TWiV 592: Coronavirus update – dangerous curve ahead

March 19, 2020

Ori joins TWiV for an update on the SARS-CoV-2 pandemic, including scary modeling, clinical trials for antivirals and vaccines, asymptomatic transmission, and much more inspired by listener email.

Hosts: Vincent Racaniello, Alan Dove, and Rich Condit

Guest: Ori Lieberman

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Intro music is by Ronald Jenkees.

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20 comments on “TWiV 592: Coronavirus update – dangerous curve ahead

  1. Cameron Rogers Mar 19, 2020

    Hi TWiV team,
    I have heard that China hasn’t been testing outside of their quarantine zones. I wonder how well the pandemic has actually been controlled in the more rural areas of China. Has anybody on the TWiV team heard anything regarding this?

    In Australia we are still getting infections in schools but not closing them for more than a day for cleaning. We have had another infection in a school just today, in NSW at a school in Port Macquarie. The government here is still sticking by the policy of not shutting down schools in Australia, which IMHO is a big mistake. We now have 709 cases and 6 fatalities. The current guidelines here allow crowds of up to 500 outside and crowds of up to 100 inside. With the exponential growth here, especially in NSW, it would seem we haven’t learnt from the mistakes of other countries! Despite the WHO recommendations to “test, test, test”, testing here is still mostly restricted to international travellers and people with known contacts.

    I read that the CDC were developing serologic tests, do you have any information as to their current progress on this development?

    Great podcasts team,

    • Priscilla Mar 19, 2020

      Also to answer what was asked to med student re: when pt’s get intubated -> guidelines exist such as resp. rate, PaO2 to FiO2 ratio, tidal volume, calc minute ventilation, PaCO2, etc. Some measures can be seen on ABG. Many cases, it’s a judgement call, like last week when I was called to the cath lab to help a pt in distress. On arrival, within 90 sec, I can see this pt is not going to do we’ll. No time for ABG’s etc -> just emergently intubated.

      • Priscilla Mar 19, 2020

        Sorry, commenting as I’m listening…Remdesivir is only available as IV, IV administered only… not IM, as Ory mentioned. When pts are critically ill, like a septic pt with COVID 19, perfusion to non-essential body parts (eg. muscle) is decreased. So you would avoid drug administration via muscle b/c absorption would be unquantifiable. Drugs may depot, and then later on as pt get better, and perfusion increases (to muscle) you could end up with suddenly much higher levels of drugs in the bloodstream. This could then risk hepatic or renal toxicity depending on the drug.

    • Jim Murray Mar 20, 2020

      Professor Allen Cheng, an infectious diseases expert and epidemiologist at Monash University made an interesting point recently about school closures.

      “The most powerful piece of evidence about that is there has been lots of reports around the world about outbreaks in adults, at religious ceremonies, conferences, workshops, business meetings, lots of these outbreaks that are linked to adults,” he says. “But there hasn’t actually, as far as I can tell, been an outbreak in a school”

      Anyone know of any studies that show if schools or even children’s sports clubs and group events have been shown to be a source of clustered infections?


    Update Solano County, CA (Outer Suburbs of Sacramento and San Francisco) at the epicenter over the Travis Air Force COVID-19 Quarantine Operations has issued a Shelter in place order. Note other States and cities in the USA may have issued a similar order in your area or under debate as of this posting.

    SOLANO COUNTY (CBS13) – Solano County issued a “shelter at home” order Wednesday evening, county officials confirmed.

    The order is effective immediately and will be in effect until April 7 if not extended, rescinded, superseded, or amended by the Solano County Public Health Officer

    Officials said this will be an order, not a recommendation, which will be enforceable by police.

