Conoravirus ...

[kimbottles]

Since the FDA gave provisional approval to the abbott antibody test we have been swamped with patient calls to get it. Our policy is a video or in person appointment to discus it in more detail before we will order it. After explaining the potential problems with false negatives and positives, the fact that antibodies do not diagnose the illness acutely, we do not know if antibodies infer immunity, and insurance may not cover ther $45 cost, many of my patients decide to hold off until we have more reliable information. I certainly hope in the end it is acurate and meaningful on a epidemiologic and personal basis.

The truth is the test result does not yet alter care or personal decisions. Despite seeing patients throughout and working in close proximity to partners and clinical staff for weeks I have also decided to wait. I will admit I freak a little everytime I sneeze or my toe hurts. I recall what an N95 mask looks like, but have not seen one in weeks, but I am sure the flimsy surgical masks supplied in unmarked cardboard boxes that I am supplied are the best!

Stay safe Tom!

[Jamie]

Since the FDA gave provisional approval to the abbott antibody test we have been swamped with patient calls to get it. Our policy is a video or in person appointment to discus it in more detail before we will order it. After explaining the potential problems with false negatives and positives, the fact that antibodies do not diagnose the illness acutely, we do not know if antibodies infer immunity, and insurance may not cover ther $45 cost, many of my patients decide to hold off until we have more reliable information. I certainly hope in the end it is acurate and meaningful on a epidemiologic and personal basis.

The truth is the test result does not yet alter care or personal decisions. Despite seeing patients throughout and working in close proximity to partners and clinical staff for weeks I have also decided to wait. I will admit I freak a little everytime I sneeze or my toe hurts. I recall what an N95 mask looks like, but have not seen one in weeks, but I am sure the flimsy surgical masks supplied in unmarked cardboard boxes that I am supplied are the best!

Just know those of us hiding at home appreciate you have what it takes to go out and face this directly.

[kimbottles]

Since the FDA gave provisional approval to the abbott antibody test we have been swamped with patient calls to get it. Our policy is a video or in person appointment to discus it in more detail before we will order it. After explaining the potential problems with false negatives and positives, the fact that antibodies do not diagnose the illness acutely, we do not know if antibodies infer immunity, and insurance may not cover ther $45 cost, many of my patients decide to hold off until we have more reliable information. I certainly hope in the end it is acurate and meaningful on a epidemiologic and personal basis.

The truth is the test result does not yet alter care or personal decisions. Despite seeing patients throughout and working in close proximity to partners and clinical staff for weeks I have also decided to wait. I will admit I freak a little everytime I sneeze or my toe hurts. I recall what an N95 mask looks like, but have not seen one in weeks, but I am sure the flimsy surgical masks supplied in unmarked cardboard boxes that I am supplied are the best!

Just know those of us hiding at home appreciate you have what it takes to go out and face this directly.

Amen!!

[Steele]

Thanks, but the challanges I am facing are tiny compared to what the docs and nurses are dealing with in the hospitals. On the outpatient side we are in a much more controlled environment, so my quip about the surgical masks is mostly in jest. In an odd way there is a benefit to working in healthcare right now. I still go to work, get to interact with great staff and fellow docs, and at least for now still have an income. Even working in the outpatient acute respiratory clinic was rewarding, although that is pretty much done for now since the volume of ill people is dropping off.

I think the next big challenge in the PNW will be in the fall when a combination of opening up society and the cold and flu season could keep us very busy. In my opinion closing schools had the greatest effect in dropping infection rates. It took a huge reservoir of potential respiratory illnesses out of circulation since nothing spreads germs like little kids. Closing schools also underlined the seriousness of the situation and kept parents shut down as well. I hope the policy makers keep this in mind as we approach the fall.

[Olaf Hart]

Well, we are at the bottom of the curve and gradually reopened schools this week, so watch this space and see how it goes...

[Steele]

I hope it goes well. I am not proposing keeping them closed any longer than necessary but rather being super vigilant. As I already mentioned the drop in all acute respiratory illnesses was pronounced within a week of school closures. This had been noticed before if they were closed for a prolonged weather event resulting in a drop in flu.

[Tigger]

One interesting nugget from Monday's briefing. Our Provincial Health Officer (Dr. Bonnie Henry) stated that there had been 0 of 2087 confirmed cases attributable to transmission of the disease on public transportation.

