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Old 23rd April 2020, 12:56 PM   #481
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Quote:
About half of the sailors on the aircraft carrier who tested positive were asymptomatic.
Were they in fact asymptomatic, or did they just claim to be?

Being actually asymptomatic, is a good reason to say you are..
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Old 23rd April 2020, 01:01 PM   #482
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Originally Posted by Giordano View Post
What really puzzles me about the apparently high prevalence of anti-covid-19 antibodies in NYC and California is of course they suggest a very high number of asymptotic cases vs symptomatic and lethal cases. Yet that seems absolutely counter to data from cases such as cruise ships, where entire closed populations were screened for covid-positivity by rtPCR and a high death rate was established. I presume the South Koreans, with their extensive rtPCR testing, would also have discovered wide spread asymptomatic cases.

And yes I understand that rtPCR detects active infections vs. antibody tests showing prior exposures. But under circumstances such as the cruise ships the rtPCRshould have detected asymptomatic infections too.
Yeah, and that's why I had been skeptical of antibody tests. Especially the Stanford one which really did a bad job on the stats.

It's also odd that the choir group of 60 members had 2 deaths, 28 positive tests, 45 people with Covid-19 symptoms within 3 weeks of their 3 hr choir practiced.

One possible explanation is that the exposure titer varies greatly and impacts the probability of even showing symptoms not to mention mortality rates. PCR tests have a high false negative rate and almost all are given only to people showing significant symptoms. I haven't seen any studies that have tracked negative PCR tests where a month later were serologic positive. Would be a valuable study.
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Old 23rd April 2020, 01:07 PM   #483
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One possible explanation of the inconsistencies is that we are seeing the differences between at least two different strains.
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Old 23rd April 2020, 01:09 PM   #484
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I strongly recommend this BBC podcast, and from 29:30 how this crisis was totally avoidable by simply closing the wet markets.
And for anyone who suggests this was not possible they forget China makes everything possible where appropriate.

https://www.bbc.co.uk/programmes/w3cszh06

Rule out human error.

Rule in human idiocy, we deserve everything we got.
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Old 23rd April 2020, 01:09 PM   #485
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Originally Posted by Giordano View Post
What really puzzles me about the apparently high prevalence of anti-covid-19 antibodies in NYC and California is of course they suggest a very high number of asymptotic cases vs symptomatic and lethal cases. Yet that seems absolutely counter to data from cases such as cruise ships, where entire closed populations were screened for covid-positivity by rtPCR and a high death rate was established. I presume the South Koreans, with their extensive rtPCR testing, would also have discovered wide spread asymptomatic cases.
People with antibodies do not imply people with asympotic case. It can just mean poor testing or people afraid to go to the doctor. On the ship everybody was tested.
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Old 23rd April 2020, 01:10 PM   #486
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Originally Posted by Skeptical Greg View Post
Were they in fact asymptomatic, or did they just claim to be?

Being actually asymptomatic, is a good reason to say you are..
My guess is that military personnel on a ship at sea would be more likely to report mild symptoms than would civilians, so I would expect there to be a lower percentage of asymptomatic cases in military settings.
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Old 23rd April 2020, 01:11 PM   #487
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Originally Posted by Doghouse Reilly View Post
Wow, amazing and convincing reply.
Dude, you haven't posted **** supporting your claims except opinion, mostly yours. You have shown no indication you are having an honest discussion here. You make unsupported claims and now you say I need to refute them?

I don't think so.
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Old 23rd April 2020, 01:12 PM   #488
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Originally Posted by Doghouse Reilly View Post
Exactly. So why is he speculating in an authoritative manner meant to instill fear?
Apples and oranges. Speculating about next winter is unrelated to the serious pandemic we have today.
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Old 23rd April 2020, 01:14 PM   #489
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Originally Posted by casebro View Post
and the inverse, CA's results are confirmed too. Good for us Californians. Likewise Texans, Indianians, Italians....

Though my google-fu is lacking. I haven't found which test NT used, so no false + rate.
It makes sense given what we see on the surface (known cases and deaths) that NYC would have a much higher rate than S Cal.

This is not yet homogeneously spread throughout the country.
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Old 23rd April 2020, 01:17 PM   #490
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Originally Posted by Ambrosia View Post
Edited to move my reply to this over to it's own thread here.
Good idea. Thanks.
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Old 23rd April 2020, 01:26 PM   #491
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Originally Posted by TellyKNeasuss View Post
...
My possibly/probably ignorant question is: can a person be exposed to enough virus particles to develop antibodies without having a sufficient amount to show up as a positive on a PCR test?
They would need to develop infection in order to develop antibodies.

