Talk:COVID-19/Archive 3

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CT Imaging Needed for Diagnosis?

This sentence in the lead paragraph struck me as problematic, "The infection can also be diagnosed from a combination of symptoms, risk factors, and a chest CT scan showing features of pneumonia." I was curious to see who was making such a recommendation about imaging and diagnosis.

I then followed the link to the COVID-19 testing article and found this paragraph under 'CT Imaging':

"Chest CT scan, an imaging tool for pneumonia, is fast and relatively easy to perform. One research found that the sensitivity of CT for COVID-19 infection was 98% compared to RT-PCR sensitivity of 71%.[52] Most common CT scan findings were bilateral groundglass attenuation (patchy or diffuse) with subpleural dominance, crazy paving and consolidations at later stages. However, these findings are nonspecific and found as well in other types of pneumonia. No study yet has validated the accuracy and discriminatory value of CT scans to distinguish COVID from other viral pneumonia. Therefore, the CDC - does not recommend CT for initial screening, as emphasized in the COCA call on Thursday, 5 March. People with suspected COVID should be tested with RT - PCR -which is the most specific test.[citation needed]"

The first sentence was sourced to two references, the original manuscript and an article about the manuscript. I removed the latter as per WP:MEDPOP. While the last bit is unsourced, I agree with the reasoning. There is nothing about CT imaging findings which make a clinician think it's COVID-19. The features reported in both articles mimic the findings of other infectious pneumonia. Suggesting CT imaging is needed for diagnosis is misleading in my opinion, particularly when the findings have not been well validated in other countries and settings. I'm open to what others think. Moksha88 (talk) 02:51, 13 March 2020 (UTC)

Yes one can also make a clinical diagnosis. This was done in Wuhan during the peak of the outbreak. I am sure many others will be doing this aswell as the number of cases increase beyond testing capabilities. Doc James (talk · contribs · email) 02:35, 14 March 2020 (UTC)

Putting on PPE

User:Dekimasu Putting on PPE definitely part of the management of someone with COVID19. Doc James (talk · contribs · email) 17:12, 9 March 2020 (UTC)

yes, agree--Ozzie10aaaa (talk) 20:40, 9 March 2020 (UTC)

Is there anything about it that is different from how protective gear would be put on when dealing with other infectious diseases? If not, then I think the step-by-step description is wandering into WP:NOTHOWTO. A simple statement that protective gear is used would suffice, without the graphic. For example, we mention intubation, but we don't have a description here of how intubation works. Dekimasuよ! 06:13, 10 March 2020 (UTC)

These are the specific level of instructions for PPE for this disease which are different than say the instructions were for Ebola which you can see Ebola_virus_disease#Putting_on_protective_equipment

This is not how to, but simple the recommendations from the CDC. Doc James (talk · contribs · email) 00:30, 11 March 2020 (UTC)

I really see no reason for having that image on this page specifically. The description makes sense, but a visual image for such a small section specifically for medially professionals putting on protective gear, seems unneeded to me. WikiVirusC^(talk) 14:03, 10 March, 2020

This a major aspect of treating this disease. We have a whole collection on apply PPE for Ebola_virus_disease#Putting_on_protective_equipment and than another for removing it. Doc James (talk · contribs · email) 05:29, 14 March 2020 (UTC)

Diagnostics

I suggest considering the use of this as a quality systematic review: PMID 32110875 LeadSongDog come howl! 18:43, 13 March 2020 (UTC)

Thanks User:LeadSongDog Added it to a couple of places. Doc James (talk · contribs · email) 19:01, 14 March 2020 (UTC)

Asymptomatic spread worse than thought -- needs to be updated urgently

"We now know that asymptomatic transmission likely [plays] an important role in spreading this virus," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Osterholm added that it's "absolutely clear" that asymptomatic infection "surely can fuel a pandemic like this in a way that's going to make it very difficult to control." In an article two weeks ago in the New England Journal of Medicine, Bill Gates, co-chair of the Bill and Melinda Gates Foundation, expressed concern about the spread of the disease by people who haven't yet developed symptoms, or who are only a bit sick. "There is also strong evidence that it can be transmitted by people who are just mildly ill or even presymptomatic. That means COVID-19 will be much harder to contain than the Middle East respiratory syndrome or severe acute respiratory syndrome (SARS), which were spread much less efficiently and only by symptomatic people," he wrote, using the scientific word for the disease caused by the virus. 'Prolonged, unprotected contact' led to first known person-to-person coronavirus transmission in US, study says Others agree that people without serious symptoms play a substantial role in the spread of the new coronavirus. "Asymptomatic and mildly symptomatic transmission are a major factor in transmission for Covid-19," said Dr. William Schaffner, a professor at Vanderbilt University School of Medicine and longtime adviser to the CDC. "They're going to be the drivers of spread in the community." Osterholm urged public officials to be clearer about the way the virus is spread.