    Per the order:

    Gatherings of any size that do not allow for participants to maintain six feet of distance apart are strongly prohibited unless they are for “essential activities” as defined in the Order.
    Establishments serving alcohol such as bars, wineries, nightclubs and breweries must close. Movie theaters must also close.
    Establishments serving food may remain open with takeout and delivery options only. Dine-in operations must cease.
    All health clubs, tanning facilities, gyms and spas must close.
    Prohibits non-essential travel.
    Employers are required to ensure compliance with social distancing guidelines and should implement teleworking where appropriate and feasible. Only employees performing essential duties that are not able to be done remotely should physically come to work.
    Employers that require a doctor’s note for a leave of absence due to illness must suspend those policies. Employers are strongly encouraged to allow employees flexible use of paid time off/sick leave
    All people with fever, cough, or other respiratory symptoms should stay home until seven days after symptom onset. Self-management of these symptoms is encouraged, but if difficulty breathing and lethargy develop, or symptoms suddenly become worse, they should contact their healthcare provider or urgent care center immediately. Calling ahead is strongly encouraged.
    Childcare centers may remain open if they strictly follow social distancing protocols in accordance with the guidance distributed and posted on the Solano Public Health website.
    Nonessential personnel are prohibited from entering hospitals and long-term care facilities, including patient visitation. All essential personnel displaying symptoms of COVID-19 should self-isolate until seven days after symptom onset, and hospitals are urged to delay elective procedures.
    Populations with higher risk of complications from infection should stay home and away from all gatherings involving people outside of their immediate families. These populations include: people with chronic conditions such as cardiovascular disease, diabetes cancer, heart disease, lung disease, immuno-compromising conditions and those over 65 years of age. Pregnant individuals should also strongly consider self-isolating to the extent possible.
    All Solano County Residents, regardless of risk-level, should stay home to the extent possible, and continue practicing universal precautions of handwashing for at least 20 seconds, disinfecting commonly used surfaces, and covering coughs or sneezes with their elbow or tissue instead of hands.
    This comes hours after the Yolo County public health officer issued a countywide health order for residents to shelter in place from March 19 to April 7, unless extended by the public health officer.

  3. Eugene Mosqueda Mar 19, 2020

    Can u suggest having an icon on tv that says “stop the spread” etc.. all day long? Something like a banner to stay home etc.

  4. Priscilla Mar 19, 2020

    Please! Stop calling it a respirator. It’s ventilator for intimated patients. Or BiPAP if externally supporting pat’s own respirations.

    • Priscilla Mar 19, 2020

      Intubated patients… pt’s own respiration’s…

  5. Bob Landers Mar 19, 2020

    I would like to hear how the Twievo and Immune hosts react to COVID-19 news.

    And yes the updates at this time are all over the place for COVID-19 as of 2020.

  6. Bob Landers Mar 19, 2020

    Update California has issued a statewide order for Shelter in place

    SACRAMENTO (CBS13) – Governor Gavin Newsom announced a statewide order for people to stay home amid the coronavirus outbreak.

    The order will go into effect Thursday evening, the Governor said in a press conference. He did say how long the order will last.

    “We couldn’t give you a deadline that we really believe in,” Newsom said.

    This announcement comes after several counties throughout the state ordered their residents to shelter in place for a few weeks.

    “Social pressure is leading to social distancing,” Newsom said. “Expanding this statewide makes sense, and I think people are making sense of what this is, and what this isn’t.”
    The shelter in place order allows residents to leave their homes only to perform “essential tasks” such as:

    Engaging in activities or perform tasks essential to health and safety, or to the health and safety of their family or household members, such as, obtaining medical supplies or medication, visiting a health care professional, or obtaining supplies they need to work from home.
    Obtaining necessary services or supplies for themselves and their family or household members, or to deliver those services or supplies to others, such as food and other grocery and cleaning products.
    Engaging in outdoor activity, provided the individuals comply with Social Distancing Requirements as defined, such as walking, hiking, biking, running or equestrian activities.
    Performing work to provide essential products and services at essential businesses and government entities as well as other nonprofit organizations.
    Caring for a family member or pet in another household.
    ​​Attending private gatherings of not more than six nonrelatives in a home or place of residence. Social distancing should be practiced at all times at such gatherings.

  7. Jim Murray Mar 20, 2020

    Preprint paper “Stability of SARS-CoV-2 in different environmental”
    conditions shows that the virus is only slightly attenuated after 14 day at 4C .
    I guess this may be expected, but I think general public might think that things stored in the fridge, such as milk cartons and other containers will be pretty safe even if they were contaminated when placed in there, especially if its been in there a few days.

    Any opinions?

