COVID-19

[Lurker]

Sobre UK, he encontrado esto:

https://www.dailymail.co.uk/news/article-8529269/amp/Daily-death-toll-INFLATED-fewer-40-people-dying-day-UK.html?__twitter_impression=true

"They said PHE's figures 'vary substantially from day to day' and explained: 'This variation is most likely due to the appearance of "historic" deaths that have occurred weeks before, but for some reason unknown to us, get reported in batches on particular days."

Y esto:

https://www.cebm.net/covid-19/why-no-one-can-ever-recover-from-covid-19-in-england-a-statistical-anomaly/

"Here, it seems that PHE regularly looks for people on the NHS database who have ever tested positive, and simply checks to see if they are still alive or not. PHE does not appear to consider how long ago the COVID test result was, nor whether the person has been successfully treated in hospital and discharged to the community. Anyone who has tested COVID positive but subsequently died at a later date of any cause will be included on the PHE COVID death figures."

Sds.

Puede ser - Pero en UK la variación diaria durante una semana es grande pero enteramente predecible, el fin de semana prácticament nadie da datos, y el lunes y martes se acumulan



El segundo link tiene pinta de ser verdad, porque el exceso de muertes publicado por la ONS que es el instituto de estadistica dice que desde hace un mes o así hay menos muertos que los que corresponderíá proyectando las cifras del pasado y ajustandolas por cambios demográficos y de esperanza de vida

Yo sospecho lo mismo.

Además, en Leicester hay sospechas, no tengo claro hasta qué punto son infundadas, de que hay un doble conteo en los casos de positivos.

https://www.google.com/amp/s/www.leicestermercury.co.uk/news/leicester-news/what-government-says-claims-positive-4305861.amp

[hispanic_exodus]

Estuvieron unos días sin actualizar pero ahora ya lo hacen de nuevo cada día. El de 7 días creo que es el más fiable ya que los casos en 24 horas (que es lo que publican los medios) no es real. La gráfica la hacen a partir del informe diario oficial que se publica aquí

Gracias. Estaba buscando justo esos datos. Yo estaba comparando lo que publica cada día El País con https://www.worldometers.info/coronavirus/
Y me llamaba la atención que UK estaba teniendo menos contagios diarios haciendo casi el doble de tests, y en cambio la información diaria nacional era que habíá menos de un centenar de casos. No entiendo como aún en UK siguen muriendo unos 50-70 diarios haciendo media semanal, y ahí uno o dos. Será que en UK se siguen contagiando en residencias de ancianos?

La vitamina D?, El sol?
(Recordemos la anomalía en las horas de sol que sufrió el sur de Europa durante el lockdown)

La anomalía fue precisamente el lockdown, cero horas de sol para la mayoría del pueblo español.

[Danny_M]

La anomalía fue precisamente el lockdown, cero horas de sol para la mayoría del pueblo español.

El tema es que por algún motivo, dietético o lo que sea, en España (y creo que Italia también) viene siendo endémico que la gente tenga déficit de vitamina D. He visto alguna charla donde creo que se relacionaba también con el uso de cremas solares y otros cosméticos, posiblemente por la presencia de disruptores endocrinos (también presentes en plásticos de uso alimentario, etc).

El lockdown obviamente empeoró algo las cosas, pero es que además si hubo menos horas de sol, pues hubiera seguido siendo peor. Por otra parte, parece que la vitamina D protege si tienes los niveles bien *antes* del contagio, pero una vez contagiado no parece que sirva de mucho suplementarla al enfermo.

Yo por si acaso he estado hasta que llegó el verano comiendo bastante salmón e hígado de bacalao, y comprando leche enriquecida en vit.D (aunque según algunas fuentes, las dosis recomendables para garantizar niveles saludables son más altas de las que vienen normalmente en la leche enriquecida, pero algo es algo).

Siento no poner las fuentes, cuando tenga un rato las busco.

[Lurker]

La anomalía fue precisamente el lockdown, cero horas de sol para la mayoría del pueblo español.

