COR Corona COVID-19 forum
Alles over het corona / COVID-19 virus.
New kind of CRISPR technology to target RNA, including RNA viruses like coronavirus
Type VI CRISPR enzymes are RNA-targeting proteins with nuclease activity that enable specific and robust target gene knockdown without altering the genome. To define rules for the design of Cas13d guide RNAs (gRNAs), we conducted massively parallel screens targeting messenger RNAs (mRNAs) of a green fluorescent protein transgene, and CD46, CD55 and CD71 cell-surface proteins in human cells. In total, we measured the activity of 24,460 gRNAs with and without mismatches relative to the target sequences. Knockdown efficacy is driven by gRNA-specific features and target site context. Single mismatches generally reduce knockdown to a modest degree, but spacer nucleotides 15–21 are largely intolerant of target site mismatches. We developed a computational model to identify optimal gRNAs and confirm their generalizability, testing 3,979 guides targeting mRNAs of 48 endogenous genes. We show that Cas13 can be used in forward transcriptomic pooled screens and, using our model, predict optimized Cas13 gRNAs for all protein-coding transcripts in the human genome.
Type VI CRISPR enzymes are RNA-targeting proteins with nuclease activity that enable specific and robust target gene knockdown without altering the genome. To define rules for the design of Cas13d guide RNAs (gRNAs), we conducted massively parallel screens targeting messenger RNAs (mRNAs) of a green fluorescent protein transgene, and CD46, CD55 and CD71 cell-surface proteins in human cells. In total, we measured the activity of 24,460 gRNAs with and without mismatches relative to the target sequences. Knockdown efficacy is driven by gRNA-specific features and target site context. Single mismatches generally reduce knockdown to a modest degree, but spacer nucleotides 15–21 are largely intolerant of target site mismatches. We developed a computational model to identify optimal gRNAs and confirm their generalizability, testing 3,979 guides targeting mRNAs of 48 endogenous genes. We show that Cas13 can be used in forward transcriptomic pooled screens and, using our model, predict optimized Cas13 gRNAs for all protein-coding transcripts in the human genome.
Zit net de persconferentie van de WHO te kijken. Hier kwam de vraag ook voorbij over waarom het sterftecijfer in Italië zo hoog is. Redenen die genoemd werden:quote:Op dinsdag 17 maart 2020 20:36 schreef Momo het volgende:
[..]
https://www.globaltimes.cn/content/1181612.shtml
Dat vermoeden is er wel. Waarschijnlijk wordt daar nu meer onderzoek naar gedaan.
* Mate van testen: hoe meer er getest wordt, hoe lager het sterftepercentage
* Leeftijdsdistributie van de besmette bevolking. In Italië ligt die hoger dan bij bijvoorbeeld de besmettingsgroep in Korea.
* Italië zit momenteel verder in de verspreidingscyclus. Sommige patiënten liggen eerst een aantal weken op de IC en overlijden dan alsnog. Die cijfers komen dus pas op een veel later moment in de cijfers terecht.
* De mate waarin de IC's het aantal opnames aankan. In Italië zijn in sommige regio's de IC's overspoeld, wat tot meer doden leidt.
Er werd (gelukkig) nog niks genoemd over een mogelijk agressievere mutatie.
Een heel stuk over besmetten zonder dat je symptomen hebt:
Presumed Asymptomatic Carrier Transmission of COVID-19
A novel coronavirus has resulted in an ongoing outbreak of viral pneumonia in China.1-3 Person-to-person transmission has been demonstrated,1 but, to our knowledge, transmission of the novel coronavirus that causes coronavirus disease 2019 (COVID-19) from an asymptomatic carrier with normal chest computed tomography (CT) findings has not been reported.
Presumed Asymptomatic Carrier Transmission of COVID-19
A novel coronavirus has resulted in an ongoing outbreak of viral pneumonia in China.1-3 Person-to-person transmission has been demonstrated,1 but, to our knowledge, transmission of the novel coronavirus that causes coronavirus disease 2019 (COVID-19) from an asymptomatic carrier with normal chest computed tomography (CT) findings has not been reported.
Deze past hier denk ik ook wel:
quote:
Ik probeer het nog één keer zo nadat mijn topic gesloten werd.
