[vivek95]

Found this data from Singapore. The chart is so neat and classified with all the essential details. Singapore is a little behind India with 732 positive cases till date. Enlarge the image for better readability.

-- Dr. Vivek

[charanreddy]

https://www.newindianexpress.com/sta...y-2120843.html

Look at this ! Heights of carelessness by a top police officer. Apparently this DSP bypassed quarantine procedure for his son and then engaged in a tour of relatives and feasts and finally tested positive.

[dailydriver]

Originally Posted by vivek95

fingers crossed

Asking this from a layman's perspective.

What happens to the virus after it has been inside a person for say 14 or 21 days without causing him much damage?

If the infected guy remains asymptomatic and therefore stays outside of the testing system, he wouldn't even know that he has had this viral infection. Ergo, he wouldn't get treated. The virus wouldn't be killed with medicines.

Can he infect others even after 14/ 21 days (basically, after the incubation period) or does the virus somehow lose its transmission power after being defeated by the body's immune system?

[AltoLXI]

Originally Posted by dailydriver

What happens to the virus after it has been inside a person for say 14 or 21 days without causing him much damage?

I yet do not know what happens if it stays inside the body but evidence of RNA has been found on Diamond Princess even after 17 days but RNA alone isn't sufficient to infect.

Does the cruise ship report imply that viruses survive up to 17 days on surfaces?

Dr Julia Marcus: A CDC investigation of the cruise ship found evidence of viral RNA in cabins that hadn’t yet been cleaned. But to be clear, that just means the virus was detectable – not that it was viable or that contact with those services would have been able to infect someone. (Editor’s note: RNA, or ribonucleic acid, carries the virus’s genetic information.)

Dr Akiko Iwasaki: It just means that there are parts of the virus that still remain. The virus needs many other components to be intact. If you have bits and pieces of RNA, that’s not going to make a virus, you need an entire intact genome. Just because you had a little piece of RNA doesn’t mean that there’s an infection.

Link

[McLaren Rulez]

Originally Posted by charanreddy

https://www.newindianexpress.com/sta...y-2120843.html

Look at this ! Heights of carelessness by a top police officer. Apparently this DSP bypassed quarantine procedure for his son and then engaged in a tour of relatives and feasts and finally tested positive.

Similarly, another moron here - https://www.bbc.co.uk/news/world-asia-india-52061915

The biggest problem is this type of macho-I'm-above-the-law types. The idiot is dead but not before he tried to take half a village with him.

[dailydriver]

DO MANY PEOPLE THINK THEY ARE LESS SUSCEPTIBLE TO CORONA VIRUS?

A week back, a respected lab technician dismissed my concern about Corona virus saying Don't worry sir, it won't trouble us. That he happens to be the president of the district paramedics association and is employed in a govt hospital, set me thinking about how nonchalant people in general are about this pandemic.

An alarming trend that I also noticed is the somewhat haughty belief that nothing will happen to me. This is the thought not just with Corona but also one that influences people's decision about purchasing safe cars, over speeding etc. The unwillingness of a large number of compatriots to stay at home during the current lockdown, the insistence of the elderly to go for morning walks, the persistence of the youth in going out for rides - in a nutshell, their desistence from taking care troubled me a lot.

This article by Marie Helweg-Larsen seems to provide a pointer to on why people think so.

OPTIMISTIC BIAS

Where does this complacency come from? Why are so many refusing to change their habits and going about their day as if everything were normal?

It could have to do with a well-documented phenomenon called the “optimistic bias,”... Essentially, it refers to when people see themselves as less susceptible to risk than others. We think, for example, that we’re less at risk than other people of having a stroke, getting injured in a car accident or getting divorced. Smokers know that smoking is dangerous but still think they’re less at risk than other smokers of getting lung cancer.

Why do people tend to downplay risks to themselves?

Personal experiences play a big role. For now, coronavirus can seem distant and far away. Without viscerally experiencing it – either through contracting it yourself or seeing a close friend or family member become infected – risk of infection can be hard to grasp

In general, optimism is a good coping mechanism. It gives us a sense of control and reduces our anxiety when we think that bad stuff happens to other people, but not to us.

But in the case of a pandemic like the coronavirus, if you don’t think something bad is going to happen to you, you might not bother changing your behaviors.

Wikipedia defines the concept as under:

Optimism bias (or the optimistic bias) is a cognitive bias that causes someone to believe that they themselves are less likely to experience a negative event. It is also known as unrealistic optimism or comparative optimism.

[AZT]

Mahindra group makes some progress. Can any doctors shed light if this is feasible.

[vivek95]

Originally Posted by dailydriver

Asking this from a layman's perspective.

Nice question And you are basically pointing out to an asymptomatic person ( virus inside but no symptoms ), I will try to answer this in simple language.

What happens to the virus after it has been inside a person for say 14 or 21 days without causing him much damage?

Viral load usually starts decreasing after that period owing to body's immunity in action and communicability to others is very low.