El tema es que por algún motivo, dietético o lo que sea, en España (y creo que Italia también) viene siendo endémico que la gente tenga déficit de vitamina D. He visto alguna charla donde creo que se relacionaba también con el uso de cremas solares y otros cosméticos, posiblemente por la presencia de disruptores endocrinos (también presentes en plásticos de uso alimentario, etc).

El lockdown obviamente empeoró algo las cosas, pero es que además si hubo menos horas de sol, pues hubiera seguido siendo peor. Por otra parte, parece que la vitamina D protege si tienes los niveles bien *antes* del contagio, pero una vez contagiado no parece que sirva de mucho suplementarla al enfermo.

Yo por si acaso he estado hasta que llegó el verano comiendo bastante salmón e hígado de bacalao, y comprando leche enriquecida en vit.D (aunque según algunas fuentes, las dosis recomendables para garantizar niveles saludables son más altas de las que vienen normalmente en la leche enriquecida, pero algo es algo).

Siento no poner las fuentes, cuando tenga un rato las busco.

¿Especialmente en residencias y personas mayores que viven solas? Cabría, además, poder conocer el grado de malnutrición que existe en algunos de esos centros.

[Lurker]

Sobre UK, he encontrado esto:

https://www.dailymail.co.uk/news/article-8529269/amp/Daily-death-toll-INFLATED-fewer-40-people-dying-day-UK.html?__twitter_impression=true

"They said PHE's figures 'vary substantially from day to day' and explained: 'This variation is most likely due to the appearance of "historic" deaths that have occurred weeks before, but for some reason unknown to us, get reported in batches on particular days."

Y esto:

https://www.cebm.net/covid-19/why-no-one-can-ever-recover-from-covid-19-in-england-a-statistical-anomaly/

"Here, it seems that PHE regularly looks for people on the NHS database who have ever tested positive, and simply checks to see if they are still alive or not. PHE does not appear to consider how long ago the COVID test result was, nor whether the person has been successfully treated in hospital and discharged to the community. Anyone who has tested COVID positive but subsequently died at a later date of any cause will be included on the PHE COVID death figures."

Sds.

Puede ser - Pero en UK la variación diaria durante una semana es grande pero enteramente predecible, el fin de semana prácticament nadie da datos, y el lunes y martes se acumulan



El segundo link tiene pinta de ser verdad, porque el exceso de muertes publicado por la ONS que es el instituto de estadistica dice que desde hace un mes o así hay menos muertos que los que corresponderíá proyectando las cifras del pasado y ajustandolas por cambios demográficos y de esperanza de vida

Yo sospecho lo mismo.

Además, en Leicester hay sospechas, no tengo claro hasta qué punto son infundadas, de que hay un doble conteo en los casos de positivos.

https://www.google.com/amp/s/www.leicestermercury.co.uk/news/leicester-news/what-government-says-claims-positive-4305861.amp

El secretario de sanidad en UK, Matt Hancock, ordena una investigación sobre el asunto del conteo de fallecidos:

https://www.google.com/amp/s/amp.theguardian.com/world/2020/jul/17/matt-hancock-calls-urgent-inquiry-phe-covid-19-death-figures

[Danny_M]

¿Especialmente en residencias y personas mayores que viven solas? Cabría, además, poder conocer el grado de malnutrición que existe en algunos de esos centros.

Hablo de memoria, pero creo recordar que a partir de cierta edad (no sé si 70 o así) el aumento de vitiamina D no mejora la respuesta inmune, así que para los muy mayores la vitamina D no era tan importante. Todo esto suponiendo que la clave era que el Covid te mata por la tormenta de citoquinas que se provoca por una respuesta inmune defectuosa, lo cual a su vez pasa más en los individuos con déficit de vitamina D, que tiene un papel de regulador de la respuesta inmune.

Creo que esta info ya había salido en el hilo. Si no, el blog de Knownuthing en Rankia tenía un post sobre el tema de la vitamina D, donde creo que comentaba también el tema de la edad.

