700 tests in pipeline after 8 more negative samples
(CNS): After a day of maintenance at the HSA lab yesterday, Chief Medical Officer Dr John Lee had just eight results to reveal at Wednesday’s daily COVID-19 briefing, all of which were negative. But the CMO said that another 150 samples were going through the machine and a further 700 were pending. He said more than fifty tests for people still in quarantine after returning to Cayman on the air-bridge and another 30 for clinical reasons were being prioritised.
MLAs will be in the Legislative Assembly on Thursday dealing with laws to help Cayman navigate its way through the current coronavirus health crisis. Therefore, the usual daily update will be replaced by a briefing from healthcare professionals across the island focusing on the management of the virus itself.
Meanwhile, the patients suffering from the virus who have been admitted to hospital are all improving and none are on ventilators. Currently, only seven people who were diagnosed with COVID-19 have officially recovered, but Dr Lee said that in the next batch of results that number should jump up significantly.
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Category: Health, Medical Health
Meantime in Bermuda:
“…drive-through testing would start for the uniformed services and other “high-risk essential workers” at 2pm today and continue over the weekend.”
Anchorage family of 5 survives and fully recovers from COVID-19.
https://www.ktuu.com/content/news/Anchorage-family-of-5-survives-and-fully-recovers-from-Covid-19-569922681.html
CIG should NEVER approve, allow or permit the importation and use of home-based DIY coronavirus test kits!! We know that not everyone is responsible enough to inform health professionals if they were to test positive, nor to self-isolate to the required degree.
Testing MUST remain in the hands of medical professionals, no matter how long it takes!!!
It’s weird that there are no calls for rolling out the existing anonymous voluntary smart phone contact tracing apps using crowdsourced time mapping data to identify possible interactions with a very limited number of known infected. This is how South Korea managed their way out of a bigger problem. Australia, Singapore and others are now doing this too. We could either slowly “whack-a-mole” our entire population of 55,000 over 3.5 months, or specifically target those few thousand that actually show to have crossed paths with those infected…in a week.
Greenland, St Bath, Saint Lucia, and Yemen all purport to be fully recovered and free of their active cases of COVID-19. Let’s hope we can join the observation ranks in the coming months, and hold off a second wave through vigilance, until a vaccine is available.
There are a lot of comments, mostly negative, around the low numbers of people tested. It may be helpful for Dr. Lee to have an infographic (landscape orientation please) that outlines all of the required parts to complete a single test in Cayman.
Included on this infographic would be current on hand supply quantities, including human resources, and then in brackets the quantity on order and expected arrival date on island. This would give the public a clear picture of where the bottlenecks are and help set expectations accordingly.
The graphic could also include timelines for tests, regular maintenance intervals, and other relevant data.
Improved communication in this area would create better understanding for all.
Thought I would share this.
http://www.msn.com/en-xl/northamerica/northamerica-top-stories/white-house-promotes-new-lab-results-suggesting-heat-and-sunlight-slow-coronavirus/ar-BB138OWZ?ocid=spartandhp
All coronaviruses hate the sun. This means you need your skin in the game of the sun.
The Premier shows courage in acting to protect the Cayman people from this new Chinese disease threat. However, now the actual percentage of deaths expected from infection are being revised down and down by the USA CDC as actual numbers replace the inaccurate models. Perhaps it is time for a reassessment based on facts instead of on inaccurate models, and time for a new plan.
CNS: The prediction models are being revised down because governments, like ours, are listening to scientists and taking drastic measures to contain the virus and seriously curtail the spread. They are also revised as scientists learn more about COVID-19. That’s not the same thing as being wrong.
With all due respect, CNs, you are only half right here. Yes, mitigation efforts have resulted in better outcomes has saved many lives which is why they are worthwhile. But as testing becomes more widespread it is apparent that the death rate used in some of these models is higher by an order of magnitude (I.e. 3% vs 0.3%). That is in fact “being wrong”. That is not to blame the people that made the models who are doing the best they can with the data they have. But as the months go by we learn more about the virus and must factor it into our thinking. Similar to the way it has now been shown that chroloquine is not a miracle cure but might provide slightly better outcomes for some patients and ventilators might not be helpful as we thought. I realize many people are trying to discredit the models to suggest we go back to work but as a journalist you are obligated to acknowledge reality even if it gives these people ammunition for their arguments. For the record I think we should definitely keep up the social distancing measures as although this virus is less lethal than once thought it is still lethal to many people and can cause permanent lung damage even in moderate cases.