Chinees ziekenhuis heeft hun bevindingen omtrent corona virus op papier gezet. vooral gericht op medisch personeel maar heel interessant om te lezen. Zou eigenlijk onder al het personeel in ziekenhuis verspreid moeten worden.
Via onderstaande link te downloaden.
https://covid-19.alibabacloud.com
Wer lesen kann, ist klar im Vorteil.
Over het ontwikkelen van PTSS na het beleven van Covid-19 infectie zelf of in je omgeving:
Prevalence and predictors of PTSS during COVID-19 Outbreak in China Hardest-hit Areas: Gender differences matter
Highlights
•The prevalence of posttraumatic stress symptoms (PTSS) in China hardest-hit areas a month after the COVID-19 outbreak was 7%.
•Hierarchical regression analysis and non-parametric test suggested that women reported significant higher PTSS in the domains of re-experiencing, negative alterations in cognition or mood, and hyper-arousal.
•Participants with better sleep quality or less frequency of early awakenings reported lower PTSS.
Prevalence and predictors of PTSS during COVID-19 Outbreak in China Hardest-hit Areas: Gender differences matter
Highlights
•The prevalence of posttraumatic stress symptoms (PTSS) in China hardest-hit areas a month after the COVID-19 outbreak was 7%.
•Hierarchical regression analysis and non-parametric test suggested that women reported significant higher PTSS in the domains of re-experiencing, negative alterations in cognition or mood, and hyper-arousal.
•Participants with better sleep quality or less frequency of early awakenings reported lower PTSS.
Geupdate versie van klinische beschrijving van 69 patienten in China
Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China
From December 2019 to February 2020, 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a serious outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China. Related clinical features are needed.
We reviewed 69 patients who were hospitalized in Union hospital in Wuhan between January 16 to January 29, 2020. All patients were confirmed to be infected with SARS-CoV-2 and the final date of follow-up was February 4, 2020.
The median age of 69 enrolled patients was 42.0 years (IQR 35.0-62.0), and 32 patients (46%) were men. The most common symptoms were fever (60[87%]), cough (38[55%]), and fatigue (29[42%]). Most patients received antiviral therapy (66 [98.5%] of 67 patients) and antibiotic therapy (66 [98.5%] of 67 patients). As of February 4, 2020, 18 (26.9%) of 67 patients had been discharged, and five patients had died, with a mortality rate of 7.5%. According to the lowest SpO2 during admission, cases were divided into the SpO2≥90% group (n=55) and the SpO2<90% group (n=14). All 5 deaths occurred in the SpO2<90% group. Compared with SpO2≥90% group, patients of the SpO2<90% group were older, and showed more comorbidities and higher plasma levels of IL6, IL10, lactate dehydrogenase, and c reactive protein. Arbidol treatment showed tendency to improve the discharging rate and decrease the mortality rate.
COVID-19 appears to show frequent fever, dry cough, and increase of inflammatory cytokines, and induced a mortality rate of 7.5%. Older patients or those with underlying comorbidities are at higher risk of death.
Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China
From December 2019 to February 2020, 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a serious outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China. Related clinical features are needed.
We reviewed 69 patients who were hospitalized in Union hospital in Wuhan between January 16 to January 29, 2020. All patients were confirmed to be infected with SARS-CoV-2 and the final date of follow-up was February 4, 2020.
The median age of 69 enrolled patients was 42.0 years (IQR 35.0-62.0), and 32 patients (46%) were men. The most common symptoms were fever (60[87%]), cough (38[55%]), and fatigue (29[42%]). Most patients received antiviral therapy (66 [98.5%] of 67 patients) and antibiotic therapy (66 [98.5%] of 67 patients). As of February 4, 2020, 18 (26.9%) of 67 patients had been discharged, and five patients had died, with a mortality rate of 7.5%. According to the lowest SpO2 during admission, cases were divided into the SpO2≥90% group (n=55) and the SpO2<90% group (n=14). All 5 deaths occurred in the SpO2<90% group. Compared with SpO2≥90% group, patients of the SpO2<90% group were older, and showed more comorbidities and higher plasma levels of IL6, IL10, lactate dehydrogenase, and c reactive protein. Arbidol treatment showed tendency to improve the discharging rate and decrease the mortality rate.