[uno]

Un análisis parece que en profundidad con muchas gráficas y datos

¿Cómo de cerca estamos de un rebrote?

https://www.elconfidencial.com/tecnologia/ciencia/2020-07-18/covid-19-rebrotes-provincias_2685656/

[saturno]

[Lurker]

No paro de darle vueltas al repunte en Cataluña.

https://www.google.com/amp/s/www.niusdiario.es/sociedad/sanidad/cataluna-balance-nuevos-casos-covid-19-coronavirus-barcelona-area-metropolitana-lleida-departament-salut_18_2980695064.html%3famp=true

"Este balance incluye los resultados de los test serológicos, que no indican necesariamente nuevos contagios; los PCR reflejan 18 activos".

18 casos activos por PCR. Parece que existe un interés en mostrar una 'realidad', o una parte de la realidad. Exigirá fondos sin contrapartidas por haber sido 'duramente castigada' dos veces? Le tocará al gobierno español ser Holanda?

Muy probablemente soy una persona muy paranoica.

Sds.

[wanderer]

Yo no paro de darle vueltas al tema de las mascarillas y de los encierros.

En los medios aparece constantemente la disyuntiva: "¿qué preferís, mascarillas o encierros?". Como saben, yo ya me he posicionado como no muy favorable a las mascarillas (aunque procuro respetar su uso en la calle), pero sinceramente, yo opto decididamente por los encierros, aunque voluntarios.

Y nada de vacaciones, consumo al mínimo, terrazas y restaurantes, sólo de forma excepcional... En la disyuntiva de aceptar un remedo de apertura a la que pomposamente se llama "nueva normalidad" o de seguir con lo que hacíamos durante nuestro encierro obligatorio, prefiero no asumir ésa nueva normalidad y vivir una vida ostrífera, aunque elegida de forma voluntaria: me siento más libre en mi casa que en la calle, y la verdad, la mayoría del contacto social constato que sobra.

[Maloserá]

Continuando los mensajes anteriores, respecto al número de muertos por Covid en UK -

https://www.theguardian.com/society/2020/jul/18/daily-updates-on-english-covid-19-deaths-paused-amid-accuracy-concerns

Daily updates on the coronavirus death toll in England have been paused amid growing concern that the numbers could have been exaggerated.

A message on the government’s website on Saturday said: “Currently the daily deaths measure counts all people who have tested positive for coronavirus and since died, with no cut-off between time of testing and date of death.

“There have been claims that the lack of cut-off may distort the current daily deaths number. We are therefore pausing the publication of the daily figure while this is resolved.”

On Friday the health secretary, Matt Hancock, ordered a review after the data was called into question in a paper by Yoon K Loke and Carl Heneghan, of the centre for evidence-based medicine at Oxford University, titled Why No One Can Ever Recover From Covid-19 in England – a Statistical Anomaly.

The academics wrote: “It seems that PHE regularly looks for people on the NHS database who have ever tested positive, and simply checks to see if they are still alive or not. PHE does not appear to consider how long ago the Covid test result was, nor whether the person has been successfully treated in hospital and discharged to the community.”

They said this meant people who had tested positive for coronavirus and recovered would still be counted as dying from the virus “even if they had a heart attack or were run over by a bus three months later”.

[Maloserá]

Varios gráficos que están bien, incluído el  'excess deaths' de la revista The Economist. Creo que esta página está fuera del paywall, pero  sii no podéis acceder y hay interés puedo copiar la imagen. Si se puede acceder, mejor, porque son interactivos.

Los más interesantes son el primero y especialmente el cuarto gráfico, en el  que podéis seleccionar  varios países especialmente afectados, incluída España, y da la información por regiones. Si movéis el cursor encima de los cuadritos, muestra los datos numéricos exactos.

https://www.economist.com/graphic-detail/2020/07/15/tracking-covid-19-excess-deaths-across-countries