CNS: I have added a sentence to clarify. All the scientists working on every aspect of COVID-19 have said from the start and repeatedly that there is much that they do not know about this brand new virus, and clearly as time goes on they will learn more, including those doing the modelling. The number of asymptomatic carriers is going to decrease the mortality rate as a percentage of those infected but also makes the virus far more lethal.
The idea that chloroquine was a miracle cure was not spread by the leading scientists but very recklessly touted by Trump and the trumpets on right wing media. The real scientists were saying this is a possibility but it needs controlled testing before we can say either way.
Thumbs up to the CNS comment and down to the “Chinese” disease threat.
Agreed, I don’t think they have a clue. I think the models are clearly wrong. It’s either that or reporting around the globe is highly and I mean highly wrong or using vastly differing standards country to country or in the case of the US, state to state.
Draconian measures have and have not been taken in different regions and the results are so diverse it’s impossible to claim that one strategy is better than another. One thing is clear however, Asia has done far better than Europe and N. America.
India has some of the worlds largest slums and densely populated cities and the virus should have been raging and ravishing through that country in many places. Their cases per million 17 and deaths per million .5
China is open for business with very low rates per capita. They are either lying about their numbers or about their strategy and treatments.
We will know what happened about 3 years from now. Scientists are very far behind the curve on this.
Here’s some news from CNN.
https://edition.cnn.com/2020/04/22/health/coronavirus-ventilator-patients-die/index.html
this has been covered here already
With all the calls for mass testing, I hope that at least CNS will question the CMO or the Premier, as to why this strategy has not been employed and not accept the same old excuses of maintenance of machines, lack of swabs, people tired or not enough trained people..Press for a real answer!!!! We have been locked down since late March and please stop giving us excuses and start ramping up testing..We will never get out of this 2 week holding pattern every time somebody tests positive if we don’t get the masses tested..
We’re processing 8 tests a day? Wow.
Island time. Soon come.
Raybiotech sells a 10 minute DIY IgM/IgG finger prick test – 20 pack for $280…$14 per test. Cuomo is saying 20% of NYCer’s tested had already had the virus. We need to get our order in.
https://www.raybiotech.com/covid-19-igm-igg-rapid-test-kit/
For those people who persist in believing that the only people who need worry are those with underlying conditions, the evidence is mounting that that is not necessarily so.
CNN just aired a story on the first person in the US to be diagnosed with Covid-19—a California woman who had no apparent underlying conditions, was healthy and exercised regularly. In early 50s.
Her death was first attributed to a heart attack, but her family was skeptical and asked for Covid-19 testing. Bingo, she died of Covid-19.
I am interested that today’s local discussion panel at the national press conference disclosed that men comprised the largest group of local persons infected. Not surprised at all—our brawnier (note, decidedly not brainer) sex tends to feel invulnerable, and unlike women, are less likely to take precautions.
Men beware!
And by the way, the average of age for Cayman’s Covid cases is 43, impacting individuals between the ages of 14 to 84.
How very interesting! We are all vulnerable, regardless of age or sex.
Oh God give it a rest. If you wanna continue hiding for the rest of your life please do so….the rest of us are going to take our chances and actually enjoy life.
7:04, not a lot of enjoyment suffering through a case of Coronavirus—or even dying.
You really sound silly and thoughtless.
There is a Bible verse for you: eat, drink and be merry, for tomorrow we die.
Enjoy.
Good thing that fairytale book does nothing for me , just like your reply.
Hope you’re not a diver
Are you saying the doctors lied about her having a heart attack? In British Columbia the average age of the person dying is Eighty-Six.
7:15 pm, No, doctors didn’t lie.
The patient died on 6 February in Santa Clara, California. She is retrospectively the first case identified to have Covid-19 in the US. So doctors did not suspect Covid-19.
It was all over the US news tonight, as her case now identified indicated that there was community transmission in the US from early January. This woman had no travel history.
Had cases been identified earlier health authorities could have commenced containment strategies earlier.
Notably, Santa Clara was the first in the nation to implement containment strategies, resulting in a remarkable record of flattening the curve and lowering the death rate.
In doctors we trust. THEY DON’T KNOW! They simply don’t know. It is all assumptions.
There are many reasons for heart attacks.
Women in particular have coronary microvascular disease (sometimes called small artery disease or small vessel disease) which nearly always remain hidden, unrecognized and undiagnosed, for doctors focus mostly on the “male” type heart disease which is coronary. Even Health City doesn’t have equipment (at least they didn’t 2 years ago when I asked) to diagnose coronary microvascular disease.