What can happen with a mild or completely asymptomatic case is the window for which the PCR is positive is narrow.
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Old 23rd April 2020, 01:27 PM   #492
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Originally Posted by casebro View Post
...more than 10 times the state's confirmed ...
That's more like it - if you check all the way back to thread 1.0, the 10 times rate has been fairly obvious since then.

Which still makes it much worse than a seasonal 'flu, and clearly, with vastly more people impacted.

Originally Posted by Giordano View Post
What really puzzles me about the apparently high prevalence of anti-covid-19 antibodies in NYC and California is of course they suggest a very high number of asymptotic cases vs symptomatic and lethal cases.
I don't think that's obvious at all - I think it merely emphasises what's been said all the way: there are a lot of mildly symptomatic cases, a sore throat, bit of a cough... Those people may not have even thought of being tested for Covid when the TV keeps showing pictures of bodies piling up in NY, Italy & Spain.
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Old 23rd April 2020, 01:29 PM   #493
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Originally Posted by marting View Post
Yeah, and that's why I had been skeptical of antibody tests. Especially the Stanford one which really did a bad job on the stats.

It's also odd that the choir group of 60 members had 2 deaths, 28 positive tests, 45 people with Covid-19 symptoms within 3 weeks of their 3 hr choir practiced.

One possible explanation is that the exposure titer varies greatly and impacts the probability of even showing symptoms not to mention mortality rates. PCR tests have a high false negative rate and almost all are given only to people showing significant symptoms. I haven't seen any studies that have tracked negative PCR tests where a month later were serologic positive. Would be a valuable study.
Two more likely reasons are one) the PCR tests were done in that narrow window, and two) the demographics of the choir included more high risk people.
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Old 23rd April 2020, 01:32 PM   #494
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Originally Posted by Pixel42 View Post
One possible explanation of the inconsistencies is that we are seeing the differences between at least two different strains.
[Takes a breath to calm down.]

There is no evidence of that! Other people are making this claim too. It's unsupported made up stuff!

There are several clades, none of which are consistently associated with more or less virulent cases. And mild and severe cases are occurring in single populations.
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Old 23rd April 2020, 01:34 PM   #495
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Originally Posted by Skeptic Ginger View Post
They would need to develop infection in order to develop antibodies.

What can happen with a mild or completely asymptomatic case is the window for which the PCR is positive is narrow.

We had that one employee with a positive PCR. Completely asymptomatic. We did an Igm/Igg which showed positive Igm only. She is still, now about 4 weeks later, showing positive on the PCR, 2 tests a week apart. So I think this is still very much up in the air. We havenít let her come back to work until she has 2 negative PCRs, according to CDC guidelines.

A question about the antibody tests: isnít it possible that there are a lot of false positives if the test is reacting with other coronavirus antibodies? IOW, given that the tests have not been thoroughly and independently validated, can we make any conclusions based on studies that use them?
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Old 23rd April 2020, 01:34 PM   #496
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This one seems different than the standford study but seems just as flawed, has someone dealt with it yet?

https://news.usc.edu/168987/antibody...iXOXMaXJLqZuTQ
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Old 23rd April 2020, 01:36 PM   #497
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Originally Posted by Samson View Post
I strongly recommend this BBC podcast, and from 29:30 how this crisis was totally avoidable by simply closing the wet markets.
And for anyone who suggests this was not possible they forget China makes everything possible where appropriate.

https://www.bbc.co.uk/programmes/w3cszh06

Rule out human error.

Rule in human idiocy, we deserve everything we got.
On big giant problem with that: If the trade didn't happen in a single market, it would move to smaller markets.

People in much of rural China, and rural Africa, live in very close proximity to their domestic animals. In other countries including the US, we have crowded domestic animal populations.

Both are conducive to the emergence of zoonotic diseases.
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Old 23rd April 2020, 01:38 PM   #498
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Originally Posted by Skeptic Ginger View Post
Two more likely reasons are one) the PCR tests were done in that narrow window, and two) the demographics of the choir included more high risk people.
I would hope that they are doing serological tests on a sample from the Diamond Princess. They tested everyone and the death rate of positive PCR tests has climbed to 1.8%. However, they do also skew older but cruise ships passengers tend to be somewhat healthier relative to others in their age group. Nursing home residents don't go on cruises and they are a pretty large part of covid deaths.