[spainfull]

https://www.zerohedge.com/markets/gilead-will-charge-more-3000-course-remdesivir

All those stories about patients being billed for tens of thousands of dollars for coronavirus-related care elicited promises from the White House that "everything will be covered". Still, as thousands of Americans complain about charges related to COVID-19 testing and care being passed on by their insurance companies, Gilead, the pharmaceutical company that has pushed remdesivir down the world's throat despite the fact that the cheap steroid dexamethasone has proven - in at least one high quality study - more effective at lowering mortality rates, has just published its expected pricetag for a five-dose course of the drug.
On Monday, Gilead disclosed its pricing plan for Gilead as it prepares to begin charging for the drug at the beginning of next month (several international governments have already placed orders).  Given the high demand, thanks in part due to the breathless media coverage despite the drug's still-questionable study data, Gilead apparently feels justified in charging $3,120 for a patient getting the shorter, more common, treatment course, and $5,720 for the longer course for more seriously ill patients. These are the prices for patients with commercial insurance in the US, according to Gilead's official pricing plan.
As per usual, the price charged to those on government plans will be lower, and hospitals will also receive a slight discount. Additionally, the US is the only developed country where Gilead will charge two prices, according to Gilead CEO Daniel O’Day. In much of Europe and Canada, governments negotiate drug prices directly with drugmakers (in the US, laws dictate that drug makers must "discount" their drugs for medicare and medicaid plans).
But according to O'Day, the drug is priced "far below the value it brings" to the health-care system.

However, we'd argue that this actually isn't true. Remdesivir was developed by Gilead to treat Ebola, but the drug was never approved by the FDA for this use, which caused Gilead to shelve the drug until COVID-19 presented another opportunity. Even before the first study had finished, the company was already pushing propaganda about the promising nature of the drug. Meanwhile, the CDC, WHO and other organizations were raising doubts about the effectiveness of steroid medications.
Months later, the only study on the steroid dexomethasone, a cheap steroid that costs less than $50 for a 100-dose regimen, has shown that dexomethasone is the only drug so far that has proven effective at lowering COVID-19 related mortality. Remdesivir, despite the fact that it has been tested in several high quality trials, has not.
So, why is the American government in partnership with Gilead still pushing this questionable, and staggeringly expensive, medication on the public?

https://timmermanreport.com/2020/07/the-remdesivir-pricing-letter-gilead-should-have-written/

Dear America,

We’ve decided to grossly underprice remdesivir.

Hundreds of thousands of COVID-19 patients in America, and even more around the world, need our drug. But the US insurance system is corrupt and heartless. It has demonstrated that it will go to great lengths to prevent patients from getting appropriate, physician-prescribed treatments. You know their tricks: high deductibles, high copays, lengthy prior authorization forms, phone calls unreturned, surprise bills for patients.

Sadly, these barriers are common practice. So we decided to underprice remdesivir to get around the barriers, and make it as fast and easy as possible for all patients to quickly get this much-needed medicine.

In normal times, we drug developers have plenty of time to devise a counterstrategy. Development of new therapies typically takes years. That long lead time enables us to make the case for the value of our innovation and its proper use, and to plan our strategy for negotiating with insurers to lower barriers to accessing treatment. Knowing they often won’t, we usually also have time to set up patient assistance programs that help patients afford the out-of-pocket costs demanded by their insurance plans.
With remdesivir, amidst the COVID-19 pandemic, we don’t have that time. So, we have opted to undercut the value of our innovation to get the therapy to as many patients as possible as soon as possible.

The price we settled on is $2,340 for a five-day course for governments in the developed world, and for the US Department of Veterans Affairs and the US government’s Indian Health Services. U.S. private insurers, in addition to Medicare and Medicaid, will pay $3,120. At this price there’s really no excuse for a private insurance plan or Medicare to put up barriers (though it somehow still won’t come as a shock if they try).

Having to combat insurers’ bureaucracy with our own counter-bureaucracy wastes society’s and our company’s resources. But our insurance system has succumbed to pathological bloat and learned to feed off the bureaucracy. It has learned to extort a profit stream from all drugs, regardless of how expensive they are, to pad their own incomes.

These insurance companies invent nothing and gaslight America into thinking they are doing favors for patients. Why do insurers require that doctors seek prior authorization to confirm that a medicine is medically necessary for a patient and then, after granting authorization, still demand high copayments that many patients cannot afford?
They will say they are trying to prevent over-utilization. They will claim that is the purpose of this “skin in the game.” But really, they are trying to prevent appropriate utilization. That is not insurance. That is disgusting.