Source: https://us.cnn.com/2020/03/14/health/coronavirus-asymptomatic-spread/index.html

73.195.225.148 (talk) 03:56, 15 March 2020 (UTC)

one's face

there should be an apostrophe in "one's face" 2A01:CB0C:CD:D800:8DDB:442D:27B:61DD (talk) 09:50, 21 March 2020 (UTC)

thank you for grammatical correction--Ozzie10aaaa (talk) 14:36, 21 March 2020 (UTC)

Editsemiprotected

Please add the Coronavirus disease 2019 portal Portal:Coronavirus disease 2019 to the see also section

{{Portal|Coronavirus disease 2019}}

-- 67.70.32.186 (talk) 01:00, 22 March 2020 (UTC)

 Done WikiVirusC^(talk) 02:17, 22 March 2020 (UTC)

Herd immunity

• https://www.msn.com/en-nz/news/world/majority-of-uk-needs-to-get-coronavirus-for-herd-immunity-chief-scientist-says/ar-BB1195At
• https://www.mirror.co.uk/news/uk-news/coronavirus-what-herd-immunity-how-21681418
• https://www.newsweek.com/herd-immunity-protect-coronavirus-covid-19-1492143
• https://www.nbcnews.com/now/video/experts-hope-herd-immunity-flattens-the-coronavirus-curve-80512581952
• https://www.wired.co.uk/article/herd-immunity-uk-coronavirus-robert-peston

I'm surprised Herd immunity isn't covered in this article. Sun Creator^(talk) 13:55, 13 March 2020 (UTC)

User:Sun Creator there is no herd immunity. And we should be using better sources if we can. Yes herd immunity after enough people are infected and survive will be useful but not until a substantial population has it. And there is also the chance that this virus will mutate and herd immunity may be lessened. Doc James (talk · contribs · email) 05:46, 14 March 2020 (UTC)

Also, at the moment we do not know if past coronavirus infection provides effective immunity. Or has it been confirmed? --Gtoffoletto (talk) 15:02, 14 March 2020 (UTC)

We do not know if you can become infected again. Not enough people who have recovered yet. Likely the answer will be you will be immune for some time anyway. But the other question is how fast this virus mutates. Doc James (talk · contribs · email) 18:50, 14 March 2020 (UTC)

Where should this information be placed in the article? It seems an important point. Any sources on this you are aware about. --Gtoffoletto (talk) 19:27, 14 March 2020 (UTC)

There is a paragraph about immunity under Prognosis. -- Dandv 13:19, 15 March 2020 (UTC)

I know. I wrote it. --Gtoffoletto (talk) 15:37, 15 March 2020 (UTC)

Article

• White House Coronavirus Task Force SandyGeorgia (Talk) 18:23, 15 March 2020 (UTC)

ACE2 is not sensitive to ACE inhibitors nor angiotensin II receptor blockers

The following article mentions that ACE2 is upregulated by ACE inhibitors and Angiotensin II Receptor Blockers and TZDs. Reminder: ACE converts ANG I to ANG II(vasoconstrictor) and ACE2, ANG II to ANG1-7 (vasodilator) ACE2 is protective against lung inflammation in high levels but the CoVir19 causes it to decrease, thus the pro destructive effect. https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf Jetumele45 (talk) 03:16, 14 March 2020 (UTC)

Just a letter to the BMJ, but worth keeping an eye on: https://www.bmj.com/content/368/bmj.m325/rr

The active site of ACE2 appears to bind both angiotensin II and the SARS coronavirus spike glycoprotein through an FQ-containing motif shared by quinapril. The active site of ACE2 thus resembles the N terminal active site of ACE. In patients lacking the systemic blood pressure for an ACE inhibitor like quinapril, an ARB such as losartan could be substituted as a first approximation, since we found it useful for West Nile virus encephalitis. Shtove 19:54, 15 March 2020 (UTC)