Update--folks in the Ministry of Health have now traced a total of 87 confirmed cases related to the Dental Conference held here just before it all shut down. Some (many? most?) of these are people who travelled back to their communities elsewhere in Canada and the US.

We are hearing rumblings of a slow and thoughtful relaxation of guidelines, guided by science (so says Bonnie). Here's hoping we can have our son and pregnant daughter-in-law over for dinner again soon!

[BeauV]

For the Doctors here, could you give a read to this and rate credibility. I had thought much of this was tin-foil-hat stuff, but maybe not. Thoughts??

https://www.newsweek.com/dr-fauci-backed-controversial-wuhan-lab-millions-us-dollars-risky-coronavirus-research-1500741

[Benno von Humpback]

For the Doctors here, could you give a read to this and rate credibility. I had thought much of this was tin-foil-hat stuff, but maybe not. Thoughts??

https://www.newsweek.com/dr-fauci-backed-controversial-wuhan-lab-millions-us-dollars-risky-coronavirus-research-1500741

The assertion that the NIAID gave money to that lab is true. It is also true that that lab could have been the source of the pandemic virus. Beyond that, Fauci is just the institute director. Every grant application is scored by an external peer study section and all grants must be approved by an external advisory council before any money goes out the door. Finally, virus research can be risky and it can be low quality, but it’s one of the jobs congress and the taxpayers put the NIAID there to do. Did you know that the Air Force kills women and children?

Of course, now science is just one more dark conspiracy.

[Tim Ford]

Of course, now science is just one more dark conspiracy.

Ya think? Someone should tell Galileo Galilei. Nothing new here, folks. Except for the highly elevated means of rumor/chatter.

[TheOffice]

On a somewhat positive note, Hopkins is temporarily closing its pediatric unit because kids are not spreading disease at daycares and schools.

Bermuda will start to reopen next week, flights from US start by June 1.

[Benno von Humpback]

For the Doctors here, could you give a read to this and rate credibility. I had thought much of this was tin-foil-hat stuff, but maybe not. Thoughts??

https://www.newsweek.com/dr-fauci-backed-controversial-wuhan-lab-millions-us-dollars-risky-coronavirus-research-1500741

More on this.

https://www.npr.org/sections/goatsandso ... coronaviru

[Tim Ford]

this is a lovely little snippet from that article, Benno:

"That poses a threat to U.S. national security and public health, he[Daszak]says. "Once this pandemic is over, we know of hundreds of other coronaviruses that we've found evidence of in China that are waiting to emerge," says Daszak. "We are now going to be unable to know about the risk of that, which puts us completely at risk of the next pandemic."

Whuddaya make of that? Hundreds, he says!

[Ajax]

Of course, now science is just one more dark conspiracy.

Ya think? Someone should tell Galileo Galilei. Nothing new here, folks. Except for the highly elevated means of rumor/chatter.

I get to keep Benno's middle finger in a reliquary on my dresser if he's convicted of heresy or dark arts.

[LarryHoward]

this is a lovely little snippet from that article, Benno:

"That poses a threat to U.S. national security and public health, he[Daszak]says. "Once this pandemic is over, we know of hundreds of other coronaviruses that we've found evidence of in China that are waiting to emerge," says Daszak. "We are now going to be unable to know about the risk of that, which puts us completely at risk of the next pandemic."

Whuddaya make of that? Hundreds, he says!

Maybe I'm jaded by years in government procurement but a nonprofit that sees a big funding stream dry up goes public warning of the Armageddon to come if they don't get the tap turned back on.....

[Benno von Humpback]

this is a lovely little snippet from that article, Benno:

"That poses a threat to U.S. national security and public health, he[Daszak]says. "Once this pandemic is over, we know of hundreds of other coronaviruses that we've found evidence of in China that are waiting to emerge," says Daszak. "We are now going to be unable to know about the risk of that, which puts us completely at risk of the next pandemic."

Whuddaya make of that? Hundreds, he says!

Maybe I'm jaded by years in government procurement but a nonprofit that sees a big funding stream dry up goes public warning of the Armageddon to come if they don't get the tap turned back on.....

Absolutely.

[Benno von Humpback]

this is a lovely little snippet from that article, Benno:

"That poses a threat to U.S. national security and public health, he[Daszak]says. "Once this pandemic is over, we know of hundreds of other coronaviruses that we've found evidence of in China that are waiting to emerge," says Daszak. "We are now going to be unable to know about the risk of that, which puts us completely at risk of the next pandemic."

