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On the trajectory of Covid-19 (and similar diseases)

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As a FYI, we need to understand the pattern of such diseases, so courtesy Yandex Image search (Google did an obvious results suppression):

This leads to the simplified U/L trajectory description. If a vulnerable patient catches, things tend to get worse over several days, potentially leading to a crisis from immunity system over-reaction and/or secondary infection (“complications”). That can lead to flat-lining, the L, death. But if one makes it through the trough, a recovery period extends the disease process, the U trajectory. BTW, to see the U/L, invert the black line that rises with severity on the chart. Shouldn’t a deterioration lead to sinking?

U/D, HT Jerry and MedCram/Mina: Let’s look at a plot of viral load vs time [refining the viral phase triangle] and sensitivity of tests vs threshold where patients are infectious:

The viral phase and testing vs threshold where one is infectious. Note rapid ascent and much slower descent. Also, how high sensitivity tests may highlight patients past the threshold where they are relevant to transmission.

The chart shows that the viral phase comes early, and leads to onward phases, which would be where flat-lining vs recovery happens. An effective antiviral would reduce rate of descent, giving time for the normal immune response to trigger a recovery without life threatening crisis.

Of course, a bad sign of going towards crisis is needing to be hospitalised. Hence the problem that antivirals will tend to have reduced effect on the hospitalised. As the chart suggests. Of course, by the time one is in ICU and/or on a ventilator, one is in serious trouble.

Therefore, signs of an effective antiviral will be reduced hospitalisation in vulnerable population segments (co-morbidities, age, reduced immune system effectiveness etc). As a result, too, reduced death rates. This would be due to suppressing the viral cell-hijack replication cycle.

A mechanism proposed for Covid-19, has been propping open cell pores allowing higher Zn concentration. Where, there seems to be a reasonable body of evidence that Zn is able to suppress that replication. Similarly, pH shifts may derange key-lock fitting for target points for corona viruses. At least one mentioned drug, Azithro, may be destroying receptor cells, which are tied to senescence. Obviously, there is much more out there.

So, let us attend to the trajectory. END

U/D: I just added a key chart on the viral phase, with test thresholds vs infectivity. KF PS: Note, if the gold standard [!] tests are highlighting an irrelevant tail, then that can be warping discussion on public health management, i.e. a more cost effective test costing 2 orders of magnitude less, requiring no technical equipment or even staff may allow much better management of say re opening for school and work. BTW -3.3 in Ct value reflects x 10 in viral load per ml; this is due to a log scale on the vertical axis. kairosfocus
Fixing testing https://www.youtube.com/watch?v=cP-MHKU_cQE It's looking like the gold standard evidence fallacy may be rearing up its head again . . . a perverse, unintended consequence of well intentioned regulation. kairosfocus
PS: There will be a problem with dealing with a polarised, indoctrinated officialdom, media and public. kairosfocus
Jerry, that sounds a lot like something I ran across. Indeed, here, the Chief Medical Officer has made noises about chain reaction -- thus gene amplifying -- tests being over sensitive, detecting viral remnants effectively after the disease is over. I am also thinking that the treatments are doing in effect marginal things that hamper but do not utterly stop replication, until an immune response kicks in without going into storm. So, we could also be detecting extremely mild cases. The translation into more cost effective containment is interesting. KF PS: MedCram-98 https://www.youtube.com/watch?v=h7Sv_pS8MgQ Referenced paper https://www.nejm.org/doi/pdf/10.1056/NEJMc2001737 Also Mina et al https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2.full.pdf kairosfocus
Kf, I know you are a science junkie just as I am. A very interesting MedCram - 98. Apparently you must reach a certain point of viral infection before you can spread the virus. The traditional test, PCR test, for RNA is so sensitive that it will identify someone as positive and they do not have the ability to spread the virus because their viral load is so little. The less sensitive test identifies those who can spread the test and cost about a $1 and takes about 10 min. The PCR test cost about $100 and take several days. So the idea is use the less expensive, less sensitive quick test to identify those who may be contagious and keep them home. Not quite sure I got it all right. The doctor from Harvard who developed the test has an hour interview on MedCram on their latest video. Haven't watched it yet but will later tonight. jerry
MMT, High risk and exposed - treat. Covid-19 seems to be only disease we do not try to treat early. Treatment is safe enough for virtually all persons to receive it. More interesting are anecdotal stories of seriously sick Democratic lawmakers who had remarkable recoveries with HCQ. The Michigan lawmaker is black and it appears from pictures that Paul Vallone (NYC councilman) may have a Black ancestry. Raises questions about whether there are real genetic or other factors (beyond the social factors - poverty, etc) which make Black persons more susceptible. Very interesting times - including lack of real scientific interest in the establishment. God Bless. GCS
MMT, Drs Raoult and Zelenko have long pointed out a window of effectiveness during which one who is a high risk patient is symptomatic but not yet into the complications stages. During this window, cocktails are effective, and others noted that Ivermectin seems to stretch it. There is such a thing as a cumulative, gradual process, as is mapped in the chart. KF kairosfocus
KF, I realize that once it starts seriously affecting the lungs, the risks dramatically increase. For the sake of argument let’s assume, as you have claimed, that HCQ is a very effective treatment. But you have also claimed that it is only effective in early stage infections. Given that people don’t seek testing until they are symptomatic, and given that there is still a huge problem in obtaining testing, and delays in getting result, and given that there is a very high false negative percentage for the tests, how do would you propose that HCQ be used to affect a significant reduction in serious infections? Mac McTavish
MMT, the OP was intended to give a baseline for reasonable discussion, by giving a quasi-timeline reference. Yes, the problem is that antivirals are only going to work where the virus is the key driver. Once lung damage, sludge, secondary infections and/or immune system over-reaction take over, then there are very different challenges, with far less favourable prospects and odds. KF kairosfocus
If people would just eat healthy and take their vitamins D, liposomal C and zinc, most would be OK and not get infected. Two papers say that vitamin D alone could have saved thousands of people. ET
I don’t think that anyone would argue that in most cases the best time to treat, assuming there is an effective treatment, is early in the infection. Although, there are some drugs that only have an effect in more advanced stages. The problem is that most people don’t seek testing Until they start showing symptoms (the pulmonary phase it the chart). And the results often take several days. Mac McTavish
The article: EDITORIAL COMMENTARY COVID-19 illness in native and immunosuppressed states: A clinical ? therapeutic staging proposal Hasan K. Siddiqi, MD, MSCR, and Mandeep R. Mehra, MD, MSc --> context is, in China heart transplants were proceeding apace, epidemic or no. kairosfocus
On the trajectory of Covid-19 (and similar diseases) --> Working around a bit of Google censorship . . . why would something like the above come up blank on Google search (with suggestions on "love" of all things)? Yandex gave an instant, multiple match. Of course, the original image I found was at Todaro's Medicine UNcensored. (Todaro is an MD in his own right and is using a journal article per fair use. kairosfocus

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