It wouldn't surprise me if a fair chunk (like possibly 30-50%) of all the ones that tested negative are antibody positive.
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Old 23rd April 2020, 01:39 PM   #499
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Quote:
https://jamanetwork.com/journals/jam...tm_term=042220

.....The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%)......
Upthread someone had posted that hypertension is in 72 % of oldsters. If it is in only 56% of covid vicitms, it is protective, not a comorbidity. Same for the obesity etc. The linked article is an abstract, it just came out today. I don't know if the whole paper is around with the percentage of asthma. But what if no asthma = much less death?
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Old 23rd April 2020, 01:40 PM   #500
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Originally Posted by Dr.Sid View Post
People with antibodies do not imply people with asympotic case. It can just mean poor testing or people afraid to go to the doctor. On the ship everybody was tested.
Again a small closed population (meaning you can find everyone in a timely manner) means testing people within a narrow window of infection.

There was probably also repeat testing.

What we need to know is how many sailors testing positive developed symptoms and during what timeframe, not just who had symptoms before testing.

We need a good MMWR report on outbreak on the ship. That will take time.
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Space Force.
Because feeding poor people is socialism.

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Old 23rd April 2020, 01:41 PM   #501
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Originally Posted by pipelineaudio View Post
This one seems different than the standford study but seems just as flawed, has someone dealt with it yet?

https://news.usc.edu/168987/antibody...iXOXMaXJLqZuTQ
Yeah, I commented on it earlier. Because the serologic positive tests significantly exceeded the outer bands of the test's false positive rate it was more meaningful than the Stanford test.

It's also pretty consistent with the new NY state tests and relative difference in case and death rates.
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Old 23rd April 2020, 01:43 PM   #502
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Originally Posted by casebro View Post
Upthread someone had posted that hypertension is in 72 % of oldsters. If it is in only 56% of covid vicitms, it is protective, not a comorbidity. Same for the obesity etc. The linked article is an abstract, it just came out today. I don't know if the whole paper is around with the percentage of asthma. But what if no asthma = much less death?
So if you are old, fat and smoke you are better off than just old?
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Old 23rd April 2020, 01:50 PM   #503
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Originally Posted by xjx388 View Post
We had that one employee with a positive PCR. Completely asymptomatic. We did an Igm/Igg which showed positive Igm only. She is still, now about 4 weeks later, showing positive on the PCR, 2 tests a week apart. So I think this is still very much up in the air. We haven’t let her come back to work until she has 2 negative PCRs, according to CDC guidelines.

A question about the antibody tests: isn’t it possible that there are a lot of false positives if the test is reacting with other coronavirus antibodies? IOW, given that the tests have not been thoroughly and independently validated, can we make any conclusions based on studies that use them?
First, I'm glad to see you are double testing.

You shouldn't see IgM if it is from past coronavirus infection crossover.

There are a lot of things we are only learning slowly about this disease. One of them is that some people have had relapsing fever after a week of being well. Another is not everyone clears the virus along with cleared symptoms. Many people are testing positive again after being symptom free and testing negative.

It's not really that unusual. This is true of a lot of pathogens actually. Viral shedding can occur before symptoms, during symptoms, after symptoms and combinations of the patterns.

We use this very crude measure of letting people return to work after URIs when they are no longer febrile. There are no studies to back that up, and the studies would be impractical anyway because there are more than 200 known different respiratory pathogens and less than half have been specifically identified.
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Space Force.
Because feeding poor people is socialism.

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Old 23rd April 2020, 01:56 PM   #504
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Originally Posted by pipelineaudio View Post
This one seems different than the standford study but seems just as flawed, has someone dealt with it yet?

https://news.usc.edu/168987/antibody...iXOXMaXJLqZuTQ
Yep, discussed upthread.
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Old 23rd April 2020, 02:00 PM   #505
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Originally Posted by marting View Post
I would hope that they are doing serological tests on a sample from the Diamond Princess. They tested everyone and the death rate of positive PCR tests has climbed to 1.8%. However, they do also skew older but cruise ships passengers tend to be somewhat healthier relative to others in their age group. Nursing home residents don't go on cruises and they are a pretty large part of covid deaths.

It wouldn't surprise me if a fair chunk (like possibly 30-50%) of all the ones that tested negative are antibody positive.
I don't know. I have zero faith that any kind of decent public health consulting was done on those cruise ships despite the companies' claims. I would not make much of the data from any of the cruise ships.

Even people released after two weeks quarantine was bizarre if not followed by two more weeks of quarantine on land. There was no evidence the cruise ships properly managed their crew outbreaks. Passengers could have been infected their last days on the ships.
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Space Force.
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Old 23rd April 2020, 02:07 PM   #506
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Originally Posted by Skeptic Ginger View Post
[Takes a breath to calm down.]