Today, we cannot play these games. COVID-19 has filled our hospitals and ravaged our economy. So, we will eat this one. In addition to all the doses of remdesivir we have donated, we are pricing remdesivir at a fraction of what we know America tacitly recognizes it is worth.

Think about how much the US has already sacrificed to save millions of lives from COVID-19. The country has spent <a href="https://www.washingtonpost.com/business/2020/04/15/coronavirus-economy-6-trillion/">$6 trillion dollars</a> to save what would likely have been about two to three million lives lost if the virus had been allowed to run rampant. That comes to about ~$2M-$3M per life. Remdesivir trials have <a href="https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19">demonstrated</a> that the drug plausibly cuts mortality by ~30% and saves the life of one person for every ~30 who are treated.

The US has demonstrated that it values each life saved from COVID-19 at $2 million or more, so should be willing to spend more than $60,000 on a course of remdesivir. At $20,000, remdesivir would be an extraordinary bargain, leaving plenty of margin for error if it turns out that the drug is less effective than so far shown in trials.
Political organizations like ICER will ignore this logic. But ICER is backed by a billionaire who thinks that people would do a better job of curing their kids’ sickle cell disease and cystic fibrosis if only they had more skin in the game. That is a particularly insidious form of libertarianism better understood as “You’re free to die of treatable diseases I’d just as soon not pay to solve, because I’m rich and those diseases don’t affect me.”

Americans disagree, as evidenced by the tremendous sacrifices so many have made to save lives.
And yet, we’re charging only $2,340-$3,120 for remdesivir. That does not mean we agree that the benefit remdesivir offers is only worth $3,120. Far from it – our price is about 20-fold less than it is worth just based on its odds of saving lives. And remdesivir’s clinical trials also show it can probably cut the length of hospital stays for COVID-19 patients by an average of four days. In the US, that means about $12,000 in savings per patient. [<em>Clarification: 5:51 pm PT July 14. An earlier version said remdesivir clinical trials show it cuts average length of hospital stays by an average of four days. It has been amended to say “it probably can cut” the length of hospital stays by an average of four days.–LT</em>]
Given how expensive drug development is, how can we afford to underprice our innovation? Fortunately, Gilead remains profitable enough from our past successes that we can deeply discount remdesivir to ensure that all patients get access quickly.

Since Gilead is the biotech adult in the room, let me be clear to the scores of younger, unprofitable, scrappy biotechs out there fighting COVID-19: do as we say, not as we do … for everyone’s sake.

Most small biotechs are supported by investors (which include teachers’ and firefighters’ pension funds, not just billionaires). Their drugs may combine with remdesivir to save even more lives or may even displace remdesivir altogether. Most of those companies cannot afford to underprice their drugs, and they should not.
If investors thought that those companies would have to follow our example, they could very well decide to invest elsewhere. Without the promise of an adequate financial return, these companies would be entirely reliant on government funding. If that seems like a good idea, then you have not spent any time in either industry or the NIH. The government cannot keep up with the thriving, creative innovation engine that private capital has made possible. The NIH funds basic science, yet the drug industry funds the extremely expensive clinical trials and drug development required to turn ideas into products, investing well over $100 billion each year.

That’s not to take away anything from taxpayers. Nothing would be possible without taxpayers. &nbsp;Gilead is able to be the successful company it is because of US roads, the rule of law, public schools, a science-based FDA, and yes, even some taxpayer subsidies for projects like repurposing remdesivir for COVID-19 after it originally fell short as an Ebola medicine. But all of that government support, necessary as it is, isn’t sufficient to actually create remdesivir.
American taxpayers have elevated private enterprise to Mount Everest’s base camp, already a great height. And yet, taxpayers do not fund the climb to the peak. That’s achieved by the market offering incentives to those who succeed. Without taxpayer support for the foundation on which the biomedical innovation industry exists, there would be no innovation. But without adequate returns for private funding of development, there would be no products.