Whuddaya make of that? Hundreds, he says!

No idea how valid or spun that comment is.

[Jamie]

Probably true - but I'd add - not just China. Big reservoir of people, lots of human/animal contact, weak healthcare system in the countryside. That kind of reminds me of a a number of countries.

[Tim Ford]

Probably true - but I'd add - not just China. Big reservoir of people, lots of human/animal contact, weak healthcare system in the countryside. That kind of reminds me of a a number of countries.

Yup, you got it. I wouldn't so go far as to anthropomorphize nature, but she does find a way to exploit weaknesses in terms of population dynamics and stressed out environments.

[BeauV]

For the Doctors here, could you give a read to this and rate credibility. I had thought much of this was tin-foil-hat stuff, but maybe not. Thoughts??

https://www.newsweek.com/dr-fauci-backed-controversial-wuhan-lab-millions-us-dollars-risky-coronavirus-research-1500741

The assertion that the NIAID gave money to that lab is true. It is also true that that lab could have been the source of the pandemic virus. Beyond that, Fauci is just the institute director. Every grant application is scored by an external peer study section and all grants must be approved by an external advisory council before any money goes out the door. Finally, virus research can be risky and it can be low quality, but it’s one of the jobs congress and the taxpayers put the NIAID there to do. Did you know that the Air Force kills women and children?

Of course, now science is just one more dark conspiracy.

Well, I wasn't calling it a conspiracy, despite my tin-foil-hat crack. That crack was an indication that until this article I thought claims that we might have helped fund research in this area in a Chinese Lab was a conspiracy theory. Now, I guess I'm not so sure. I get that Fauci is the Director and not going grind through the details of each grant. But, we're not really talking about a single grant, we talking about a policy change in 2017.

What I would like to hear are your thoughts on why the changes made during the Obama Admin to stop trying to get coronaviruses to be able to leap to humans was reversed in 2017. In reading about the debate amongst researchers, there is a pretty robust argument that has been going on for more than a decade or two. I also understand that one would like to understand any capability that a "bad actor" might develop in the area of biological weapons, and work out a defense to that in advance of the attack.

What I can't understand is why the US would fund research of this type in China vs in a US Gov. lab.

EDIT: OK, I get it. (NPR Article was VERY helpful) These guys were the field team looking for Bad Bats. Or at least Bad Bat Bugs. That is an entirely rational reason for the research.

So, do I have this right? The US has (or now had) field team of locals and others who are looking through dozens or hundreds of viruses which might escape into the human population from other species (EG: Bad Bats With Bad Bugs) Thus, the discovery of a lot of folks with various other coronaviruses in China which haven't yet become contagious enough or populous enough to make it into the world population.

That seems like a totally rational thing to do. Dangerous as hell, but rational.

This doesn't seem to have anything to do with what the Newsweek article referred to as enhancing the Bad Bugs to get them to migrate to Humans. Which I believe is what was cancelled by the Obama administration. Thought?

[Tim Ford]

Because, that's where the Bats is At?

[Benno von Humpback]

Well, I wasn't calling it a conspiracy. I also get that Fauci is the Director and not going grind through the details of each grant. But, we're not really talking about a single grant, we talking about a policy change in 2017.

What I would like to hear are your thoughts on why the change made in the Obama Admin to stop trying to get coronaviruses to be able to leap to humans was reversed in 2017. In reading about the debate amongst researchers, there is a pretty robust argument that has been going on for more than a decade or two. I also understand that one would like to understand any capability that a "bad actor" might develop in the area of biological weapons, and work out a defense to that in advance of the attack.

What I can't understand is why the US would fund research of this time in China vs in a US Gov. lab.

These are complex decisions and the line on what's acceptable keeps shifting. Lots and lots of public health-relevant research is potentially applicable to bio warfare and the difference is often a matter of emphasis.

NIH extramural funding is an investigator initiated, bottom-up process. They know the academic community is a hell of a lot smarter than they are, so they come up with a program and solicit applications that fit a broad set of requirements and goals with plenty of room for creativity in the design of the individual projects. They can and do place more specific limits on who can do stuff, for instance, by federal regulation, any work on pathogens, like coronaviruses, has to be has to be done at BSL 3 or above, but those facilities are rare and you can't get them to switch programs very easily. They are lucky when they find the interest and expertise combined with the facilities. Should they have considered doing this in China a security risk? Maybe, but that's hindsight.

