Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

epicentro.iss.it

Post reply on HN
Print view View original

21–30 of 96 posts

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#21

Post by fileeditview »

dakrisht wrote: post #12

Some interesting data here. - Mean age of 79.5 sheds light on Italy’s extremely high fatality rates; in essence, it’s the (very) elderly that are dying due to complications from viral pneumonia. Which begs the next question... Why are they overwhelmingly treating patients with antibiotics in cases of viral pneumonia and not antivirals (Remdesivir)/ chloroquine? Sure, these are “experimental” therapies but decent data…

> Why are they overwhelmingly treating patients with antibiotics in cases of viral pneumonia and not antivirals (Remdesivir)/ chloroquine?

My guess is that they try to avoid an additional bacterial super infection with antibiotics. Also these antivirals can be dangerous to (very) old people. I think because of liver malfunctions. But take all I say with a grain of salt.. this is all stuff in the back off my head that I remember vaguely from my father (a doctor).

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#22

Post by xenonite »

gvjddbnvdrbv wrote: post #16

This is encouraging for healthy youngsters BUT age and health are also the criteria for receiving treatment in Italy at the moment. As the epidemic grows the categories of people that get ventilation decrease and the deaths will get younger and healthier.

Even if a youngster as a higher change of survival, there are serious effects reported. Fibrosis (damage of the lung tissue) lasts for much longer (over 4 weeks) than it is known in any typical flu. And what happens after 4 weeks is still totally unclear.

As we don't know yet of the long term effects, please don't take that lightly!

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#23

Post by dakrisht »

fileeditview wrote: post #21
dakrisht wrote: post #12

Some interesting data here. - Mean age of 79.5 sheds light on Italy’s extremely high fatality rates; in essence, it’s the (very) elderly that are dying due to complications from viral pneumonia. Which begs the next question... Why are they overwhelmingly treating patients with antibiotics in cases of viral pneumonia and not antivirals (Remdesivir)/ chloroquine? Sure, these are “experimental” therapies but decent data…

> Why are they overwhelmingly treating patients with antibiotics in cases of viral pneumonia and not antivirals (Remdesivir)/ chloroquine? My guess is that they try to avoid an additional bacterial super infection with antibiotics. Also these antivirals can be dangerous to (very) old people. I think because of liver malfunctions. But take all I say with a grain of salt.. this is all stuff in the back off my head that…

I wonder if intubating these patients is actually killing them. I have ZERO evidence but is there an off chance they’re actually treating them incorrectly?

There’s the cytokine storm problem although I just wonder, for some weird and maybe even wrong reason, that the standard of care, the protocol for this particular viral infection is not intubation for most?

If you look at a video of the ICU or ward in Lombardy, everyone is either intimated or negative pressure oxygen. Yes, their Sp02 levels are bad and they have breathing difficulties. So I get why they are following standard protocol - but I just wonder if this particular infection, at its peak, requires a different approach.

But enough Doogie Howser from me.

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#24

Post by laGrenouille »

dakrisht wrote: post #14
kayoone wrote: post #7

Doesn't the median age of 60 years for positively diagnosed patients suggest a huge number of non-detected cases?

Probably tens of thousands of undiagnosed, asymptomatic. Aka super carriers. The virus is smart and has evolved from an evolutionary standpoint. Infect younger and asymptomatic patients with the goal of spreading and infecting as many as possible. Eventually, the more infected, the more that will die. The young are just carrier pigeons and don’t even know it.

> The virus is smart and has evolved from an evolutionary standpoint. Infect younger and asymptomatic patients with the goal of spreading and infecting as many as possible.

I think you are giving a bit too much agency to the virus. It has evolved in such a way that optimises for further spreading for sure, but I do not think it has a sneaky strategy to use young people as attack vectors.

What's more likely is that it has evolved to replicate and spread within the human population, while not acting so fast as to kill most people. The problem is that replicating at a rate that doesn't kill most people will kill some of the oldest and sickest within a population.

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#25

Post by dakrisht »

xenonite wrote: post #22
gvjddbnvdrbv wrote: post #16

This is encouraging for healthy youngsters BUT age and health are also the criteria for receiving treatment in Italy at the moment. As the epidemic grows the categories of people that get ventilation decrease and the deaths will get younger and healthier.

Even if a youngster as a higher change of survival, there are serious effects reported. Fibrosis (damage of the lung tissue) lasts for much longer (over 4 weeks) than it is known in any typical flu. And what happens after 4 weeks is still totally unclear. As we don't know yet of the long term effects, please don't take that lightly!