So to say this particular woman, may she RIP, had no underlying health issues at 50 is a stretch.
Covid 19 doesn’t kill you – it’s the body’s reaction to the virus that kills you, whether it’s pneumonia or organ failure. So how do you differentiate between someone who has a pre existing medical condition and also has Covid as to the primary cause of death? If one of those people in New York found to have already have the virus but be asymptomatic dies of a heart attack, their autopsy will show both virus and heart attack.
Doctors and scientists don’t understand this disease well enough yet to make definitive treatment decisions.
So far few possible causes of death have been identified already:
– ventilators
– blood clots
– possible antibiotic resistance
– possible C19 interference with influenza vaccine virus that could lead to systemic inflammatory response syndrome, multiorgan dysfunction syndrome, and macrophage activation syndrome
Don’t forget that life built around artificial light and pulsed technology is undoubtedly unhealthy. However, an additional consideration might be the prevalence of autoimmune conditions in the 20-40 segment of the population. Autoimmune conditions are at epidemic levels nowadays, with frequent and indiscriminate use of vaccines as a major contributing factor.
So think before you put on your body another pulsed technology gadget or sleep with your smart phone under the pillow.
How sensitive is it? How specific is it? What is its rate of false negatives? What is its rate of false positives?
Current testing levels are inadequate for many reasons. We are not doing enough testing to understand the extent of the virus in the community. We are also looking at the potential waste of scarce resources. The test kits we acquired will expire some time around the end of this year. That means that unless we get our act together and do something like 2,000 – 3,000 tests per week on average, a lot of effort and money will be wasted.
I’m not sure what you’re smoking, but the logistics of testing 3000 people a week in Cayman is crazy.
They’re doing all they can, and improving where possible. Be patient.
No because at this rate we’re not getting out of our homes until 2053.
According to the article in the Compass the other day there is a private sector lab on island who reckons they can do 670 a day.
I hope their reckoning is right
No wonder Alden is trying to kill the compass. (See Worc now posting job ads only) It’s not helping his narrative that they are doing all they can.
He wants us locked up. They are pissed their port deal was ruined by the good people of Cayman.
Can’t happen if we leave it to the HSA to do the test…4 machines and producing 8 tests per day…UGH!!!
Okay, assume we find willing volunteers for that dangerous and skilled collection assignment…and that there are now 55,000+ collected and spoiling samples…then what? After full max testing capacity ramp-up the pros are handling 500 samples a day for the next 110 days.
Around end of July or early August, the all-clear whistle is blown and then what?
There is no scenario where we open the airlines to business and recreational/tourism travel, hotels, or attractions until the rest of the planet gets a handle on their own mis-managed situations – and possibly raging second waves.
And then what is we get to go back to all non tourism related work, and live life a kittle normally. What’s your plan genius – going to stay in your house until / if ( no vaccine ever developed for SARS or MERS) a vaccine is discovered?
Mandatory door-to-door MASS testing, census style. There shouldn’t be a choice of “I’m going to get tested”, it should be we are coming to test you.
Go back to Cuba. They miss you.
We are not in the 2nd world war, papers ID poilce roadblocks now compulsry testing, I don’t agree we have fundemantal rights. On the flip side I would get tested and it might be mandatory for workplaces, however if you just want to hide at home what is the issue. Also test 1 person per household would be a great picture. We really should have antibody testing as well.
People mumbling and moaning about how things need to open back up, and not being willing to test themselves is the issue. You can’t have your cake and eat it to, there has to be some compromise if things are to go back to normal. People whine when there’s only 8 test results available but when someone says to go door to door and test everyone it’s an uproar. At this rate they’ll never be any progress.
People complained in regards to the proposal of drive through testing “so how are we going to get tested if I don’t have a car, I hope someone is going to provide transportation”, now as you can see above someone says “go back to Cuba” implying that mandatory door to door testing is somehow communist or some way of dictatorship. If say go left people will go right just for the sake of them wanting to feel like they had a choice.
Facts are, if you put “free food” next to “mandatory vaccine” the majority of naysayers would flock.
Umm – there’s usually a T-shirt on offer too. Don’t be cheap 😉
No we are in a bio-war with a virus, if we act like it’s not there there will be more casualties than WWII. Check your history on the Spanish Flu of 1918 and see how bad it could be. This thing will be with us for at least another year or until a satisfactory vaccine is available to us. But I suppose you will refuse to be vaccinated too?
Sounds like a democrat.
Exactly! You can’t force people to get tested.