There is no evidence of that! Other people are making this claim too. It's unsupported made up stuff!

There are several clades, none of which are consistently associated with more or less virulent cases. And mild and severe cases are occurring in single populations.
It was just a thought.
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Old 23rd April 2020, 02:13 PM   #507
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Originally Posted by Ambrosia View Post
No it isn't.

Smoking is highly addictive. Nicotine not so much.

Smoking is nicotine and all the other chemicals and the rituals and the hand to mouth action and a whole raft of other things. It gets really complicated and it's far too easy to reduce things to simple soundbites.

If nicotine was the main reason for smoking addiction, then NRT would be a very effective treatment, and it's not. There's a lot more to it than that.
Part of getting over an addiction is not just stopping using the substance, it's also dealing with the rituals and activities associated with it. When I quit drinking, my therapist gave me advice on how to avoid activities, people and places associated with my drinking. That doesn't mean that alcohol isn't addictive and that I wasn't addicted to it, just that there's more to addiction that the addiction to the substance itself. Nicotine is most certainly addictive, but getting over nicotine addiction also means changing your habits so that you also replace the activities involved with smoking with something else. Addiction is a complicated business, and it's very wrong to say that nicotine is not an addictive substance.
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Old 23rd April 2020, 02:33 PM   #508
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Originally Posted by Skeptic Ginger View Post
I don't know. I have zero faith that any kind of decent public health consulting was done on those cruise ships despite the companies' claims. I would not make much of the data from any of the cruise ships.
Such a missed opportunity. So much that could have been learned and helped the World earlier on.
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Old 23rd April 2020, 02:41 PM   #509
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Originally Posted by marting View Post
SYeah, I commented on it earlier. Because the serologic positive tests significantly exceeded the outer bands of the test's false positive rate it was more meaningful than the Stanford test.

It's also pretty consistent with the new NY state tests and relative difference in case and death rates.
What's the real takeways though? It seems to be a self selected group of drive up tests from what I read and still a very small number in a very specific place. WHat does it tell us, or what does it likely tell us?
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Old 23rd April 2020, 03:13 PM   #510
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Originally Posted by Giordano View Post
What really puzzles me about the apparently high prevalence of anti-covid-19 antibodies in NYC and California is of course they suggest a very high number of asymptotic cases vs symptomatic and lethal cases. Yet that seems absolutely counter to data from cases such as cruise ships, where entire closed populations were screened for covid-positivity by rtPCR and a high death rate was established. I presume the South Koreans, with their extensive rtPCR testing, would also have discovered wide spread asymptomatic cases.

And yes I understand that rtPCR detects active infections vs. antibody tests showing prior exposures. But under circumstances such as the cruise ships the rtPCRshould have detected asymptomatic infections too. Unless in most individuals covid-19 replicates so minimally to avoid detection by rtPCR yet enough to induce a detectable immune response. It will be very important to find out if these immunopositives are protected from subsequent infections.
One thing leading to a high death rate on the cruise ships is probably the age of the cruise ship population.
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Old 23rd April 2020, 03:13 PM   #511
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Originally Posted by Skeptic Ginger View Post
First, I'm glad to see you are double testing.

You shouldn't see IgM if it is from past coronavirus infection crossover.

There are a lot of things we are only learning slowly about this disease. One of them is that some people have had relapsing fever after a week of being well. Another is not everyone clears the virus along with cleared symptoms. Many people are testing positive again after being symptom free and testing negative.

It's not really that unusual. This is true of a lot of pathogens actually. Viral shedding can occur before symptoms, during symptoms, after symptoms and combinations of the patterns.

We use this very crude measure of letting people return to work after URIs when they are no longer febrile. There are no studies to back that up, and the studies would be impractical anyway because there are more than 200 known different respiratory pathogens and less than half have been specifically identified.

I had that backwards. IGg was positive, not IGm. Sorry.

Itís just very difficult for us to wade through all the stuff floating around so we are trying to err on the side of caution. The docs have decided that since the PCR is positive itís very possible she is still shedding. I think that makes sense.
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Old 23rd April 2020, 03:18 PM   #512
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Originally Posted by pipelineaudio View Post
What's the real takeways though? It seems to be a self selected group of drive up tests from what I read and still a very small number in a very specific place. WHat does it tell us, or what does it likely tell us?
The LA USC study of LA County "random" peeps (it was people randomly selected from a marketing email list that agreed to be tested) didn't make sense in that it suggested a very large group of infected people re the known caseload and deaths in the county.