COVID-19 appears to show frequent fever, dry cough, and increase of inflammatory cytokines, and induced a mortality rate of 7.5%. Older patients or those with underlying comorbidities are at higher risk of death.
Hier is ook een mooi overzicht van betrouwbare, peer-reviewed Corona berichtgeving:
https://decorrespondent.n(...)09944-d9fdf3ca#about
https://decorrespondent.n(...)09944-d9fdf3ca#about
Dit is gewoon raar :l
Nieuw artikel:
Viral Invasion and Type I Interferon Response Characterize the Immunophenotypes during COVID-19 Infection
The new coronavirus COVID-19 has spread globally and caused a pneumonia outbreak. Although the whole genome sequences of COVID-19 have been rapidly obtained, pathogenesis of COVID-19 caused severe disease remains elusive. Understanding the immune responses in patients with severe disease may significantly advance the development of effective therapies. Here, using scRNA-seq technology, we profiled the immunophenotypes of four patients’ PBMCs before, during, and after their ICU cares. Our data identified gene expression signatures of viral invasion and type I interferon (IFN-I) responses as the key manifestations characterized the life-threatening stage of COVID-19 infection in human. The association between viral load/IFN-α levels and disease severity in COVID-19 infection marked the key difference in the pathogenesis of this new coronavirus from previous coronavirus such as SARS-CoV infections.
Viral Invasion and Type I Interferon Response Characterize the Immunophenotypes during COVID-19 Infection
The new coronavirus COVID-19 has spread globally and caused a pneumonia outbreak. Although the whole genome sequences of COVID-19 have been rapidly obtained, pathogenesis of COVID-19 caused severe disease remains elusive. Understanding the immune responses in patients with severe disease may significantly advance the development of effective therapies. Here, using scRNA-seq technology, we profiled the immunophenotypes of four patients’ PBMCs before, during, and after their ICU cares. Our data identified gene expression signatures of viral invasion and type I interferon (IFN-I) responses as the key manifestations characterized the life-threatening stage of COVID-19 infection in human. The association between viral load/IFN-α levels and disease severity in COVID-19 infection marked the key difference in the pathogenesis of this new coronavirus from previous coronavirus such as SARS-CoV infections.
Ook een nieuw artikel:
Potentialdual therapeutic approach against SARS-CoV-2/COVID-19 with Nitazoxanide and Hydroxychloroquine
Coronaviruses are ubiquitous in nature and infectsdiverse species with frequent cross-species transmission. There have been multipleevents of animal to human transmission throughout historyincludingSARS,MERS and most recently SARS-CoV-2(COVID-19)that is responsible for the current pandemic. The rapid spread of SARS-CoV-2/COVID-19 has overwhelmed the capabilities of major nations due to the sheer number of patients with severe disease and critically ill patients requiring intensive care. The high molecular and clinical similarity between SARS and SARS-CoV-2 enable us to draw some parallels between them and utilize nearly two decades of existing researchfrom SARS. Herein I describe a Novel synergistictherapeutic approach against SARS-CoV-2/COVID-19 by repurposing Nitazoxanide and Hydroxychloroquineto target viral and host factors for controlling this disease. Both these drugs are readily available, expected to be highly potent andcan be administered at the population level to ensure infected patients do not advance to the point of needing prolonged hospitalization and critical care thereby changing the course of this disease. The proposed treatment regimen would be expected to diminish the severity of illness by reducing viral titersandrescuing the innate-immune system dysregulation brought about by the viral infection that underlies the high mortality in the older/vulnerable populations there by allowing our health-care system a more controlled disease response.
Potentialdual therapeutic approach against SARS-CoV-2/COVID-19 with Nitazoxanide and Hydroxychloroquine
Coronaviruses are ubiquitous in nature and infectsdiverse species with frequent cross-species transmission. There have been multipleevents of animal to human transmission throughout historyincludingSARS,MERS and most recently SARS-CoV-2(COVID-19)that is responsible for the current pandemic. The rapid spread of SARS-CoV-2/COVID-19 has overwhelmed the capabilities of major nations due to the sheer number of patients with severe disease and critically ill patients requiring intensive care. The high molecular and clinical similarity between SARS and SARS-CoV-2 enable us to draw some parallels between them and utilize nearly two decades of existing researchfrom SARS. Herein I describe a Novel synergistictherapeutic approach against SARS-CoV-2/COVID-19 by repurposing Nitazoxanide and Hydroxychloroquineto target viral and host factors for controlling this disease. Both these drugs are readily available, expected to be highly potent andcan be administered at the population level to ensure infected patients do not advance to the point of needing prolonged hospitalization and critical care thereby changing the course of this disease. The proposed treatment regimen would be expected to diminish the severity of illness by reducing viral titersandrescuing the innate-immune system dysregulation brought about by the viral infection that underlies the high mortality in the older/vulnerable populations there by allowing our health-care system a more controlled disease response.
