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Thu Apr 9, 2020, 05:29 PM

R0 and cytokine storms revisited

CDC has published a paper establishing the median R0 (reproductive number) of the novel coronavirus at 5.7, with a 95% confidence interval of 3.8 to 8.9. This is far above the initial estimates of 2.2 to 2.7, and helps to explain the explosive spread of the disease.

https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article

A couple of weeks ago, someone started a thread here about the probability that cytokine storms were involved in Covid-19. The poster was roundly criticized and soundly spanked. Weeeelllll...

What it feels like to survive COVID-19’s dreaded “cytokine storm”

A doctor and coronavirus patient in recovery describes his experience surviving COVID-19's worst side effect

The cytokine storm affects a substantial number of severe COVID-19 patients, enough that it has become the subject of a subset of medical research into COVID-19. Those unlucky enough to experience cytokine storm will have their bodies and especially lungs flooded with cytokines, immune system helper molecules, as their immune system struggles to fight off the invading virus and the dead lung cells it produces en masse. The overreaction results in the immune system building up too many of these kinds of cells, which can lead to respiratory distress or bacterial pneumonia and, ultimately, death.

Not everyone who experiences a cytokine storm will die, fortunately. Such is the case of Jonathan Raskin, a 69-year-old pulmonologist who practices medicine in New York City, and who contracted coronavirus a few weeks ago and is currently in recovery. After self-isolating at home, Dr. Raskin's temperature swelled to 102.8°; he spent several days in the hospital in a very bad state (by his own admission) before slowly recovering. As a pulmonologist, Dr. Raskin's insights into what was happening to his own body are particularly keen, as he had a medical understanding of what was happening as it happened to him.

My lab work was stunningly bad. A normal white count might be between 4.5 and 10. My white cell count was at 2,000. My lymphocytes — which are the cells that fight in a virus, normally fall somewhere between 1000 and 1,500 — they were under 200. I don't know if you know the term but the early cells that fight infection are called "bands," and you don't have [them] normally — I had 20% bands. My platelet count was around 100,000, which is low, and I knew I was in trouble.

In the current context, we believe we have a biomarker of this condition, a serum level of a non-specific but is an acute phase reactant called serum ferritin. It looks like it may be to be one of the more reliable biomarkers of cytokine dysregulation. A serum ferritin is normally below 400 in our lab, mine was 18,000!

This is one seriously vicious disease, and it probably hasn't shown all its cards yet.

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Reply R0 and cytokine storms revisited (Original post)
The_jackalope Apr 2020 OP
still_one Apr 2020 #1
The_jackalope Apr 2020 #4
Drahthaardogs Apr 2020 #7
Mike 03 Apr 2020 #2
The_jackalope Apr 2020 #5
Squinch Apr 2020 #3
gristy Apr 2020 #6
Marrah_Goodman Apr 2020 #8

Response to The_jackalope (Original post)

Thu Apr 9, 2020, 05:37 PM

1. This might be one of the reasons hydroxycloroquin seems to work in some

It can act as an immunosupressive among other things

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Response to still_one (Reply #1)

Thu Apr 9, 2020, 05:43 PM

4. Yeah, this is a complicated bugger.

Treatment might depend on whether your immune system is in good shape or not - in either case it looks like there are therapies that could kill the patient.

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Response to still_one (Reply #1)

Thu Apr 9, 2020, 05:50 PM

7. Probably the ONLY thing it works on

But it is likely a reasonable treatment for it.

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Response to The_jackalope (Original post)

Thu Apr 9, 2020, 05:39 PM

2. This is why I'm so curious to see the results of clinical trials on the

IL-6 inhibitors. Would those have a good chance of knocking these storms out?

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Response to Mike 03 (Reply #2)

Thu Apr 9, 2020, 05:45 PM

5. Raskin seemed to feel IL-6 inhibitors helped him

At least they seemed to bring the fever down. this is all showing how much we don't know about this little bastard.

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Response to The_jackalope (Original post)

Thu Apr 9, 2020, 05:40 PM

3. Wow on the R0. That's shocking. Also wow on the horrible effects.

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Response to The_jackalope (Original post)

Thu Apr 9, 2020, 05:48 PM

6. 5.7!!

Last edited Thu Apr 9, 2020, 06:24 PM - Edit history (2)

Holy shit!

This is going to make any "opening" of the country and the economy fraught with danger. Actually, it's going to make it impossible until there is a treatment or a vaccine. May, my ass...

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Response to The_jackalope (Original post)

Thu Apr 9, 2020, 06:44 PM

8. wow...5.7 R0

That is scary.

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