However, it turns out to be consistent with NY. It also suggests that the IFR isn't significantly different between East coast strains and West coast strains that looked to be a possible explanation earlier.

All in all, relatively good news.
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Old 23rd April 2020, 03:20 PM   #513
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Originally Posted by xjx388 View Post
A question about the antibody tests: isnít it possible that there are a lot of false positives if the test is reacting with other coronavirus antibodies? IOW, given that the tests have not been thoroughly and independently validated, can we make any conclusions based on studies that use them?
This is something I'm wondering about, too. I have seen reports elsewhere that antibody tests may not distinguish between covid-19 and the older coronaviruses that cause the common cold. So for example, someone had a common cold this winter from one of those four coronaviruses, still has antibodies from that, and when tested for covid.-19 now shows a positive result. Is this a thing?
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Old 23rd April 2020, 03:28 PM   #514
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Originally Posted by Pixel42 View Post
It was just a thought.
That's OK, it wasn't personal. I know other people are repeating it, a lot.

The same way people are repeating claims like, since flu is seasonal it's a given this will be too and it's mutating into a milder form because we see some mild cases. And the vaccine won't work because we have trouble developing a flu vaccine that works for very long.

There are hundreds of other viral pathogens, many of which are respiratory. Why should anyone expect this one to have similarities with the influenza virus. On what basis is that?
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Old 23rd April 2020, 03:30 PM   #515
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Originally Posted by marting View Post
Such a missed opportunity. So much that could have been learned and helped the World earlier on.
Yep.
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Old 23rd April 2020, 03:36 PM   #516
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Originally Posted by xjx388 View Post
I had that backwards. IGg was positive, not IGm. Sorry.

It’s just very difficult for us to wade through all the stuff floating around so we are trying to err on the side of caution. The docs have decided that since the PCR is positive it’s very possible she is still shedding. I think that makes sense.
So IgG and no IgM suggests a resolved infection PROVIDED the antibody tests really do have the sensitivity and specificity the manufacturers' claim. But we know they have done very few studies on very small subjects to determine that sensitivity and specificity.

I have not read anything suggesting crossover positivity with other coronaviruses. Doesn't mean anyone looked.

If the manufacturers have isolated antibodies from other viruses they used in testing their products that would be interesting data to see.

This manufacturer's insert acknowledges the fact cross reactivity can be occurring.

https://www.fda.gov/media/136963/download

Probably a standard disclaimer.


Useful for further reading, small but very precise samples:

https://wwwnc.cdc.gov/eid/article/26/7/20-0841_article
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Old 23rd April 2020, 03:54 PM   #517
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Northwell Hospitals runs 12 hospitals in NY City. They published a few statistics on the people admitted to their hospitals (statistics are only for those who have either been discharged or died):
average age was 63
60% were men
40% were "obese"
57% had hypertension
34% were diabetic
20% died
88% of those put on ventilators died
And the most surprising statistic: 70% did NOT have a fever when admitted

The long version: https://jamanetwork.com/journals/jam...rticle/2765184

The short version:
https://www.washingtonpost.com/healt...tors-survival/
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Old 23rd April 2020, 03:58 PM   #518
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Originally Posted by Skeptic Ginger View Post
That's OK, it wasn't personal. I know other people are repeating it, a lot.

The same way people are repeating claims like, since flu is seasonal it's a given this will be too and it's mutating into a milder form because we see some mild cases. And the vaccine won't work because we have trouble developing a flu vaccine that works for very long.

There are hundreds of other viral pathogens, many of which are respiratory. Why should anyone expect this one to have similarities with the influenza virus. On what basis is that?
At this point I think we are just crossing our fingers and hoping for both of those things, that it is seasonal and/or it mutates into a less virulent strain. While we don't yet have evidence for either of these things, it wouldn't be that surprising given the track record of other viruses.
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Old 23rd April 2020, 04:21 PM   #519
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Originally Posted by marting View Post
So if you are old, fat and smoke you are better off than just old?
Yes, it looks that way. BMI over 40 is a risk factor, but only for those younger than 60. Looks like Syndrome X may be protective, or may be a wash. Is there is some other confounder in the old, or is it just age?

eta: Poor athletic condition? / cardiovascular condition?
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Old 23rd April 2020, 04:28 PM   #520
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Originally Posted by casebro View Post
Yes, it looks that way. BMI over 40 is a risk factor, but only for those younger than 60. Looks like Syndrome X may be protective, or may be a wash. Is there is some other confounder in the old, or is it just age?

eta: Poor athletic condition? / cardiovascular condition?
It's probably that obesity's risk in the elderly is overwhelmed by other properties.
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