En deze:
https://www.mediterranee-(...)e_final_DOI_IJAA.pdf
Combinatie van Azythromycine en Hydrochloroquine heeft 8 patienten genezen tov 1 patient in de controlegroup.
https://www.mediterranee-(...)e_final_DOI_IJAA.pdf
Combinatie van Azythromycine en Hydrochloroquine heeft 8 patienten genezen tov 1 patient in de controlegroup.
Super deze:
https://www.bddataplan.nl/corona/
https://www.bddataplan.nl/corona/
- edit: adverteren kan middels een mail naar pr@fok.nl -
Toch even hier (Informatie van Artsen voor Longziekten en Tuberculose (NVALT) ), ondanks het een AD.nl artikel is. Voor al die mensen lopen te roepen dat allerlei middelen gebruikt moeten worden.
quote:Longartsen met handen in haar: ‘Aanbevolen medicijnen hebben niet veel effect, maar wel bijwerkingen’
Longartsen zitten met hun handen in het haar omdat er geen effectieve behandeling is voor het coronavirus. In een nieuwe Nederlandse richtlijn die specialisten gisteren met elkaar bespraken, staat dat er nog onvoldoende bewijs is voor de werking van de in de richtlijn genoemde medicijnen. Sommigen richten wellicht zelfs meer schade aan dan dat ze goed doen. ,,In de praktijk zien we in Brabant tot nu toe niet veel effect van die medicijnen, maar hebben patiënten wel last van bijwerkingen.’’
De eerste behandelresultaten stemmen de voorzitter van de Nederlandse Vereniging van Artsen voor Longziekten en Tuberculose (NVALT) Leon van den Toorn treurig. ,,Wat we tot nu toe in de praktijk zien in de regio Brabant is dat de aanbevolen medicijnen niet veel effect lijken te hebben’’, verklaart Van den Toorn. ,,Maar patiënten hebben in ieder geval wel last van bijwerkingen, zoals depressieve klachten, misselijkheid en braken.’’
Hartritmestoornissen
In de databank voor bijwerkingen Lareb staat dat chloroquine naast maagdarmklachten en hoofdpijn bijvoorbeeld ook ernstige hartklachten en hartritmestoornissen kan veroorzaken. ,,Gebruik dit medicijn NIET als u deze hartritmestoornis heeft’’, klinkt het dringende advies.
Volgens de longarts, die zelf werkzaam is in het Rotterdamse Erasmus MC is het middel dat ‘in Nederland verreweg het meest geprobeerd wordt ‘chloroquine’, een medicijn dat ook gebruikt wordt om malaria te voorkomen. ,,Niet alle ziekenhuizen zijn er enthousiast over, maar de in meeste ziekenhuizen wordt het wel gegeven bij de ziekere patiënten.’’ Of er in Nederland mensen gered zijn met dat middel? ,,Zo kun je dat niet zeggen, heel veel weten we er nog niet over’’, erkent de voorman. Bovendien benadrukt hij: ,,Je weet natuurlijk ook niet wat er met die mensen was gebeurd als je het middel níet had toegepast.’’
Reageerbuisjes
Longartsen staan mede door het gebrek aan bewijs voor grote dilemma’s bij de behandeling van coronapatiënten. ,,In lekentaal komt het er simpel gezegd op neer dat de medicijnen in reageerbuisjes zijn onderzocht’’, legt Van den Toorn uit. ,,In het laboratorium zijn er aanwijzingen dat die medicijnen mogelijk iets tegen het virus doen, maar we weten nog niet of dat daadwerkelijk het geval is als je er mensen mee behandelt.’’
