm actually thinking about outside of market hours, starting about 5 am.

There's very good work being done. Containment is important, and preparedness is essential.

Cough into your elbow, wash your hands after touching surfaces, and try to avoid small rooms where someone has recently been sick.

This article is a preprint of a research letter. Charts on log scale. Decay is exponential (which is good) but not instant

https://twitter.com/jdronaldson/status/1238681881794707456

A few details on this. #COVIDー19 (#SARSCoV2) is in red. SARSCoV1 (what we just call "SARS") is blue. COVID19 is less easily sent into the air than SARS, but similar on surfaces.

Charts are log scale, (1000, 100, 10, 1) so there's a ~50% decline after ~an hour, but not to zero.

This article by @Harry_Stevens at WaPo is a MUST read. The graphics are brilliant. Social distancing beats lockdowns because with an R0 of ~2.6, stabilizing cases would need 1-1/2.6 = 62% of potential contacts to be contained. See my threads for more.
washingtonpost.com/graphics/2020/…