In regard to quarantine duration for persons testing positive, 25% of people who test positive may be completely asymptomatic. People who test positive are quarantined until they have 2 consecutive negative tests 24 hours apart even if this requires quarantine for much longer than 14 days. The reasoning behind this is that persons who continue to test positive may be able to infect other persons. For those interested there is an excellent paper published in the British Medical Journal on Tuesday.
https://www.bmj.com/content/369/bmj.m1443
The article states in part that virus is shed in respiratory droplets, in stool and in urine. It also states that infected persons who develop symptoms may shed virus for much longer than 14 days. The summary reads in part:
The median duration of virus in stool (22 days, interquartile range 17-31 days) was significantly longer than in respiratory (18 days, 13-29 days; P=0.02) and serum samples (16 days, 11-21 days; P<0.001). The median duration of virus in the respiratory samples of patients with severe disease (21 days, 14-30 days) was significantly longer than in patients with mild disease (14 days, 10-21 days; P=0.04). In the mild group, the viral loads peaked in respiratory samples in the second week from disease onset, whereas viral load continued to be high during the third week in the severe group. Virus duration was longer in patients older than 60 years and in male patients.
The CMO is trying to completely eliminate the virus in the Cayman Islands, not “flatten the curve” of infections, as is the strategy elsewhere. If we can isolate active cases until they resolve, we could be in the enviable position of being COVID-19 free in a month or so. To loosen up the current curfew regulations, the untraced local transmission cases need to fall to zero and stay there for days with bulk of previous confirmed cases fully resolved (hopefully confirmation of that next week). Cayman is small enough that we can do it, and we must.
10.30am Pardon me, the CMO is not a fantasist like Our Leader believing we can completely eliminate the virus without a single local death. However even Our Leader is not suggesting it will be over in a month
If people stayed home and ACTUALLY honored the legal 6ft distance in public, the virus would not transfer to new hosts and would go away…the problem is that the 6 ft minimum buffer is still nowhere near happening in practice inside the main transmission areas – which are the supermarkets/banks/etc. Cops need to go inside these places and fill the ticket books until attitudes are compelled to adjust to the new normal.
Have yo seen the studies re air conditioning?
Great. Then what? Seal off the borders until there’s a vaccine some time in 2022? Some plan.
Mrs. Olde did not spend millions for these results. Just sayin. Please do get better
Out of 200,000 test kits flown here expeditiously by DART and part-paid for Mrs.Olde we have only been able to use about 1500 or them..What the hell is wrong? Why aren’t we mass testing? What are we waiting on, another death??
I can see now why Dr. Lee said the excess test kits should be sold off. By the time, they even get up to 5000 the test kits will have reached their expiry date..
If we don’t start mass testing we will be into the next flu season before we get a handle of this situation.
Even Haiti has tested 642 compared to our 778 or whatever. Shameful!
It’s not Dr Lee who makes these decisions, that responsibility rests with the Honourable Minister of Health. The Minister will issue the necessary instructions as soon as they have been translated into Spanish, Tagalog, Urdu, Russian, French, German, Polish and Italian.
You forgot the Aramaic – a language spoken by a significant percentage of our expats.
Did the Syrians not have to pass the English test upon entry?
It is not just the test kits… we also need the swabs and chemical reagents, which are both in high demand around the world. We just have to be a little patient for the orders to come in. Once we get more supplies, the testing will surely increase.
Also, a newspaper article in early February indicated that the GT hospital flu clinic had seen over 800 cases in January. I am wondering if the HSA is looking back at the possibility that some of those were actually COVID-19, especially in light of the information that has come out in the USA over the past 24 hours. It would be good if a random sample of those who thought they had the flu a couple of months ago were given antibody testing.
We bot 200,000 reagents and sold the 100,000 excess. We need the sample extraction tools.
We only have 3000 swabs. At least that Is what I understand from the press briefing. I e the test kits need more ‘stuff’ to actually be used. We need long assed Q-tips. Guess the PRC hoarded that item at the end of last year, when they knew about the virus, and lied to the world.
Why aren’t we doing mass testing? Worldwide, this has been the optimum way of knowing where this virus is and to flatten the curve faster and get at least our local economy going again.