De voorzitter van de longartsen pleit voor gedegen onderzoek naar de medicijnen die tot nu toe geprobeerd zijn tegen het nieuwe coronavirus. Hij krijgt bijval van arts-microbioloog Marc Bonten uit het UMC Utrecht: ,,De middelen die er nu zijn moeten getest worden op twee dingen: één, of ze mensen beter maken, en twee, of ze veilig gebruikt kunnen worden. Die middelen moeten op grote schaal bij mensen gebruikt gaan worden, om te zien of ze effect hebben.’’
Testen op mensen
De Rotterdamse longarts Hans in ‘t Veen uit het Franciscus Gasthuis en Vlietland herkent de moeilijkheden. ,,Er zijn drie problemen: De medicatie is niet beschikbaar, de medicatie is vaak toxisch en we weten zelfs niet eens of het helpt.’’ Volgens hem gaat er over die richtlijn ‘zeker veel discussie’ komen. ,,Als het niet bewezen is en heel schadelijk is: moet je de vraag stellen of je de behandelingsadviezen zo nadrukkelijk kan opschrijven?’’ zo nuanceert hij de aanbeveling hardop.
Om te achterhalen of de middelen werken moeten mensen min of meer gaan functioneren als proefkonijn. Bonten: ,,Het zijn helaas echte mensen die je daarvoor nodig hebt, maar je moet die medicijnen onderzoeken. Anders weten we over een half jaar nog steeds niet wat de beste behandeling is.’’
In levensgevaar
De richtlijn beveelt specialisten aan om de omstreden middelen alleen te gebruiken bij patiënten met ‘ernstige klachten’ en als mensen in levensgevaar zijn. Gisteren spraken artsen via een videoconferentie over de richtlijn: ,,De bewijslast voor de middelen die in de richtlijn genoemd worden is helaas flinterdun’’, erkent Van den Toorn. ,,Daarom is er continue overleg, wordt van vele patiënten bijgehouden wat de behandeling is geweest en proberen we daar uiteindelijk wijzer van te worden. Ondertussen wachten we ook op de uitkomsten van studies die nog lopen. Alleen het duurt nog wel even voordat daar de resultaten van binnenkomen: dat gaat niet in een week.’’
Naast chloroquine, is er ook nog een een ander malariamedicijn ‘hydroxychloroquine’, ,,Dat lijkt op chloroquine en wordt in sommige ziekenhuizen ook toegepast’’, weet Van den Toorn. En verder is er de virusremmer ‘remdesivir’. Dit middel werd oorspronkelijk gebruikt tegen de extreem dodelijke ziekte ebola, maar viel af omdat andere middelen beter bleken te werken. In Nederland wordt het volgens Van den Toorn nog bijna niet voorgeschreven, omdat dat middel heel slecht beschikbaar is’.
Strijd zonder wapens
Zo lijken de doktoren een oneerlijke strijd te voeren tegen het nieuwe coronavirus dat in steeds meer landen om zich heen slaat. Of je dat een strijd zonder wapens kunt noemen? Van den Toorn geeft toe: ,,Tot nu toe voeren we oorlog zonder goede wapens, maar we gaan er desondanks vanuit dat we de strijd uiteindelijk gaan winnen. Bovendien knapt het overgrote deel van de patiënten op, óók zonder die medicijnen, dus dat geeft hoop.’’
Hier een NRC artikel over hoe het RIVM de maatregelen zoals bijvoorbeeld sluiten van de scholen ook zeer wetenschappelijk benaderd. Een wiskundige benadering met modellen.
Waarom bierviltjesberekeningen over het virus niet werken
Wiskundige modellen Afstand houden, scholen sluiten, ‘lockdown’: bij het RIVM rekenen hypercomplexe wiskundige modellen alle maatregelen na. NRC sprak er vijf wetenschappers over. „Zonder wiskundige modellen is niet te begrijpen wat je ziet.”
Waarom bierviltjesberekeningen over het virus niet werken
Wiskundige modellen Afstand houden, scholen sluiten, ‘lockdown’: bij het RIVM rekenen hypercomplexe wiskundige modellen alle maatregelen na. NRC sprak er vijf wetenschappers over. „Zonder wiskundige modellen is niet te begrijpen wat je ziet.”
