COVID-19 Update - 04/30/2020

My own workup | 04/30/2020 | DoughtyOne

[DoughtyOne]

PING LIST - Please contact me as needed...

COVID-19 Update

As of 04/29/2020 23:45 PDST     Johns Hopkins University - Capture Nations Informaton
As of 00/00/2020 23:45 PDST     Johns Hopkins University - Capture Counties Informaton
As of 00/00/2020 23:46 PDST     Johns Hopkins University - Process JHU Data
As of 00/00/2020 23:59 PDST     WorldofMeters - Document Core Numbers
As of 00/00/2020 23:59 PDST     WorldofMeters - Capture Nations Informaton
As of 00/00/2020 23:59 PDST     WorldofMeters - Capture States Informaton
As of 00/00/2020 00:00 PDST     WorldofMeters - Data Processing begins...
As of 00/00/2020 ??:?? PDST     Publish COVID-19 Update - 00/00/00

Thank you for stopping by to check out the COVID-19 Update.

Here you can find...

Section: 01     Commentary, Special Reports, COVID-19 Update Info, & System Notes
Section: 02     the United States Situation
Section: 03     the Global Community Situation Outside China
Section: 04     the Global Community Situation Including China with reservations
Section: 05     the Mortality Report
Section: 06     Miscelanious Reports of Interest
Section: 07     the United States, Counties (alphabetical / case no descending)
Section: 08     the United States, States Ranked with the Other States Territories at Bottom
Section: 09     the United States, Ranked with Other Nations
Section: 10     the End of this COVID-19 Update
Section: 11     Data Sources and a Link to My Own Spreadsheet
Section: 12     Link to Spreadsheet: Our Counties, States, Territories, & Other Nations
Section: 13     Links to Other Resources

Section: 01

Commentary, Special Reports, and COVID-19 Update Information¹
Interesting Tid-bits (hopefully)

Global Recoveries

Global Recoveries topped one million cases yesterday.

COVID-19 Update Dashboard

I decided to add a small data dashboard to the opening of the Updates.

You probably tripped over it on the say in. Hope you're alright...

Section: 02

The Following Addresses the Numbers Here in
the United States of America

Okay, you should probably smile a little less today.

It's actually kind of a mixed bag. We are up from a few days ago, but
then down decently from last week. Here comes Thursday and Friday...

Fatalities, Recoveries, Resolved, Active Cases, and
Serious/Critical Cases in the United States
Concept of adding in Active Cases and Serious Crital here, courtesy of amorphous

Here's more of our numbers...

We had over 2,400 fatalities yesterday. That's not good. We'll see
more about that down in the Mortality Report Section

Our Slice of the COVID-19 Pie

The growth of our Slice of the Pie has been slowing. On the 16th it actaully
went netative for one report row on my spread-sheet. Luckily it was the EOD
figure so you could see it.

Here are the numbers I've been tracking, Globale Declared and Active Cases.

It pains me to see these numbers grow larger.

Section: 03

The Following Addresses the Global Numbers
without Mainland China

Here is the first chart for the Global Outside China Territories

Well, we did see a rise here, just like in the U. S. I'm thinking we
may see some big numbers on Thursday and Friday. Hope not.

Fatalities, Recoveries, Resolved, Active Cases, and
Serious/Critical Cases - Globally, Excluding M/L China
Concept of adding in Active Cases and Serious Crital here, courtesy of amorphous

Here we go...

Over 10k fatalities yesterday. That's a massive number.

How is the Global Community Outside China Doing,
Without U. S. numbers?

Well, not too good yesterday...

Still edging up. Not liking this neighborhood.

There it is, that typical cyclical increase at this stage of the
week.

Just be glad that first chart wasn't your brain wave. You'd
have some loose teeth. Another day, another pattern starting
to play out like the last few weeks.

Special Section on France, Germany, Italy, Spain, and the U. K.
Case growth.

Lets Look at Some Numbers in Five Day Increments:

The same comments fit for about each day here.

Germany has been able to keep their deaths down. Nice job...

Both France and Germany have somehow altered thier trajectory
to a better outcome. Looks like the U. K. is about to pass
them by.

Sweden and It's Neighbors, Who Has the Best Tactic Againt COVID-19?

Sweeden is doing their own thing with regard to isolating. I think most people
are aware of it by now.

Here are some numbers to help us look at this issue.

As a good adendum to these figures, I invite folks to check out the
international comparisons, with regard to Deaths Per Million. As with
any metrics here, these are not the total answer to anything. This
is simply more information to consider.