In Cayman, we were afforded the opportunity that many countries were not, in that, we were able to secure more test kits then we needed. The issue is though that it appears that we don’t have a grip on how to do mass testing. We have become a media circus where the populace glues themselves to their TV’s and computers around the 2pm hour everyday to hear that we have tested 8 or 12 people and how many are positive and negative…We now hear that we will get 400 by next week. This is absolutely ridiculous. If we have four machines, we should be able to crank out more than the few that we are doing per day..If it is a labor issue, let’s put a priority on getting people trained or get the private hospitals that have these machines fast tracked to approval, as they will inevitably get more done than is currently being done on any day by the HSA. The inefficiencies of the Government are staring us in the face right now…
We need to be testing hundreds of people per day not a few. Bermuda started behind Cayman in terms of resources and testing capacity and now has capacity for processing 200+ tests per day (210 reported on Tuesday). Enough with the excuses. Get it done.
It was explained that we don’t have all of the swab and sample extraction kits to fully ramp-up PCR testing – which involves many steps and supporting materials beyond the reagent kit. Those supporting supplies are expected to arrive next Tuesday on BA air-bridge flight. Even then though, a PCR test, which takes 2-3 days for a result, would only instruct those random asymptomatic that they are indeed carrying the active virus unknowingly at that snapshot moment. This is, at best, a lengthy expensive whack-a-mole approach to containment, which could take 3.5 months at full capacity. The IgM and IgG blood testing is not what HSA are using, and gives different data – the IgM being potentially misleading in it’s own way as it doesn’t specifically scrutinize for the problem COV-19 strain.
There are 700 tests in the queue…some people will never be satisfied!
Having test samples in a queue of 700, 7000, or 70,000 does not get us anywhere. Having test results does.
We should have 700 in queue everyday!!! We have 200,000 test kits flown here expeditiously on a private jet and we haven’t even used 1% of these as yet..Ridiculous!!!
Oh really…what’s the shelf life of your sample? Why should you be in the first round? Where do you think you’re going? Sit down and wait your turn.
We need to all wear masks. Can we make it compulsory? We need to stop spread.
We need to start mass testing!!! Masks will help but until we know who has it, nothing changes…
Masks provide very limited protection. We need to strictly enforce the 6 foot social exclusion zone in the supermarket vector areas. You’re lucky to get more than 6 inches in some aisles, even months into this crisis. Attentive police officers need to get in the food supply stores with their ticket books.
You are proposing ticketing people for walking by someone who is blocking an aisle?
This has truly made people lose the plot. I am speechless.
Agreed 6 foot and masks
Which compulsory mask-wearing will not do. Masks give people a false sense of security so they pay less attention to hand-face hygiene.
3:49: your theory sounds good, but you could equally argue that wearing a mask is a sign of taking the threat seriously, and that such persons are likely to be conscious of practicing other precautions.
Medical science is coming down on the side of wearing masks. It helps to protect other people and offers a level of protection to the wearer as well. This depends, of course, on type of mask and proper handling.
CNS: I have tried sending questions to both you, the Compass, and the CIG website and I realize that not all of questions can be asked but I would like to know if it is possible to ask the Premier or the CMO this question please..
We have a town hall or school hall in every district, We have 200,000 test kits and from what I gather somewhere in the region of 12 PCR Machines. Why not set up drive thru’s or walk up testing centers in each district and get as many people tested as possible. We could knock this out in no time..We are sitting around waiting for someone to call the FLU-Line or show up at the hospital with symptoms..WHY?????? By that time they have already infected other people…Are we waiting on a few more deaths to happen? What about the ones that are asymptomatic that are spreading it..None of these are being tested and could be spreading it around the island unknowingly.
I am getting concerned now that the CMO and the Premier are trying hard to keep the positive numbers artificially low and dragging this situation out to make us look good to the outside world. Bermuda without as many test kits as us have already test 1000 and we can’t seem to test more than a few a day..What the hell are we waiting on???
We are small enough that if we need to we could test everybody within a month, be able to identify and isolate in the hotels, the asymptomatic and full blown cases. The recovery period would probably take us another month and by then we would have flatten the curve and can get out from under this lockdown and open up our domestic economy and get people back to work..This is not rocket science, people!
Why is so difficult for the press to ask the hard questions and not the same old, repeated questions everyday??? Everyday Trump is hammered with hard questions and the reporters take their licks from him and come the next day armed with more “real questions” that need answered whether or not they have to take the insults from him again. I get the feeling that this whole question and answer session is no more than when the Government handed out pieces of paper at the Cruise meetings which were sanitized before they were asked to the platform..
No press conference today but we may have 400 results for you sometime next week…Really Dr. Lee??
Let’s put the pressure on for more testing. We know this is the only way to slow this virus down..If we keep going at this rate we will be in our homes for years waiting for the next few results to come in from the CMO each day..