Additional information to help you understand better, I will mention two scenarios --

1. A person with strong travel history from affected region but is asymptomatic for all the 14 days of quarantine ( equivalent to incubation period ) but still gets tested for COVID-19 and the result is "Negative" --- Infers either the person never contracted the virus in the first place or the immune system took care of the virus without any overt manifestations. Post this period, the communicability of the virus to others is very low to nil.

2. What if someone is symptomatic and has a strong travel history but tests negative for COVID-19 ?? -- The first test could be negative because of less viral load. However, such patients are admitted under isolation for atleast 10-12 days and repeat tests are performed as a symptomatic person is highly contagious. Discharge the patient after symptoms disappear and tests are negative.

If the infected guy remains asymptomatic and therefore stays outside of the testing system, he wouldn't even know that he has had this viral infection. Ergo, he wouldn't get treated. The virus wouldn't be killed with medicines. Can he infect others even after 14/ 21 days (basically, after the incubation period) or does the virus somehow lose its transmission power after being defeated by the body's immune system?

1. Let me answer this by first presenting an instance where the patient is either - asymptomatic and positive OR symptomatic and positive. The latter is more contagious. But, both these individuals even after getting discharged from the hospital with test results as negative, can still remain contagious for a week or so. This is my hypothesis considering the well known viruses and their behaviors.

In other words, what is the timeline for COVID-19 patient to remain contagious after discharge from hospital with negative tests/recovery ??--- I honestly don't know, that has not been established yet, but most viruses "may" continue to infect others normally for 1-2 weeks even after full recovery of the patient himself.

2. Someone who remained outside of testing system and is asymptomatic but let's assume had indeed harbored the virus inside his/her body ---- This is a tricky scenario, but as I mentioned earlier, this person is at a very low risk of transmitting the infection to others beyond the incubation period.

Hope I did not confuse you

-- Dr. Vivek

[charanreddy]

Originally Posted by McLaren Rulez

Similarly, another moron here - https://www.bbc.co.uk/news/world-asia-india-52061915

The biggest problem is this type of macho-I'm-above-the-law types. The idiot is dead but not before he tried to take half a village with him.

It’s time our system including govt and the prime minister publicly names and shames. Even now I hear folks complaining that their near and dear ones aren’t taking this seriously and may be it is because they have not experienced in their life till now. A shock move or action is needed to knock some sense back into the system.

[PaddleShifter]

Originally Posted by AZT

Mahindra group makes some progress. Can any doctors shed light if this is feasible.

The Rs7500 device is simply an automated system that compresses the ambu bag for bag and mask ventilation.

When a patient is unable to breathe on his/her own, they are intubated (a tube is put in their airway to establish a path for air by artificial means). There are two ways to ventilate this patient: a manual method where a bag is connected to this tube and someone has to keep pressing and releasing that bag manually with hands. The patient needs this 24x7 so it needs a very dedicated effort, usually by patients' relatives who take turns to do this.

Mahindra has made a prototype to automate this procedure. The other one is the dedicated system (ventilator) with many more settings and is the best equipment to ventilate patients. Costs some 10-12 lacs per machine.

Apart from these, there are what we call non invasive ventilators. They cost around 2-4 lacs per machine and can even be set up at home (not easy thing).

Originally Posted by dailydriver

What happens to the virus after it has been inside a person for say 14 or 21 days without causing him much damage?

If the infected guy remains asymptomatic and therefore stays outside of the testing system.....

........Can he infect others even after 14/ 21 days (basically, after the incubation period) or does the virus somehow lose its transmission power after being defeated by the body's immune system?

This is the second pandemic I am witnessing as a doctor. The first being H1N1 Swine flu in 2009 when I was posted to screen patients as an intern. We were not quarantined or isolated and went about our normal business.

This COVID-19 is a totally different situation. Healthcare workers (HCWs) have been divided into teams here in my city. Each team will work for 15 days and will then be kept isolated for 15 days so that HCWs do not been a source of infection themselves.

Asymptomatic people (infected people without symptoms) are able to fight the virus but they are being considered an important reservoir of infection for others.

There are studies that have shown that some of those who had cleared RNA of the virus in their body (thereby testing negative) have shown a repeat presence of RNA during follow up testing. (Note- I refrained from saying re-infection). There is information in the scientific literature that is changing about this virus. Hence, I have been refraining to comment much except the precautionary measures I have been stressing upon to prevent infection in the at risk population.

[AltoLXI]

Originally Posted by dailydriver

If the infected guy remains asymptomatic and therefore stays outside of the testing system, he wouldn't even know that he has had this viral infection.

Originally Posted by vivek95

In other words, what is the timeline for COVID-19 patient to remain contagious after discharge from hospital with negative tests/recovery ??--- I honestly don't know, that has not been established yet, but most viruses "may" continue to infect others normally for 1-2 weeks even after full recovery of the patient himself.