Again today, Sweden looks good compared to larger nations in Europe.
Their neighbors have keep their cases and fatalities down by comparison.

Sweden still looks very competitive against France, Italy, Spain, and
the U. K. Now I don't have a problem with comparing Sweden with the
other Nordic countries, where it doesn't come off well. It still holds
it's own against other top rank nations that have locked down. I'm
not rabidly pro or con when it comes to what Sweden is doing, but I do
find myself defending it more than I really want to, based on what I
see as pointed criticism that isn't exactly reasoned > IMO.

Finland is still looking good.

One more thing about Sweden here. However Sweden ultimately turns out,
I think it is the canary in the coal mine. We all have wondered what
would have happened if we had gone their route. I'm glad to see at
least one nation giving it a go, to satisfy what I believe to the
curiosity of many of us.

Section: 04

The Following Addresses the Global Numbers
including Mainland China*

Mainland China's numbers are 0.03% of today's total global numbers.

A Look at Declared, Resolved, and Active Cases, Includes M/L China

End of day figures follow:

That recovery percentage continues to climb. It looks like we're headed to
40% and above in the next few days.

Fatalities, Recoveries, Resolved, Active, and Serious/Crical
Cases Globally, Including M/L China
Concept of adding in Active Cases and Serious Crital here, courtesy of amorphous

Not much to say here. Big numbers getting bigger...!

Section: 05

the Mortality Report

Making an effort to provide more mortality numbers these days.

Hopefully these upcoming numbers and charts will help with that.

Our numbers are big enough that they can hide the finer nuances of the
Global numbers outside China. For that reason, I strip our numbers off
that group and report them separately for this area of study.

Here are the figures for the growing case totals for four entities.

Here's the chart to go along with those figures.

Looks pretty ominious there doesn't it.

Here are figures revealing the daily growth for those four entities.

The numbers fell off considerably for two days. We're back up now.
hopefully lower case increases, will make for lower fatalities down
the road.

We remain down a bit, but it's not the big move I had hoped it wold be, and tomorrow and Friday, who knows?

Here's two charts to go with the above data.

We don't look terrible there, but the global figures are
troublesome.

Here, lets look at data for the U. S. broken out by itself.

Well, I guess we should be thankful these numbers weren't higher
coming off some very low days. There is some brighter spots in these
numbers. Other entities have faired a little better than us.

Level yesterday to the day before, but I had hoped it would happen
at a lower level.

Section: 06

Population Saturation

Here are figures revealing how many people in each population base represent one case.
I'm also showing what percent of each population base is infected at this time.

This area looked quite a bit better the day before yesterday. Back to
normal here. Ug...

Nations With Lots of Cases

At the end of the day yesterday, there were:

That's a whole lot of nations there. With over 1,000 in each one, we know
that over time they are potential declared cases time-bombs.

Daily Case Report Evaluation

I'll be keeping tabs on the daily tallies for days of the week for a while. Folks have
noticed some patterns of larger and smaller data entry on certaind days, and on Fridays
sometimes the numbers get noticably larger because of it.

And we now know Thurdays have potential to break out also. Yikes!

Let's check out the numbers and a chart.

Well, here comes Thursday and Friday. Keep an eye on the right green
stacks coming across there. You can see Tuesday and Wednesday already.

Section: 07

The Top 200 Counties in the U. S., by Number of Cases

This little report lists 200 Counties in the United States in declining Case numbers.
There is also a listing that is alphabetical. This report list only the entities
and the number of Cases in the two different sorts.

It will also be available as a downloadable Excel file in Section 12.

Section: 08

States of the Union and the District of Columbia, Compared to Each Other

Each of these pages is sorted differently. Look at the red header above
the columns to see which column was used for the sort on any given page.

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

Some interesting figures there for various segments.

Section: 09

The United States, Where it Ranks With Other Natons?

Each of these pages is sorted differently. Look at the red header above
the columns to see which column was used for the sort on any given page.

The U. S. will be highlighted red here so we can find it easily in the list.
There were 212 nations on this list last night now. I didn't want to post
seven lists with 212 nations on it, so I picked the top 50. Coincidentally,
one report category has the U. S. at 41st, so it wasn't showing up on the
list with 31 top spots on it. That wasn't the reason why I extended the
list length, but it did work out well.

I work on the nations right next to the states on my spreadsheet. The
states with the Disctrict of Columbia come in at a total of 51 lines.
I decided to keep the international reports near that length, and 50
was good enough.