One thing we have to remember is that everyone in that press briefing room, despite their hard work and possibly well intentioned efforts are on full pay and benefits and I don’t think fully realize the enormity of what we as a public are feeling mentally and financially.
I’ll say it again, we need to get on with mass testing! We have the tests, lets get on with it. We want 700 results a day, not a month. We have the ability and the test kits. We are tired of the excuses!!
For starters, Bermuda has almost twice our “best-case” lab capacity at 900 tests per day.
Why is that? Their population is sought smaller than ours now & economically their island us so much worse off than ours, so why is their capacity to test higher?
and why are we selling Bermuda or test kits??..Maybe easier to send Cayman Airways once a week with a large amount of tests to be done in Bermuda since we can’t get more than a few done per day..
Bermuda population is 65K
Population about the same as us. They are in debt & do not have a surplus of $’s in their budget – whilst Cayman was raving about the boom here. Why then can they test more than us?
8:21 pm: Bermuda probably don’t have a faster testing capacity than we do. Check it out before accepting inaccurate info by posters.
10:47 am: what is your source on Bermuda testing 900 per day? I visited their website and their total tests at this tube is 900. Some co fusion here.
Would Dr. Lee please let us all know how many total persons have died in the Cayman Islands since March 12, not just those with Covid-19.
Funny, I was wondering the same thing.
You can just go to the Bodden’s Funeral Home Facebook page and Churchill’s webpage.
I would like to know how many have been cremated a $2,000 a pop.
That is the burning question
What BS from an inept team of talking heads. Seems the curve is flattened so let’s relax some things.
We get 1 positive from a test bunch and they say that’s positive news. Then we get 0 positive from a test punch and they say they’re expecting for more positives in the next bunch. It’s a bunch of crap.
There is no curve here! Get it in your head. To have a curve you need infection, through some of your population, but not enough to overwhelm your hospitals. We are overwhelmed just trying to do testing.
They are going for E L I M I N A T I ON & will be kept under curfew until it’s achieved.
Real time update on COVID 19.
April 23, 2020
At the end of March, a New York City doctor drew massive attention with his claim, published in a YouTube video, that COVID-19 was more similar to altitude sickness than to acute respiratory distress syndrome (ARDS), and that it was being treated the wrong way.
At the root of his claim was that ARDS patients typically have muscles that can no longer support their own breathing, thus requiring mechanical ventilation. By contrast, COVID-19 patients can breathe fine, but they are starving for oxygen.
Italians had already beat him too it, publishing about this in a peer-reviewed journal. They wrote that COVID-19 patients have an “atypical form” of ARDS, where the mechanical function of their lungs is preserved, but they have severe hypoxemia, meaning severely low levels of oxygen in their blood.
The Italians published new research today as a preprint* shedding light on how the hypoxemia might develop. This is the first release of findings from a large number of post-mortem analyses conducted on the lungs of people who died from COVID-19.
They found increased numbers of megakaryocytes in the lung capillaries, which are bone marrow cells responsible for making the platelets that are needed to form blood clots. 33 out of 38 patients had blood clots in the lung arteries. Had they been able to observe the clotting in real-time over the course of the disease, they may have seen these blood clots in all 38 patients. They suggested that the blood clots interfere with the delivery of oxygen to the blood and explain the hypoxemia of severe COVID-19 cases.
The capillaries were congested, which happens when blood clots in larger vessels prevent blood from moving smoothly out of them.
Based on findings in SARS macrophages accumulate in the lungs and drive the inflammation. Indeed, they found “a large number” of macrophages in the alveolar lumens, which are the open spaces within tiny sacs where gas exchange takes place.
The macrophages may be generating cytokines such as interleukin-6 (IL-6) that increase the formation of blood clots. Blood levels of IL-6 could predict who would go on to require ventilation with stunning accuracy. The level of D-dimer, a protein formed from the breakdown of blood clots, was nearly twice as high in the patients who required mechanical ventilation than in other severe cases.
Together these data support an emerging picture wherein inflammatory macrophages accumulate in the lung in response to the viral infection; they make cytokines such as IL-6 that increase the formation of blood clots; clotting in the small arteries of the lungs blocks the flow of blood, backing up blood in the capillaries, and preventing adequate oxygen from reaching the systemic circulation.
Theoretically drugs that block the actions of IL-6 or that reduce clotting could be useful.