Artikel over Ijsland waar ze de gehele bevolking kunnen gaan testen.
Iceland finds half of positive cases have no disease traits
https://www.bloomberg.com(...)symptom-scmp-reports
en hier een statement van de Ijslandse regering
https://www.government.is(...)in-Iceland-underway/
Iceland finds half of positive cases have no disease traits
https://www.bloomberg.com(...)symptom-scmp-reports
en hier een statement van de Ijslandse regering
https://www.government.is(...)in-Iceland-underway/
quote:• Iceland has tested 9 768 individuals for COVID-19, which translates to 26 762 per million, compared with 6 343 in South Korea and 13 999 in Bahrein
• Iceland has tested a higher proportion of inhabitants than any other country after deCode genetics started offering free screening among the general, non-symptomatic, non-quarantined population
• deCode has published the results of a total of 5 571 tests. Those have yielded 48 positive results (0.86%) indicating that the prevelance of the virus is modest among the general population.
• A total of 473 cases have been identified in Iceland since the first case on February 28th. One person with COVID-19 has died. Twelve individuals with COVID-19 are hospitalized.
https://equalocean.com/he(...)ia-ct-lung-screening
quote:Infervision: Our AI Detects Deadly Coronavirus via CT Lung Screening
The lung cancer detection company has launched a deep learning-based coronavirus detection system in Wuhan.
Infervision (推想科技) described its coronavirus detection model as working through CT lung screening. This means that the new model detects ground-glass opacities (GGO) in the lung that may later be confirmed as one of the complications of the virus.
The firm's model has already been used by Wuhan Tongji Hospital, one of the frontline hospitals that has been fighting with the epidemic in Wuhan. It is set to be deployed in multiple other hospitals in the near future, Infervision said.
“It serves as a surrogate to PCR diagnostic as the lab capacities aren't enough to keep up with the rising number of suspected cases in the afflicted regions," added the company.
Another diagnostics solution support for the rising crisis was launched by Shenzhen-based genomics giant BGI Genomics (300676: SH) on January 28. The company's stocks opened around 10% up as the mainland's stock markets open on January 3, 2020.
“The new coronavirus may cause infections with no symptoms and sicken otherwise healthy people,” postulated the Lancet, showing how hard it is presently for hospitals in Wuhan, which are racing against time to diagnose large numbers of patients.
The new diagnostic solutions possess tremendous importance for the afflicted region, considering the symptoms of the new virus are similar to other fast-spreading diseases like flu, complicating the process and creating excess demand thanks to a large number of concerned patients who need to be assessed. "Symptomatic patients are piling up in the hospital – AI can help triage the patients quickly," said the firm. "Patients have been seen without any noticeable symptoms like fever or cough, but showing large GGOs in the lung,"
The Beijing-based private firm had long been drawing the attention of wealthy venture capitalists, including Qiming Venture Partners and Sequoia China; it has secured around USD 100 million since its inception in January 2016. The team has been adopting deep learning technology broadly in the medical imaging field.
The firm was involved in an early victory in this complex battle: for the first time since the emergence of the new virus in late 2019, the number of new suspected coronavirus cases in China started to drop, over two consecutive days, on December 31 and January 1, 2020 - mostly driven by faster diagnostic solutions. PCR diagnostics had shown that it could play a crucial role.
Wer lesen kann, ist klar im Vorteil.
Op weather.com staat een interactieve kaart waar Amerikanen (en wij 
)op county-niveau het aantal gevallen kunnen zien (plaatsnaam invullen dan kun je in/uitzoomen):
https://weather.com/coronavirus/
)op county-niveau het aantal gevallen kunnen zien (plaatsnaam invullen dan kun je in/uitzoomen):https://weather.com/coronavirus/
Wer lesen kann, ist klar im Vorteil.
Epidemiologische situatie COVID-19 in Nederland 25 maart 2020
Samenvatting
Tot en met 25 maart 2020 zijn er in Nederland in totaal 6412 COVID-19 patiënten gemeld aan het RIVM Rijksinstituut voor Volksgezondheid en Milieu . De meeste gemelde patiënten vallen in de leeftijdscategorie 55-59 jaar. Tot nu toe zijn van deze gemelde patiënten 1836 opgenomen in het ziekenhuis en 356 overleden.