Here we go... for your review.

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

For your review...

Section: 10

Here's what it's all about. From January 20th to the present.

This concludes our look back at yesterday's data. Take care...

Courtesy of: foldspace

Section: 11

Data for this Report Sourced From:

LINK   Johns Hopkins University
               The Center for Systems Science and Engineering (CSSE)

LINK   WorldoMeters

LINK   You are Invited to Review My COVID-19 Spreadsheet (XLSX)
               There is not an XLS version available for distribution at this time.

Section: 12

Other Features:

LINK   US Counties²⁰⁰, States & DC⁵¹, Territories, & Other Entities¹¹, and Nations²¹²
                Four Excel Spreadsheet datasets you can sort for your own studies...

Section: 13

Links to other resources:
I cannot vouch for these sites. Please use your own discression.

LINK   Adventist Health Coronavirus Resource Hub - Scroll down for useful info

LINK   CDC Data for Download - Scroll down - Excel required. Includes death stats.

LINK   CDC Secondary Data and Statistics - Portal Entry / Look around

LINK   Coronavirus (COVID-19) Map

LINK   COVID-19 First U.S. Case, Treatment, features Remdesivir
               New England Journal of Medicine article

LINK   Cytokine Storm, med Actemra, Physician near death saved

LINK   Diamond Princess Review at 634 Case Point of Eventual 712

LINK   earlyAlert

LINK   Hydroxychloroquine Article: International Poll
               Daily Mail Reports, Most Effective Treatment According to 6,000 Physicians

LINK   IHME - Institute for Health Matrix and Evaluation

LINK   National Institutes of Health - Cornavirus (COVID-19)

LINK   Nazal Irrigation is the Key, COVID-19 Related

LINK   New York City - interesting breakdown, burough, age, sex

LINK   On the Origin of CCP Virus, A Documentary Movie (turn up the sound)
               Epoch Times: I highly recommend this very well documented report.

LINK   World Health Organization

[DoughtyOne]

                       

[nbenyo]

Looks like a good chance we will exceed 100,000 deaths.
Here in Bayonne, NJ, a councilman’s wife passed yesterday. She was 53 and had been getting gradually better for 10 days and then took a sudden turn for the worse.

[nbenyo]

Looks like a good chance we will exceed 100,000 deaths.
Here in Bayonne, NJ, a councilman’s wife passed yesterday. She was 53 and had been getting gradually better for 10 days and then took a sudden turn for the worse.

[wastoute]

https://externalmediasite.partners.org/Mediasite/Play/f936c99a56cc4cf7a3097c0bce6421021d

Something I just stumbled to. “Grand Rounds” is a tradition that is probably 100 years old. Hospitals have them in the Internal Medicine Department at regular intervals. The tradition is that a “case” that is interesting is discussed in great detail by multiple Staff members usually with great experience but frequently Residents will be called on initially to present the case and then be humiliated by the staff.

This is a Grand Rounds on COVID at MGH. Over an hour long but if you want to hear something about this disease these are the people who know.

[SaveFerris]

Looks like NYC is roughly 16% of the total cases in the U.S.A.?

(but then it’s late and I’m pretty tired so I might have messed that up)

[LouieFisk]

“Something I just stumbled to. “Grand Rounds” is a tradition that is probably 100 years old.”
—
You just heard of this now? I’d figure anybody who’s been hospitalized has seen this, if not experienced it. Kind of hard not to notice when 8 doctors of various ages fill your hospital room and talk about you. If you’ve never seen it before you might think you’re gonna die and they got all the docs in to try to save you, but it’s just hospital SOP. Giving the med students & residents a looksee and some kibitzing.

[billyboy15]

Call me a tinfoil hat conspirasist but I believe it is well known that this world wide lock down as a cure is turning out to be far worse then the disease and we are seeing many people begin to defy the lock down.

In response those who seek to continue the lock down need to do something to re enforce their decision to shut everything down.

How do they do this? In America they begin reporting inflated death totals and including deaths among heretofore mostly immune sub groups such as young people. The hope is by ramping up the totals again people will go back to hiding in their basements and the destruction of America (and our president) will continue.

Remember, if a patient with heart issues dies in the hospital and the patient next to him has China Virus the heart patients death will be deemed caused by the virus.

[LouieFisk]

“Looks like a good chance we will exceed 100,000 deaths.”
—
Yup. The people who revised their projecting down from 100,000 to 60,000 have revised it back up 4 times in the last few weeks. At 2000+ deaths/day that former 60,000 figure will be surpassed before very long instead of being a final tally..