Another preprint released today looked retrospectively at people who were and weren’t treated with IL-6 blockers. It wasn’t randomized and it is possible that randomized controlled trials (RCTs) will wind up undermining its conclusions, but patients who took the IL-6-blocking drugs had a 58% lower risk of going on to need mechanical ventilation and a 75% lower risk of dying. 3 out of the 30 patients had adverse outcomes that might have been related to treatment, two with mild damage to liver cells and one who acquired pneumonia from ventilation. There are three RCTs of IL-6 blockers underway, and we should have far more reliable results soon.
There currently are no evaluations of the safety or efficacy of anticoagulants in COVID-19.
It is important not to jump to conclusions here and use drugs with anti-clotting activity, such as NSAIDs, to treat COVID-19 before we have more data. Such drugs can alter levels of PGE2, a substance that is involved in blood clotting, but which also can promote or inhibit viral growth, depending on the virus.
*Footnotes
* The term “preprint” is often used in these updates. Preprints are studies destined for peer-reviewed journals that have yet to be peer-reviewed. Because COVID-19 is such a rapidly evolving disease and peer-review takes so long, most of the information circulating about the disease comes from preprints.
Dr Aybolit, a little technical, but very interesting.I’m not a doctor, but I have read about this and in several countries they are now administering blood thinning drugs to all covid patients on admission. I’m sure Dr Lee is keeping up with developments and will be aware of this.
1:35 pm: I agree mostly with your observation, but not necessarily that Dr. Lee “is keeping up with developments and will be aware of this.”
This is new information that is coming out as Covid-19 rampages through populations, and a lot of doctors, including Dr. Lee, are too busy to research stuff like this.
Dr. Aybolit, keep it coming.
I was especially interested in : “The macrophages may be generating cytokines such as interleukin-6 (IL-6) that increase the formation of blood clots. Blood levels of IL-6 could predict who would go on to require ventilation with stunning accuracy. The level of D-dimer, a protein formed from the breakdown of blood clots, was nearly twice as high in the patients who required mechanical ventilation than in other severe cases.”
My brother who is nearing 80 years old, and otherwise in good health, was infected, likely related to his daughter’s occupation. My niece is a health care worker in a New York nursing home, and they were both diagnosed with Covid-19 at the same time.
We have naturally been quite worried about him, but he has thankfully been recovering. Just as we were about to give a sigh of relief, yesterday, his leg began swelling and his doctor diagnosed a blood clot. He is now on blood thinners.
I really hope that local doctors are taking note of these helpful pieces of research information that keeps popping on sites like CNS and others.
There’s been some very interesting articles about blood thinners helping with Covid patients.
South Korea has a population of 51 million. They have never really locked down and have kept their economy moving. According to the expert models they should be tracking at worst case scenario infection and death rates per capita, instead they are among the lowest. Same goes for Japan. Both countries have high population density.
The key missing ingredient is that South Korea used voluntary anonymized crowdsourced cell phone mapping to instruct those that may have been unintentionally exposed to a subsequent positive – to get tested themselves. They didn’t employ a “whack-a-mole” random testing model that takes months. There are a dozen or more of these apps.
7: am: interesting comment.
I looked up what these countries have done.
The bases of their success so far, barring a resurgence, are:
1. Experience with managing SARS outbreaks
2. Wide scale testing, contact tracing, home isolation of all contacts, and further quarantining of positive cases.
Some of the tactics in contact tracing are not necessarily those that we would accept. For example, they publicized names and addresses of diagnosed persons, their workplaces, and even taxi drivers. Why? Not to expose them but to allow persons who had been in contact with them to come forward for testing.
They isolated asymptomatic persons but further quarantined those with symptoms.
The article I looked at did not discuss measures to enforce isolation, but it may be that the population’s experience with SARS also prompted people to be appropriately cooperative. More research would be required.
We here in Cayman have been very reticent about officially quarantining diagnosed cases beyond home isolation, and which I think has been a mistake.
However, we are doing the best we can In an area in which we have not had the background experience and the readiness that these mentioned countries have had.
Notably, their proximity to China increased their awareness and enabled them to take the target actions earlier.
Here is the address for the article I looked at and a couple of paragraphs from it below:
https://www.npr.org/sections/goatsandsoda/2020/03/26/821688981/how-south-korea-reigned-in-the-outbreak-without-shutting-everything-down :
“Hong Kong and Singapore have followed similar paths [to Korea] in responding to this outbreak.
“They’ve used testing aggressively to identify cases — not only testing people who are so sick that they’re hospitalized but also mild cases and even suspected cases. They’ve quarantined tens of thousands of people who may have been exposed to confirmed cases.