Full page protection

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

The extremely controversial and extraordinary decision to fully protect this page over a minor dispute was made single-handedly by ToBeFree after a single post at WP:RFPP (permalink). The egregious nature of this action should certainly not be overlooked, and calling into question administrator privileges should be done.
The page has seen hundreds of edits in the past 48 hours, and a block of a further 48 hours has the potential to cause severe harm for Wikipedia. This overstepping of administrator privileges is under no circumstance to be taken lightly and may be brought forth at the Wikipedia:Administrators' noticeboard. I simultaneously suggest a Wikipedia:Requests for de-adminship. Carl Fredrik ^talk 19:26, 23 March 2020 (UTC)

The protection policy, section "Full protection: Content disputes", lists full protection as "an alternative approach" (to blocking) "to end an ongoing edit war". It is described as "better suited to multi-party disputes and contentious content as talk page consensus becomes a requirement for implementation of requested edits". I'll reduce the protection duration to 12 hours to limit the impact of your content dispute on other editors, and will use blocks if it continues instead.

Regarding de-adminship, you may like to bookmark User:ToBeFree/recall. ~ ToBeFree (talk) 19:33, 23 March 2020 (UTC)

I will quote what I wrote on your talk-page:

If you don't understand that the extraordinary volume of edits currently experienced makes this into an exceptional and frankly WP:UNPRECEDENTED situation, where ordinary application of policy is not only unwise but foolish and severely lacking in judgement — you are truly not fit to be an administrator.

The amount of edits this page is experiencing in relation to the minuscule controversy you chose to fully protect it for can only lead ones' mind to Wikipedia:Do not disrupt Wikipedia to illustrate a point. I don't have more time for this issue now; but I'm also positive about it and I trust others will solve it before I'm back tomorrow.

Carl Fredrik ^talk 19:36, 23 March 2020 (UTC)

I can understand these concerns, and I do thank you for the feedback. You can be pretty sure that it won't happen again, and if it's only because I am uninterested in the drama some editors are making of such decisions. I'd argue that especially regarding this topic, careful editing and proper discussion is important. This is why the community has authorized general sanctions in the area, after all. ~ ToBeFree (talk) 19:37, 23 March 2020 (UTC)

I'm sorry to be quick to cast asperations regarding your competence, but it was an extreme act to protect the page. The volume of edits makes many things difficult, but on the whole it has to be seen as something good for Wikipedia, and clanking down on editing here could cause real harm for Wikipedia as a whole. This might end up in the newspapers. Carl Fredrik ^talk 19:45, 23 March 2020 (UTC)

Thank you ToBeFree for starting your own discussion at Wikipedia:Administrators'_noticeboard#Page_protection_of_Coronavirus_disease_2019. The current situation is trying for all of us, and I apologize for being aggressive, and am the first to admit that I may also not be acting my best fully-rational self. Carl Fredrik ^talk 19:52, 23 March 2020 (UTC)

I have restored the previous protection level of the page to prevent possible damage to Wikipedia's reputation, given the high amount of edits that are unrelated to the conflict (Doc James's happened while I was looking at the protection interface, if someone wonders) and the necessity to allow experienced editors to quickly fix issues in the highly visible article, given the constantly and rapidly changing information about the topic.

Protecting the page was an unnecessary decision to deal with a relatively low-frequent, low-damaging edit conflict. CFCF is correct about it having been "an extreme act". It wasn't intended as such; ironically, it was even meant as a soft alternative to an extreme act, blocking editors. Neither is required to deescalate the conflict. ~ ToBeFree (talk) 19:55, 23 March 2020 (UTC)

Just the two of us discussing, archiving this. Carl Fredrik ^talk 20:21, 23 March 2020 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Should information on the risk of exposure by occupation be added?

The NYT article https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html used as Source the O*Net, Bureau of Labor Statistics. Income and employment statistics are from May 2018, the most recent Occupational Employment Statistics release. I was not sure if and how to do it. A student of mine thought of adding the risk to some of teh pages of professional hazards of specific occupations. TMorata (talk) 12:14, 16 March 2020 (UTC)

In my opinion premature. David notMD (talk) 20:02, 16 March 2020 (UTC)

Sequelae

Should we have a section on the consequences of recovering from COVID-19, separate from complications? Many voices claim "it's just a bad flu", others state that consequences are unknown, while a minority claim permanent lung or brain damage can result from the disease. — Preceding unsigned comment added by Dandv (talk • contribs) 04:51, 10 March 2020 (UTC)

Consequences are part of the prognosis.Cinadon36 09:39, 10 March 2020 (UTC)