[DoughtyOne]

I went to the state's comparisons report, the second in that
series. It is sorted by cases, and New York winds up on
top. I used it's listed number of cases there, and used the
total at the bottom of the page.

That total varies from the final number my dataset showed.

The column total there was 1,044,000 and change, and my
workup tonight had the U. S. at 1,064,000 and change. I
thought it best to used the figure at the bottom of that
column, since it was probably live at the time the New York
figure was pegged at it's level.

Okay here's the percent:

New York:     306,158
the U. S.:  1,044,094
---------------------
                29.32% is New York's slice of that pie

[SaveFerris]

So my NYC figure was close.

And you got numbers for all of NY state.

Over 29% in New York state alone. Wow

TFTI

[DoughtyOne]

I know that they are gaming the numbers.

Several states had to admit to it, and reclassify some of
their numbers downward.

[DoughtyOne]

Sorry to hear about the councilman’s wife.

Yeah, we may go a lot higher. I had hoped we were seeing
a reduction, but it may have only been reporting related.

[wastoute]

“Grand Rounds” are an event in a large conference room typically attended by over 100 doctors. It won’t fit in a hospital room. I know all about “rounds”. I had hoped for more from this video but it is just “logistics” and no real patholgy or pulmonologist. Just logistics of supply healthcare to the homeless infected.

\interesting to note, they quickly had 36% of the population test positive by PCR (Abott) which should have a very low false positive, it’s not an antibody test it’s a test that uses probe RNA to identify actual genome of the virus. Only 10% of the population had symptoms. Indicating a very large reservoir of Asymptomatic.

[wastoute]

https://www.youtube.com/watch?v=bt-BzEve46Y

This one appears to be a “more typical” Grand Rounds. Looks like they get into the details.

[wastoute]

This one looks like GOLD. It seems to be just what I was looking for and the info is a week old not a month old.

https://www.youtube.com/watch?v=Aj2vB_VITXQ

[daniel1212]

Another one for the group; with improved formatting (however, source does not list of enable one to toggle the order):