De meeste overleden patiënten zaten in de leeftijdscategorie 80-84 jaar.
https://www.rivm.nl/documenten/epidemiologische-situatie-covid-19-in-nederland-25-maart-2020
Samenvatting
Tot en met 25 maart 2020 zijn er in Nederland in totaal 6412 COVID-19 patiënten gemeld aan het RIVM Rijksinstituut voor Volksgezondheid en Milieu . De meeste gemelde patiënten vallen in de leeftijdscategorie 55-59 jaar. Tot nu toe zijn van deze gemelde patiënten 1836 opgenomen in het ziekenhuis en 356 overleden.
De meeste overleden patiënten zaten in de leeftijdscategorie 80-84 jaar.
https://www.rivm.nl/documenten/epidemiologische-situatie-covid-19-in-nederland-25-maart-2020
Treatment of COVID-19 with Individualized Immune Boosting Interventions
There are major concerns regarding the current global pandemic of coronavirus disease 2019 (COVID-19) caused by the coronavirus SARS-CoV-2. Whereas most of the infected individuals have no symptoms or only mild symptoms, in a small minority, the infection can lead to pneumonia and death. One major concern regarding the pandemic is the 2.3% average case fatality rate of the COVID-19 patients, with the fatality rate increasing to 8% for patients aged 70 to 79 and 14.8% for those aged 80 and over. Another major concern is the person-to-person transmission of the coronavirus by asymptomatic individuals during the incubation period, making it difficult to limit the spread of the disease. Many steps are underway worldwide to limit the spread of the disease, e.g. cancellation of conferences and large gatherings, closure of schools, curtailment of travel, etc. Considering the magnitude of the adverse impact on the social, cultural, commercial, educational, scientific, health, and other aspects of the society from such steps and the large anticipated casualties with the expected spread of the disease worldwide, it is important to explore methods of reducing the fatality rates of COVID-19 patients. Since the weakness of the immune system is one of the major contributing factors for the occurrence of pneumonia, and inflammation contributes to increased mortality rates of pneumonia patients, interventions that improve the immune response and/or reduce inflammation may reduce the pneumonia incidence and mortality in COVID-19 patients. There are indeed a large number of interventions that improve the immune response and/or reduce inflammation. However, all the interventions would not be applicable or acceptable to everyone and so the interventions would need to be individualized based on individual circumstances and preferences. This approach, known as “Individualized Interventions to Improve the Immune Response”, or the I4R approach needs to be tested in pilot clinical trials for the treatment of COVID-19 patients. If the pilot clinical trials demonstrate that it is effective in reducing the incidence and mortality due to pneumonia, widespread adoption of the I4R approach for treating COVID-19 patients may reduce their morbidity and mortality, reducing the concerns regarding the coronavirus. This may be helpful in reducing the need for the drastic steps that have been taken worldwide, and help in the return of life to normalcy. Therefore, clinical trials of the I4R approach should be conducted on an urgent basis.
There are major concerns regarding the current global pandemic of coronavirus disease 2019 (COVID-19) caused by the coronavirus SARS-CoV-2. Whereas most of the infected individuals have no symptoms or only mild symptoms, in a small minority, the infection can lead to pneumonia and death. One major concern regarding the pandemic is the 2.3% average case fatality rate of the COVID-19 patients, with the fatality rate increasing to 8% for patients aged 70 to 79 and 14.8% for those aged 80 and over. Another major concern is the person-to-person transmission of the coronavirus by asymptomatic individuals during the incubation period, making it difficult to limit the spread of the disease. Many steps are underway worldwide to limit the spread of the disease, e.g. cancellation of conferences and large gatherings, closure of schools, curtailment of travel, etc. Considering the magnitude of the adverse impact on the social, cultural, commercial, educational, scientific, health, and other aspects of the society from such steps and the large anticipated casualties with the expected spread of the disease worldwide, it is important to explore methods of reducing the fatality rates of COVID-19 patients. Since the weakness of the immune system is one of the major contributing factors for the occurrence of pneumonia, and inflammation contributes to increased mortality rates of pneumonia patients, interventions that improve the immune response and/or reduce inflammation may reduce the pneumonia incidence and mortality in COVID-19 patients. There are indeed a large number of interventions that improve the immune response and/or reduce inflammation. However, all the interventions would not be applicable or acceptable to everyone and so the interventions would need to be individualized based on individual circumstances and preferences. This approach, known as “Individualized Interventions to Improve the Immune Response”, or the I4R approach needs to be tested in pilot clinical trials for the treatment of COVID-19 patients. If the pilot clinical trials demonstrate that it is effective in reducing the incidence and mortality due to pneumonia, widespread adoption of the I4R approach for treating COVID-19 patients may reduce their morbidity and mortality, reducing the concerns regarding the coronavirus. This may be helpful in reducing the need for the drastic steps that have been taken worldwide, and help in the return of life to normalcy. Therefore, clinical trials of the I4R approach should be conducted on an urgent basis.