You can be totally requirements-driven, like DOD, who do their science by contract or at their own labs, but you get a decidedly inferior product on average.

Finally, the NIH is not some rogue agency. The institute priorities are set explicitly by Congress through the appropriations process and the Directors testify about what they’ve accomplished every year.

[BeauV]

Because, that's where the Bats is At?

LOL!!!

No, it's where the Bad Bats is At.

[BeauV]

Well, I wasn't calling it a conspiracy. I also get that Fauci is the Director and not going grind through the details of each grant. But, we're not really talking about a single grant, we talking about a policy change in 2017.

What I would like to hear are your thoughts on why the change made in the Obama Admin to stop trying to get coronaviruses to be able to leap to humans was reversed in 2017. In reading about the debate amongst researchers, there is a pretty robust argument that has been going on for more than a decade or two. I also understand that one would like to understand any capability that a "bad actor" might develop in the area of biological weapons, and work out a defense to that in advance of the attack.

What I can't understand is why the US would fund research of this time in China vs in a US Gov. lab.

These are complex decisions and the line on what's acceptable keeps shifting. Lots and lots of public health-relevant research is potentially applicable to bio warfare and the difference is often a matter of emphasis.

NIH extramural funding is an investigator initiated, bottom-up process. They know the academic community is a hell of a lot smarter than they are, so they come up with a program and solicit applications that fit a broad set of requirements and goals with plenty of room for creativity in the design of the individual projects. They can and do place more specific limits on who can do stuff, for instance, by federal regulation, any work on pathogens, like coronaviruses, has to be has to be done at BSL 3 or above, but those facilities are rare and you can't get them to switch programs very easily. They are lucky when they find the interest and expertise combined with the facilities. Should they have considered doing this in China a security risk? Maybe, but that's hindsight.

You can be totally requirements-driven, like DOD, who do their science by contract or at their own labs, but you get a decidedly inferior product on average.

Finally, the NIH is not some rogue agency. The institute priorities are set explicitly by Congress through the appropriations process and the Directors testify about what they’ve accomplished every year.

Eric, thanks for the time to write this. I updated my original post after having read the NPR article - it was very helpful. I understand the issue far better now thanks to you and NPR. I suppose a rational analogy would be testing bombs. You need to see what they'll do and more importantly, you need to see what the other guy's bombs will do so you can defend yourself. Given "That's where the Bats is At" (To quote Tim) it makes perfect sense to study coronaviruses in China.

[Benno von Humpback]

Eric, thanks for the time to write this. I updated my original post after having read the NPR article - it was very helpful. I understand the issue far better now thanks to you and NPR. I suppose a rational analogy would be testing bombs. You need to see what they'll do and more importantly, you need to see what the other guy's bombs will do so you can defend yourself. Given "That's where the Bats is At" (To quote Tim) it makes perfect sense to study coronaviruses in China.

Yeah, important point about the bats.

Here's the NIH page on Dual Use Research of Concern

https://osp.od.nih.gov/biotechnology/du ... f-concern/

[Olaf Hart]

The Wuhan lab folks were also funded by the Oz government to check out our bats..

https://www.dailymail.co.uk/news/articl ... -bats.html

[Olaf Hart]

All is well for four year olds in Denver..

348F02AD-F8DA-41D9-8130-5B9E86167FFC.jpeg

[BeauV]

That is one hell of a cute kid!! We're getting a grandson on June 21st. I finally get a BOY!!! A GRANDSON!!! YES!!! So far, I'm calling the kid "peanut" as he's still looking a lot like a peanut in his mom's tummy. I sure hope he turns out as cute as this kid!

[Olaf Hart]

Here is the six year old brother

04031E41-C2A8-4274-9646-AE06463C9090.jpeg

Not sure their parents think they are that cute at the moment...

[H B]

That is one hell of a cute kid!! We're getting a grandson on June 21st. I finally get a BOY!!! A GRANDSON!!! YES!!! So far, I'm calling the kid "peanut" as he's still looking a lot like a peanut in his mom's tummy. I sure hope he turns out as cute as this kid!

Beau, that will be big fun if he comes out on June 21, as that is my daughter's birthday also...she will be 29 this year.