  8. Prof. Racaniello and/or other Twivers – can you relate the problem with polio (“mild childhood disease until new sanitation measures implemented,” ref: Racaniello; and “OPV immunized folks shedding active virus,” ref: Racaniello) to new CoV diseases? If emerging CoV is quickly and broadly immunized against (thinking of the next 20 years), herd immunity is never developed (?) – what are the consequences of that possibility and what policies would be effective at minimizing disease burden?

  9. Arizona just declared close-businesses (bars, restaurants, movie theaters, gyms) to counties with confirmed covid-19. Won’t this cause people to drive from infected counties to nearby “sars clean” counties and infect them??
    I guess it’s a case of politicians “needing” to be *perceived* as doing the right thing vs. actually doing the right thing. (I believe that was a comment on TWIV)

  10. William Hesbach Mar 21, 2020

    Hi, Truth With in Viruses team,

    I just wanted to say how much your efforts to bring forward the science in a responsible way means to the mental health of those who chose to listen. I hope you continue and I wish you all the best of health.

  11. Bob Landers Mar 21, 2020

    Update Nevada has issued a non essential business shutdown order by today due to COVID-19 Response.

  12. Update New Jersey has issued a Shelter in Place order

    New Jersey Gov. Phil Murphy on Saturday asked “nearly all” state residents to stay at home in light of the growing novel coronavirus crisis, signing an executive order that will close all non-essential businesses and cancel all gatherings.

    “All gatherings are canceled,” Murphy tweeted on Saturday. “ALL non-essential retail businesses must indefinitely close their physical stores to the public effective 9:00 p.m. [Saturday night].”

    Connecticut Gov. Ned Lamont, meanwhile, issued his own executive order asking people to stay at home and “directing all non-essential businesses and not-for-profit entities in Connecticut to prohibit all in-person functions if they are able to,” effective Monday, March 23 at 8 p.m.

    Non-essential businesses should also close starting at that time, Lamont added.

    At a press conference Saturday afternoon, Murphy said the New Jersey executive order includes all events, including weddings and parties.

    “This decision is not an easy one, and it pains me that important life moments will not be celebrated in the way we are accustomed to,” Murphy said. “I know this will be disappointing to many residents, but my singular goal, our singular goal… is to make sure we get through this emergency.”

    “New Jerseyans can still take a walk outside, go buy groceries, or get take-out from a local restaurant,” Murphy noted on Twitter. “But, otherwise, STAY AT HOME.”

    The state’s travel curfew for non-essential workers is now effectively a 24-hour one, Murphy said. “We don’t want you out there, period,” he added.

    The order “provides for certain exceptions, such as obtaining essential goods or services, seeking medical attention, visiting family or close friends, reporting to work, or engaging in outdoor activities,” a release from Murphy’s office notes.

    The order also requires that “all businesses or non-profits, wherever practicable… accommodate their workforce for telework or work-from-home arrangements,” according to the release.

    Businesses and non-profits that can’t do so “should make best efforts to reduce staff on site to the minimal number necessary to ensure that essential operations can continue,” the release adds.

    A total of 1,327 people in the state have tested positive for COVID-19, Murphy said Saturday, up by 442 from Friday. Five more people have died, bringing the number of novel coronavirus-related deaths in the state to 16, he said.

  13. I have been prescribed Chloroquine twice in my life when I was travelling into malaria zones.

    Both time I was told the side effects of Chloroquine were quite severe if used for more than about two weeks. These side effects included liver damage and sterility. There are numerous other lesser side effects.

    Despite having been told this by my doctors at the time these side effects are not listed on articles that are returned in Google searches for Chloroquine.

    There is a lot of social media spread of the prophylactic effects of take Chloroquine but very little being said about the potential harm of long term use.

  14. Michael Irvine Mar 21, 2020

    Regarding facemark re-usability

    I have put N-95 facemarks through the washing machine and blacked them on Chlorine bleach and they appeared re-usable to me. What, if any, alteration to it’s relative effectiveness against COVID-19 after being subjected to washing I have no idea.

    Respirators have a large number of plastic and rubber materials and as was reported on your show, corona virus seems to remain viable after three days on plastic surface so the masks should be washed often.

  15. Phillip Mar 21, 2020

    I have not yet heard any discussion of using IV vitamin C either alone or with hydrocortisone. I have read reports of this been used in China with some efficacy in seriously ill patients.