Here's a source, albeit non-medical https://news.yahoo.com/people-fully-recover-coronavirus-left-103917303.html?soc_src=newsroom&soc_trk=com.apple.UIKit.activity.PostToFacebook&.tsrc=newsroom Victor Grigas (talk) 00:49, 14 March 2020 (UTC)

I've added a section, pointing to the closest original source I could find (South China Morning Post). I couldn't find anything on the Hong Kong Authority's website. -- Dandv 13:14, 15 March 2020 (UTC)

What you DO NOT want to add is that it is “just a bad flu”!! as Corona is not influenza at all. Corona virus 19 disease is an extreme COLD, which is a different animal than an influenza. It can cause pneumonia, and/or other symptoms, but is still not flu. Ragity (talk) 03:20, 17 March 2020 (UTC)

Semi-protected edit request on 16 March 2020

Please add the additional symptoms as found on the WHO Webiste: "The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea." https://www.who.int/news-room/q-a-detail/q-a-coronaviruses#:~:text=symptoms --Find-the-evidence (talk) 22:51, 16 March 2020 (UTC)F.T.E Find-the-evidence (talk) 22:51, 16 March 2020 (UTC)

They are already mentioned in the article. See table at "Signs and symptoms" section. Cinadon36 23:10, 16 March 2020 (UTC)

Yah tiredness is so none specific. Can be mentioned in the body. Doc James (talk · contribs · email) 02:23, 17 March 2020 (UTC)

It's a very bad idea to edit the list of the most common symptoms according to your opinions instead of the reliable sources, and it's a very bad idea to make a different list in the introduction than in the symptoms section's table based on different sources, the CDC and WHO. --Espoo (talk) 08:40, 17 March 2020 (UTC)

"Common symptoms include" and "the most common symptoms are" have different meanings. "Nonspecific" is a technical term meaning that the symptom is self-reported and not necessarily associated with disease. Dekimasuよ! 09:19, 17 March 2020 (UTC)

I don't understand your answer, especially since it contradicts what you said in the edit summary ("common symptoms != the most common symptoms"). --Espoo (talk) 12:04, 17 March 2020 (UTC)

The stable version says “Common symptoms include...” and you have been arguing that the stable phrasing constituted an “incorrect list of the most common symptoms”. The stable version is not claiming to be such a list. While the WHO notes that tiredness is a common symptom, it is not a symptom that is helpful in identifying whether or not someone is suffering from COVID-19, so it has not been considered essential to include in the introduction to the article. The fact that the CDC and the WHO use slightly different wordings in describing common symptoms is also not one of the most important facts to put in the lede. Dekimasuよ! 12:12, 17 March 2020 (UTC)

I agree Dekimasu. There is no need to attribute statements on symptoms. There is a broad consensus that symptoms mimic other common upper resp. infections. See also WP:YESPOV: Avoid stating facts as opinions. Uncontested and uncontroversial factual assertions made by reliable sources should normally be directly stated in Wikipedia's voice" Cinadon36 13:18, 17 March 2020 (UTC)

This is the CDC list[1] fever, cough, shortness of breath. Doc James (talk · contribs · email) 17:36, 17 March 2020 (UTC)

 Not done: Closing this request for now as edit requests need a clear consensus to be implemented. If consensus changes in favor please feel free to re-open. Alucard 16_{❯❯❯ chat?} 06:55, 18 March 2020 (UTC)

Info on possible fecal-oral transmission of Covid-19 missing from article

Research out of China claims that the Covid-19 can be transmitted via the fecal-oral route but I could not find any mention of this in this Wikipedia article. Other medical sources claim the risk is low from fecal-oral transmission. Someone better equip to sort out this dispute should look through the medical sources I provided below and try and come up with at least a paragraph to add to the article on the differing points of view as to whether it can be transmitted through the oral-fecal route (as Chinese researchers have claimed) and if so how likely this is verses the oral/nasal transmission. Here are several mical publications that discuss this study and oral-fecal transmission of Void-19 in general:

• https://www.medpagetoday.com/infectiousdisease/covid19/85315
• http://www.cidrap.umn.edu/news-perspective/2020/03/study-covid-19-may-spread-several-different-ways
• https://www.idse.net/Emerging-Diseases/Article/03-20/GI-Tract-Possible-Route-of-Transmission-for-COVID-19-/57537
• https://www.medscape.com/viewarticle/926682
• https://www.medscape.com/viewarticle/926390
• https://www.cdc.gov/coronavirus/2019-ncov/php/water.html
• https://www.gastrojournal.org/article/S0016-5085(20)30281-X/fulltext
• https://www.mdmag.com/medical-news/gastrointestinal-issues-help-diagnose-coronavirus
• http://www.cidrap.umn.edu/news-perspective/2020/02/studies-show-covid-19-virus-likely-has-multiple-infection-routes
• https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
• https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/assumptions.html