Cases and mortality by country [https://coronavirus.jhu.edu/data/mortality last updated on Tuesday, April 28, 2020 at 11:52 PM EDT]
Country	Confirmed	Deaths	Case-Fatality	Deaths/100k pop.
US	1,012,582	58,355	5.8%	17.84
Italy	201,505	27,359	13.6%	45.27
Spain	232,128	23,822	10.3%	50.98
France	169,053	23,694	14.0%	35.37
United Kingdom	162,350	21,745	13.4%	32.70
Belgium	47,334	7,331	15.5%	64.18
Germany	159,912	6,314	3.9%	7.61
Iran	92,584	5,877	6.3%	7.18
Brazil	73,235	5,083	6.9%	2.43
China	83,940	4,637	5.5%	0.33
Netherlands	38,612	4,582	11.9%	26.59
Turkey	114,653	2,992	2.6%	3.63
Canada	51,150	2,983	5.8%	8.05
Sweden	19,621	2,355	12.0%	23.13
Switzerland	29,264	1,699	5.8%	19.95
Mexico	16,752	1,569	9.4%	1.24
Ireland	19,877	1,159	5.8%	23.88
India	31,324	1,008	3.2%	0.07
Portugal	24,322	948	3.9%	9.22
Ecuador	24,258	871	3.6%	5.10
Russia	93,558	867	0.9%	0.60
Peru	31,190	854	2.7%	2.67
Indonesia	9,511	773	8.1%	0.29
Romania	11,616	663	5.7%	3.40
Poland	12,218	596	4.9%	1.57
Austria	15,357	569	3.7%	6.43
Philippines	7,958	530	6.7%	0.50
Algeria	3,649	437	12.0%	1.03
Denmark	9,049	434	4.8%	7.49
Japan	13,736	394	2.9%	0.31
Egypt	5,042	359	7.1%	0.36
Pakistan	14,612	312	2.1%	0.15
Hungary	2,649	291	11.0%	2.98
Dominican Republic	6,416	286	4.5%	2.69
Colombia	5,949	269	4.5%	0.54
Korea, South	10,761	246	2.3%	0.48
Ukraine	9,410	239	2.5%	0.54
Czechia	7,504	227	3.0%	2.14
Israel	15,728	210	1.3%	2.36
Chile	14,365	207	1.4%	1.11
Argentina	4,127	207	5.0%	0.47
Norway	7,660	206	2.7%	3.88
Finland	4,740	199	4.2%	3.61
Panama	6,021	167	2.8%	4.00
Morocco	4,252	165	3.9%	0.46
Bangladesh	6,462	155	2.4%	0.10
Saudi Arabia	20,077	152	0.8%	0.45
Greece	2,566	138	5.4%	1.29
Serbia	6,630	125	1.9%	1.79
Moldova	3,638	103	2.8%	2.90
Malaysia	5,851	100	1.7%	0.32
South Africa	4,996	93	1.9%	0.16
Iraq	1,928	90	4.7%	0.23
United Arab Emirates	11,380	89	0.8%	0.92
Luxembourg	3,741	89	2.4%	14.64
Australia	6,744	89	1.3%	0.36
Slovenia	1,408	86	6.1%	4.16
Belarus	12,208	79	0.6%	0.83
North Macedonia	1,421	71	5.0%	3.41
Honduras	702	64	9.1%	0.67
Bosnia and Herzegovina	1,585	63	4.0%	1.90
Croatia	2,047	63	3.1%	1.54
Afghanistan	1,828	58	3.2%	0.16
Cuba	1,437	58	4.0%	0.51
Cameroon	1,705	58	3.4%	0.23
Bulgaria	1,399	58	4.1%	0.83
Thailand	2,938	54	1.8%	0.08
Bolivia	1,014	53	5.2%	0.47
Estonia	1,660	50	3.0%	3.79
Lithuania	1,344	44	3.3%	1.58
Nigeria	1,532	44	2.9%	0.02
Burkina Faso	638	42	6.6%	0.21
Andorra	743	41	5.5%	53.24
San Marino	553	41	7.4%	121.36
Tunisia	975	40	4.1%	0.35
Niger	709	31	4.4%	0.14
Armenia	1,867	30	1.6%	1.02
Congo (Kinshasa)	471	30	6.4%	0.04
Albania	750	30	4.0%	1.05
Somalia	528	28	5.3%	0.19
Sudan	318	25	7.9%	0.06
Kazakhstan	3,027	25	0.8%	0.14
Mali	424	24	5.7%	0.13
Lebanon	717	24	3.3%	0.35
Kuwait	3,440	23	0.7%	0.56
Azerbaijan	1,717	22	1.3%	0.22
Slovakia	1,384	20	1.4%	0.37
New Zealand	1,474	19	1.3%	0.39
Ghana	1,671	16	1.0%	0.05
Liberia	141	16	11.3%	0.33
Cyprus	837	15	1.8%	1.26
Uruguay	625	15	2.4%	0.43
Guatemala	530	15	2.8%	0.09
Kenya	374	14	3.7%	0.03
Singapore	14,951	14	0.1%	0.25
Cote d'Ivoire	1,183	14	1.2%	0.06
Latvia	836	13	1.6%	0.67
Diamond Princess	712	13	1.8%	nan
Kosovo	510	12	2.4%	0.65
Bahamas	80	11	13.8%	nan
Iceland	1,795	10	0.6%	2.83
Oman	2,131	10	0.5%	0.21
Mauritius	334	10	3.0%	0.79
Tanzania	299	10	3.3%	0.02
Qatar	11,921	10	0.1%	0.36
Venezuela	329	10	3.0%	0.03
Paraguay	239	9	3.8%	0.13
Senegal	823	9	1.1%	0.06
Bahrain	2,811	8	0.3%	0.51
El Salvador	345	8	2.3%	0.12
Uzbekistan	1,939	8	0.4%	0.02
Trinidad and Tobago	116	8	6.9%	0.58
Congo (Brazzaville)	207	8	3.9%	0.15
Guyana	74	8	10.8%	1.03
Jordan	449	8	1.8%	0.08
Kyrgyzstan	708	8	1.1%	0.13
Guinea	1,240	7	0.6%	0.06
Sri Lanka	619	7	1.1%	0.03
Montenegro	321	7	2.2%	1.12
Jamaica	364	7	1.9%	0.24
Taiwan*	429	6	1.4%	0.03
Costa Rica	705	6	0.9%	0.12
Togo	99	6	6.1%	0.08
Georgia	511	6	1.2%	0.16
Haiti	76	6	7.9%	0.05
Barbados	80	6	7.5%	2.09
Burma	150	5	3.3%	nan
Zimbabwe	32	4	12.5%	0.03
Malta	458	4	0.9%	0.83
Monaco	95	4	4.2%	10.34
Sierra Leone	104	4	3.8%	0.05
Malawi	36	3	8.3%	0.02
Antigua and Barbuda	24	3	12.5%	3.12
Gabon	238	3	1.3%	0.14
Nicaragua	13	3	23.1%	0.05
Ethiopia	126	3	2.4%	0.00
Zambia	95	3	3.2%	0.02
Syria	43	3	7.0%	nan

http://www.peacebyjesus.net/cdc_data_pneumonia_influenza_covid_19_deaths.html

[LouieFisk]

Ah, I see - thanks for clarifying for me. I didn’t appreciate the “Grand” part, heh.
That’s a boatload of info.