Source for this comment?

All pneumonia’s have decreased lung function post-infection and require therapy to retain full or close to full lung function.

Curious where you’re getting this info from

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#26

Post by CubsFan1060 »

kayoone wrote: post #7

Doesn't the median age of 60 years for positively diagnosed patients suggest a huge number of non-detected cases?

Assuming this was true, and there's not tons of dead young people, it also would seem to back up that people under 60 are at far less risk.

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#27

Post by dakrisht »

DocSavage wrote: post #20
dakrisht wrote: post #12

Some interesting data here. - Mean age of 79.5 sheds light on Italy’s extremely high fatality rates; in essence, it’s the (very) elderly that are dying due to complications from viral pneumonia. Which begs the next question... Why are they overwhelmingly treating patients with antibiotics in cases of viral pneumonia and not antivirals (Remdesivir)/ chloroquine? Sure, these are “experimental” therapies but decent data…

On the elderly infections: https://www.wired.com/story/why-the-coronavirus-hit-italy-so... On antibiotics, aside from secondary infections, there’s a paper out talking about azithromycin: “Our preliminary results also suggest a synergistic effect of the combination of hydroxychloroquine and azithromycin. Azithromycin has been shown to be active in vitro against Zika and Ebola viruses [20-22] and to prevent severe res…

Yeah, I remember reading this as well.

MedCram did a good video showing how Zinc, for example, actually impairs viral replication but Zinc cannot enter the cell... without chloroquine :)

Seems chloroquine has the key to the cell, otherwise nothing goes in.

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#28

Post by molodec »

dakrisht wrote: post #12

Some interesting data here. - Mean age of 79.5 sheds light on Italy’s extremely high fatality rates; in essence, it’s the (very) elderly that are dying due to complications from viral pneumonia. Which begs the next question... Why are they overwhelmingly treating patients with antibiotics in cases of viral pneumonia and not antivirals (Remdesivir)/ chloroquine? Sure, these are “experimental” therapies but decent data…

We all want to live long, and people now often live till 80+, but when a person 80+ years old dies does it make sense to search for a cause of the death? My grandmother died last year from pneumonia. She was 89, which is way above the average life expectancy. Any small infection can kill a person at this age. Is there a statistics that shows the mortality rate in Italy before the pandemic.

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#29

Post by dakrisht »

CubsFan1060 wrote: post #26
kayoone wrote: post #7

Doesn't the median age of 60 years for positively diagnosed patients suggest a huge number of non-detected cases?

Assuming this was true, and there's not tons of dead young people, it also would seem to back up that people under 60 are at far less risk.

Right. One issue we’re having globally is that we simply cannot get an accurate fatality rate.

We’re only seeing the sickest, most critical patients and the most overwhelmed hospital systems in cities.

I think MOST patients being tested in hotspots like Lombardy are those who are already at the hospital, and if you’re at the hospital you’re not in good shape.

Probably tons of positive cases at home with a fever, or mild symptoms or no symptoms.

And of course, tons of people who are not tested and probably never will be. Totally asymptomatic.

We can’t get an accurate fatality rate without these “infected but asymptomatic” cases.

Didn’t an Italian doctor do a small study showing 98% asymptomatic positive cases?

Re: Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf]

#30

Post by saalweachter »

dakrisht wrote: post #12

Some interesting data here. - Mean age of 79.5 sheds light on Italy’s extremely high fatality rates; in essence, it’s the (very) elderly that are dying due to complications from viral pneumonia. Which begs the next question... Why are they overwhelmingly treating patients with antibiotics in cases of viral pneumonia and not antivirals (Remdesivir)/ chloroquine? Sure, these are “experimental” therapies but decent data…

Something else to keep in mind is this part:

> The figure 5 shows, for the patients who died positive COVID-19, the median time in days, who spend from onset of symptoms to death (8 days), from onset of symptoms to hospitalization (4 days) and from hospitalization to death (4 days).

At this point, we know the elderly and people with pre-existing conditions are dying fast; it is also not unreasonable to think they're more vulnerable overall.

But not enough time has passed to say yet whether younger people without pre-existing conditions are not particularly susceptible or are just a little less susceptible but take longer to succumb. If the statistics are a week for someone over 65, from onset to death, and a month for someone under 40 w/o pre-existing conditions, it's going to skew the hell out of the statistics this early in the outbreak.

Post reply on HN