With profits of only 10-12% of all drug industry revenues, taxpayers would have to spend about 90% of what society spends now to preserve the drug industry as a tax-funded non-profit. Of course, those profits also incentivize talented scientists. Good luck retaining those brilliant people when other for-profit sectors offer them a piece of their profits through valuable stock. As it is, software, real estate, and finance have higher profit margins than the drug industry, so they can entice a lot of talent away.
We will all get more video games and financial instruments, but fewer medicines.

You might think that pharma could cut its sales and marketing budgets, but how will the world know about a useful new drug if nobody spends the time educating physicians and patients about it? Sure, there’s some fat here and there in our industry, and shareholders are constantly pushing companies like ours to find it and cut it. But there isn’t room for us to cut prices by as much as we have cut remdesivir’s if we want to continue to support and incentivize the level of innovation we have today.

So, treat remdesivir as a special case, please. Were all companies obliged to follow our example, the drug industry would become a high-risk/low-reward proposition. Investors would flee, academia would prove itself unequal to the task of developing drugs, and our drug armamentarium would be frozen in its current state. Our kids would have healthcare no better than ours.

The remdesivir case warns us about what is wrong with America’s insurance system. We need insurance reform so that health insurance does what it is supposed to do – pool the risk over large populations of people, so that healthy people are paying the bills for those who are sick. All of us and those we love will become patients at some point, so it’s in society’s interest to ensure fair and equal access to care.

There is no time to fix the systemic problems with US health insurance this week, or this month, so we are expediently making this pricing concession right now. But we urge all other drug companies not to follow our example.

If you invent a drug that advances our standard of care, it is imperative for the preservation of innovation that you confidently charge a price that will generate a return for you and your shareholders and incentivize others to risk their time and money to climb even higher. Congress should anticipate these breakthroughs in the coming months and be prepared to acknowledge their value. Better that America spend tens of billions on medicines that let everyone live normal lives than trillions countering economic depression as everyone hides from a viral terror.

Peter Kolchinsky, a biotechnology investor and scientist, is Managing Partner of RA Capital Management

[Lurker]

https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/ITCoronavirus.pdf

Hola,

Aquí un documento del Ministerio de Sanidad con, supongo, el state of the art coronavírico. Sobre el tema de la estacionalidad del virus, reza:

2.5. Estacionalidad

Se desconoce si el SARS-CoV-2 tendrá un patrón estacional al igual que ocurre con otros virus
respiratorios como la gripe o los coronavirus causantes de los catarros comunes. Estimando el
intervalo serial y calculando el número básico de reproducción diario, en más de 100 ciudades
chinas con más de 40 casos, se observó una relación lineal inversa con la temperatura y la
humedad. Por cada aumento en un grado Celsius y 1% de humedad, el R0 se redujo 0,0383 y
0,0224, respectivamente (136). Del mismo modo, investigadores de EEUU e Irán han observado
una expansión geográfica mundial desde China a otras regiones con una distribución
predominante en un corredor estrecho entre los meridianos 30-50 N´´, con patrones climáticos
similares (5-11º C y 47-79% humedad). En lugares más próximos a China, con mayor intercambio
de personas, como India, la expansión no se ha producido del mismo modo, lo que apoyaría la
hipótesis del patrón estacional (137). Otro grupo ha observado la correlación inversa de la
trasmisión del SARS-CoV-2 con la temperatura, ajustando por la capacidad de vigilancia de los
países (138). Aunque estas observaciones son importantes, también hay que tener en cuenta el
resto de factores que influyen en la transmisión en el curso de esta epidemia, como la alta
susceptibilidad a la infección de la población en su conjunto y la relajación de las medidas de
distanciamiento social con la llegada del verano. Por ello, es probable que en verano se seguirá
transmitiendo, aunque con menor intensidad (139).

Sds.

[CHOSEN]

Un documento muy científico, utilizando raw data del gobierno Chino.
Ok.
MINISTERIO de Sanidad.
Y las mascarillas fashion 100% algodón del Zara protegen contra el virus asesino ultracontagioso de la parka.
...

¿Cuando ha dejado España de ser aliado de occidente?