[wastoute]

This one above is really good. A long presentation of Oxidative Stress but the most concise and understandable one I have ever seen and done in the context of COVID 19. He says there will be another today. Can’t wait.

Notice the perception of this disease is shifting from “Respiratory Disease” to “vascular endothelial disease”, death of vascular endothelium exposes endothelial basement membrane. Endothelial Basement Membrane is highly thrombogenic which allows a small clot to form and “begin the healing process” (fibrin contraction and the mediators of inflammation migrating in drawing the cellular portions of the immune system). If you have many of these small clots more than a few are going to break loose and become micro emboli.

The Cardiac Output is 5 liters per minute, each heart beat produces an additional roughly 100 ml into the “vascular tree”. One liter of that output goes to the brain in the resting state. About 20 ml of each heart beat goes to the brain. ALL of that blood flows through the Internal Carotid Artery. The first place this blood flows to is what is referred to as the “Circle of Willis”. The ONLY chance arterial blood has of providing “Collateral circulation” to the brain. From the Circle of Willis on every artery in the brain is a “dead end”.

In the Operating Room when you can see the Circle of Willis Blood vessels you can SEE them absorb this 20 ml bolus of blood under pressure, the Peak Arterial Pressure is the top number of your systemic blood pressure so there is a pretty good head of pressure there and the vessels visible “throb”. Every breath you take “sucks” blood under negative pressure out of the veins in your head and so this “throb” of blood is literally sucked through the capillaries in brain tissue.

So, when micro emboli from the Pulmonary veins (the first stop of this virus after entering through lung tissue) return to the left side of the heart 20% of those micro emboli are going to be “pulsed” directly into the Circle of Willis under pressure. Cerebral blood flow is regulated to deliver the incoming blood to the places where it is needed and that coupling is 100%. The small blood vessels that perfuse the Thalamus and medial Temporal lobe perfume the parts of the brain that are involved in maintaining the wakening state and emotions and motivations for behavior. They get a very good share of this freshly arriving blood.

So the microemboli end up producing micro infarcts and some of this blood also carries viral particles. Your body’s clotting system is a “balance” of clotting and clot breaking and so your clot breaking enzymes start trying to break the clots up how well they succeed can determine the clinical progress of the disease. Direct viral attack on all the variety of cells available to the virus in this “mileux” produces the Necrotizing Encphalopathy seen in just these regions in the only MRI you can find on the internet.

I do think this does explain the “15%” of patients that present with Neurological Symptoms. If Mesial Temporal Lobe damage is a factor one could expect to see some pretty wild manifestations at “Critically Ill” stages of the disease.

So why focus on the brain? Because the Brain is the organ that has to be spared at all costs. Obviously. The question becomes at which stage of the manifestation of the Disease does this tend to occur? Obviously fairly early. We are still talking about microemboli, after all. At later stages the circulatory system is circulating much larger clots. Hence the “large Vessel Strokes” seen in kids. I suspect many, if not all, patients with “serious symptoms” would have an abnormal MRI even if they did not yet have Neurological symptoms. Remember the Neurological Symptoms to expect are subtle neurocognitive alterations of sensorium which in the context of a seriously ill patient aren’t going to be high on anybody’s list of priorities.

So what’s the point of all that? Well, any treatment that is going to be successful HAS to prevent this, what seems to me is probably a pretty characteristic presentation, serious brain injury which is likely already occurring in the seriously ill. It seems to me that no drug is going to get more than a few doses into the patient as all this is occurring. Certainly a drug that is administered IV will get maximal opportunity as it avoids all the pharmacokinetics of absorption, etc. it also has to have a MAJOR impact in those few doses to prevent death or serious disability. (Pretty obviously Remdisivir isn’t it, it has obviously been used in this context and if it was successful we would be hearing “reduces mortality” instead of “shortens hospital stays”)

It is fortunate that the disease progresses to this outcome so rarely.

[wastoute]

No problem. Why would anyone not in the business care?