I checked with my aunt who is a microbiologist. Though she does not have details about viral infections as her primary research area is in Serratia marcescens and Salmonella family, she told me about "Typhoid Mary" who remained asymptomatic and infected multiple people for years.

Mary Mallon (September 23, 1869 – November 11, 1938), also known as Typhoid Mary, was an Irish cook believed to have infected 51 people, three of whom died, with typhoid fever, and the first person in the United States identified as an asymptomatic carrier of the disease. Because she persisted in working as a cook, by which she exposed others to the disease, she was twice forcibly isolated by authorities, and died after a total of nearly three decades in isolation.

Wikipedia mentions this and looks like it is still WIP.

Asymptomatic carriers play a critical role in the transmission of common infectious diseases such as typhoid, C. difficile, influenzas, and HIV. While the mechanism of disease-carrying is still unknown, researchers have made progress towards understanding how certain pathogens can remain dormant in a human for a period of time. A better understanding of asymptomatic disease carriers is crucial to the fields of medicine and public health as they work towards mitigating the spread of common infectious diseases.

[vivek95]

Originally Posted by PaddleShifter

This is the second pandemic I am witnessing as a doctor. The first being H1N1 Swine flu in 2009 when I was posted to screen patients as an intern. We were not quarantined or isolated and went about our normal business.

Asymptomatic people (infected people without symptoms) are able to fight the virus but they are being considered an important reservoir of infection for others.

There are studies that have shown that some of those who had cleared RNA of the virus in their body (thereby testing negative) have shown a repeat presence of RNA during follow up testing. (Note- I refrained from saying re-infection).

Hello Doc,

We are contemporaries I too was posted for screening duties as an Intern in 2009 at my hometown in Belgaum, Karnataka. It used be a 10-12 hour everyday duty for around a month. As you have rightly said, we came into contact with so many H1N1 positive patients back then but didn't emphasize much on quarantine, isolation and PPE. I remember Pune was an epicenter in India for H1N1 but there were no lockdown measures or anything. People regularly travelled to Pune from my hometown and very few turned out to be positive. COVID-19 pandemic is indeed a challenging situation.

Last I took so much of precaution while handling a patient was last year when I had two suspected CJD patients in our ICU

There is information in the scientific literature that is changing about this virus. Hence, I have been refraining to comment much except the precautionary measures I have been stressing upon to prevent infection in the at risk population.

Totally agree with you on this. A simple answer to most queries would be 'unknown' due to extremely limited data available at present.

Take care, stay safe at work.

Regards
Dr. Vivek

[MasterChief]

Ever wondered why some people infected from Coronavirus develop only a mild symptom while few other lands up in hospitals and even die? Yes, of course, it's our immunity but what exactly happens that results in so drastically different outcomes.

Came across an interesting article on the response of our immune system, which I reckon will of interest to this thread as well: https://elemental.medium.com/this-is...s-cbf5271e530e

Basically, the major points are and I quote from the article:
1. "Most coronavirus-related deaths are due to the immune system going haywire in its response, not damage caused by the virus itself".
2."When you first become infected, your body launches its standard innate immune defence like it would for any virus".
3. "Ideally, this initial response enables the body to gain control over the infection quickly, although the virus has its own defences to blunt or escape the interferon effect."
4."The goal of the innate immune defense is to contain the virus and prevent it from replicating too widely so that the second wave of the immune system — the adaptive, or virus-specific response — has enough time to kick in before things get out of hand. The adaptive immune response consists of virus-specific antibodies and T cells that the body develops that can recognize and more quickly destroy the virus. These antibodies are also what provide immunity and protect people from becoming reinfected with the virus after they’ve already had it."
5. "A suppressed immune system can result in a weaker initial interferon response or a delayed antibody response, allowing the virus to spread from cell to cell relatively unchecked."
6."At this point, the disease can still go in two directions: The immune response can remain stable and regain control over the virus, eventually clearing it through T cell and antibody activity. Or the immune system can freak out and start to over-respond, churning out more and more inflammatory proteins, called cytokines, in a frantic attempt to wipe out the virus. It’s this second path - the cytokine storm - that causes substantial cell death in the lungs, resulting in the most severe infections, acute respiratory distress syndrome, and even death."

The article concludes with the most important point that "For now, your best defense against the virus is to support your immune system with sleep, exercise, and good nutrition and, most importantly, to wash your hands and practise social distancing so you don’t get infected in the first place."

[Kuldeep31]

Now this is HUGE. We may be just one-step away from what can be a potential anti-dote. It can be a life saver for the entire mankind.
https://twitter.com/ANI/status/1243500174728667139?s=19

[Vid6639]

Originally Posted by Kuldeep31

Now this is HUGE. We may be just one-step away from what can be a potential anti-dote. It can be a life saver for the entire mankind.
https://twitter.com/ANI/status/1243500174728667139?s=19

I'm no doctor and was just doing some reading.

Apparently, cytokines were responsible for a large % of death of the spanish flu patients. Most had elevated cytokine levels as per google.

So the anti dote is not exactly safe i believe.