Covid-19 fatality is likely overestimated
The final case fatality rate (CFR) from SARS-CoV-2, the virus that causes covid-19, will likely be lower than those initially reported.1 Previous reviews of H1N1 and SARS show the systematic inflation of early mortality estimates.23 Early estimates of H1N1’s mortality were susceptible to uncertainty about asymptomatic and subclinical infections, heterogeneity in approaches to diagnostic testing, and biases in confounding, selection, detection, reporting, and so on.23 These biases are difficult to overcome early in a pandemic.3
We read Xu and colleagues’ report of 62 cases of covid-19 outside of Wuhan, China, with interest, as no patients died in the study period.5 Compared with a report of the 72 314 cases throughout China, the marked differences in outcomes from Hubei (the province of which Wuhan is the capital) compared with all other provinces are worth a brief discussion.4
The CFR in China (through 11 February) is reported as 2.3%.15 The CFR among the initial Wuhan cohort was reported as 4.3%, with a rate of 2.9% in Hubei province.15 But outside Hubei the CFR has been 0.4%. Deaths occurred only in cases deemed “critical.” Importantly, the CFR from these reports is from infected, syndromic people presenting to healthcare facilities, with higher CFRs among older patients in hospital (8%-14.8% in the Wuhan cohort).
As accessibility and availability of testing for the novel coronavirus increases, the measured CFR will continue to drop, especially as subclinical and mild cases are identified.678 Alternatively, the CFR might not fall as much as in previous epidemics and pandemics, given the prolonged disease course of covid-19 or if mitigation measures or hospital resources prove inadequate.9101112
As with other pandemics, the final CFR for covid-19 will be determined after the pandemic and should not distract from the importance of aggressive, early mitigation to minimise spread of infection.
The final case fatality rate (CFR) from SARS-CoV-2, the virus that causes covid-19, will likely be lower than those initially reported.1 Previous reviews of H1N1 and SARS show the systematic inflation of early mortality estimates.23 Early estimates of H1N1’s mortality were susceptible to uncertainty about asymptomatic and subclinical infections, heterogeneity in approaches to diagnostic testing, and biases in confounding, selection, detection, reporting, and so on.23 These biases are difficult to overcome early in a pandemic.3
We read Xu and colleagues’ report of 62 cases of covid-19 outside of Wuhan, China, with interest, as no patients died in the study period.5 Compared with a report of the 72 314 cases throughout China, the marked differences in outcomes from Hubei (the province of which Wuhan is the capital) compared with all other provinces are worth a brief discussion.4
The CFR in China (through 11 February) is reported as 2.3%.15 The CFR among the initial Wuhan cohort was reported as 4.3%, with a rate of 2.9% in Hubei province.15 But outside Hubei the CFR has been 0.4%. Deaths occurred only in cases deemed “critical.” Importantly, the CFR from these reports is from infected, syndromic people presenting to healthcare facilities, with higher CFRs among older patients in hospital (8%-14.8% in the Wuhan cohort).
As accessibility and availability of testing for the novel coronavirus increases, the measured CFR will continue to drop, especially as subclinical and mild cases are identified.678 Alternatively, the CFR might not fall as much as in previous epidemics and pandemics, given the prolonged disease course of covid-19 or if mitigation measures or hospital resources prove inadequate.9101112
As with other pandemics, the final CFR for covid-19 will be determined after the pandemic and should not distract from the importance of aggressive, early mitigation to minimise spread of infection.
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