The vast majority of the people ordered to quarantine at home are perfectly healthy and never do get sick, but the few who do develop symptoms can be quickly isolated further. Tedros of the WHO refers to this as cutting off the virus at the bud — basically stopping the virus from spreading further and preventing community transmission.”
I thought the same thing a couple of weeks ago where testing is concerned but then you look at countries with far greater testing per capita who also locked down and their infections and death rates per capita are still quite a bit higher in many cases. Germany has been lauded for their low death rate and high testing rate. They locked down, tested and seem to have done a great job in treatment compared to other Western European countries and yet their stats are still not nearly as good as Japan, India, S. Korea, Indonesia, Singapore and others. All have large populations. Could be under reporting… Could be nobody has a clue what they are doing and the virus is in control and not us.
7 am, yeah, South Korea could jump right into testing and contact tracing and isolation. They knew what they were doing for a number of reasons.
We are just getting into testing, given the world-wide shortage of test kits and other medical supplies. But we have been doing contact tracing, etc.
So we are following the same trend, just that South Korea was able to get on track immediately.
On what basis people are kept in quarantine after completing 14 days isolation and exhibiting no symptoms?
Martial law
On what scientific basis people are forced to remain in quarantine after 14 days?
The practice of jonjonism
Passengers on the last BA flight as government hasn’t got their results yet. Hence no space at the hotel to bring back any Caymanians on the upcoming Miami flight.
(a) an asymptomatic positive test, or (b) awaiting one or more of the all-clear negative tests required to be released.
Ask the BA passengers, 17 days and counting. They agreed to 14.
I left.
I don’t feel too awfully bad for people who spend 17 days in isolation (3 days more than planned) —
The rest of us are 6 weeks + at this point with no end in sight, so don’t ask for my sympathy for their 17 days of being fed, cared for and cleaned up after.
..Myself and many, many of us are 50 days or more living in 2 small rooms, can’t go outside, no way to purchase any replacements for broken items (like Cookware—cooking everything n one pot now)- not even Allowed to take a short scenic drive to look at something other than my 2 small rooms without getting a ticket or arrested.
People can only take so much before they lose their minds with no hope of any end to this. It’s mental torture, solitary confinement like being in prison.
17 days? Not feeling an ounce of sympathy.
Sorry. I downvoted. I agree.
Umm – you can drive to the supermarket 3 times a week, and whilst you are there you can buy another cooking pan. Believe it or not they do sell them. And if you want to look at something other than your 2 rooms try using your 90 minutes a day 6 days a week exercise time to go for a walk. We are way better off than the guys in BVI – completely confined to home as you seem to think you are.
4.32pm Are you a hermit, don’t tell me you hardly ever leave your 2 little rooms. I am talking about one room on the second floor of a hotel for two adults and two young children and never allowed even to take one step outside into the corridor which is guarded 24/7 by police. Now for 18 days and counting.You have the nerve to say you feel like a prisoner, just you try it. These people agreed in writing to fourteen days quarantine before they were allowed to travel.
Contrast this with the local clusters who have tested positive, asked politely to self isolate in their own homes without a policeman in sight.
What the h&@k are you doing to break your pots & pans. I hope you’re not beating each other silly with them
Seems like testing capacity needs to be improved here as it does everywhere else in the world. Two days ago, the machine was down for maintenance and no tests were conducted. Yesterday, 8 tests. With testing providing the way out, we are going to be stuck in the quagmire for sometime
Apparently they have 4 machines and they were all down for maintenance at the same time..you can’t make this shit up!!!
No one thought to buy the Q-tips. Like Christmas with no AA batteries.
please test supermarket staff the police and security Id / paper enforcers then resturant and bank staff. If they all have it we are doomed and may as well open up now
I’ve seen on-duty staff in food chain stores coughing, while on shift, without masks or proper containment/decontamination protocol. As menial laborer lay-offs mount around them, I wonder if these staff feel they are even allowed to take a sick day/month?
About three weeks ago I was at the grocery store and I saw a lady packing shopping bags at the cash register and she was sweating so bad it was running down her face. She didn’t have a mask on and was busily chatting with everyone. A few days later she was not at work and I hadn’t seen her for a couple of weeks until just the other day. I saw her back at work and I said to her, “I even’t seen you for a couple of weeks have you been away?” and she replied, “Yes, I’m better now”.
Did she have COVID19? She needs to be tested. In fact every front line employee needs to be tested otherwise this whole lock-down is pointless.
How do you sweat in a grocery store? They’re freezing.
Way to ramp up testing guys!!!! At this rate we can all go back to like by 3059! Bravo!!!!