Note: While I know that many of the above sources are WP:MEDRS compliant, I am not in a position to speak to all of them in this regard but I included one I wasn't 100% sure about as a jumping off point snd not because I expect every link above to be cited/used in the article. --Notcharliechaplin (talk) 20:56, 14 March 2020 (UTC)

WHO and Health Canada are great sources. As is the CDC. Doc James (talk · contribs · email) 00:17, 15 March 2020 (UTC)

Now 137. Very bad. Pandya101 (talk) 14:41, 17 March 2020 (UTC)

Now 150+ very bad Pandya101 (talk) 15:45, 18 March 2020 (UTC)

grammar fix needed

In the "signs and symptoms" section, there's a sentence "As is common with infections, there is a delay from when a person is infected with the virus to when they develop symptoms, know..." That should be "known" not "know." I can fix, as it's all locked down, but I am sure one of you fine people can. (Just trying to help) 198.70.2.200 (talk) 13:12, 18 March 2020 (UTC)

Done thanks. --Gtoffoletto (talk) 13:16, 18 March 2020 (UTC)

It is a bit old, but also the most trusted (I think at least) that we can find out there - and the 3.4% we are listing is also arguably old and from the same sources.

I can combine some additional fact from those other data sources - any specific ones? I have been searching for others, but really hard to find. Twrobins (talk) 16:04, 18 March 2020 (UTC)

OK, I will try to hunt down some additional sources - really hard to find though. Any suggestions appreciated! Please add here and I will work on it.

On the age of that report - yes, I would agree it is a bit old, but also (I believe) the most trusted source. It also appears that is the source where the 3.4% comes from - so it itself is a moving/old stat.

I'll prep an edit as well with the above in mind. Twrobins (talk) 16:13, 18 March 2020 (UTC)

Deaths

The infobox at the top of this article states "3.4% of confirmed cases; lower when unreported cases are included".

The Lancet published an article about a week ago showing how this is wrong. If you look at the number of cases from two weeks ago and then look at the number of deaths today (using these time words very generally), it's actually ranging from 5-15%. I think that it should include a statement that offers this alternative, preferable way of examining the death rate. I will leave that to somebody else to do, though; hopefully somebody who can phrase it better.

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30195-X/fulltext

Philologick (talk) 16:15, 18 March 2020 (UTC)

See the Talk section immediately above. I think we should be using several sources here and presenting a range of numbers. Bondegezou (talk) 17:23, 18 March 2020 (UTC)

Cause

Dozens of people infected early in the current outbreak worked in a live-animal market in the Chinese city of Wuhan, but tests of coronavirus samples found at the market have yet to identify a source . Even a Nature article has the courage to spell out that a meat market is a common focal point of may of the early cases, but let wikipedians shill for the Chinese government and make sure the origin is muddled as much as possible. Completely encyclopedic indeed. 2601:602:9200:1310:F16B:3EF1:CDC8:D561 (talk) 07:07, 11 March 2020 (UTC)

The cause is the virus, but the original biological source of the virus and the "patient zero" in China are unknown. It was not even well established if it came from this market. Please correct me with refs if I am wrong. My very best wishes (talk) 19:53, 11 March 2020 (UTC)

AND please assume good faith, even when referring to the ChiCom government. It’s a basic tenet of our project. Ragity (talk) 03:38, 17 March 2020 (UTC)

They're responsible for the spreading of it, though - once they learned they were going to be put under quarantine, a few thousand got the hell out of Dodge. HalfShadow 21:31, 18 March 2020 (UTC)

Management of mild to moderate symptoms

Hi all

Just a query about whether we should be covering the management of people who have the milder symptoms, in particular fevers. I came to look at this article because there are conflicting rumours flying around in my circles about whether people should or shouldn't take ibuprofen to manage the COVID fever. For example [2]. It would be nice to see the best WP:MEDRS advice on that and other home treatments. Thanks  — Amakuru (talk) 09:57, 18 March 2020 (UTC)

Yeap, a quick note wouldnt be a problem. Cinadon36 10:12, 18 March 2020 (UTC)

I couldnt find WHO statement on ibuprofen...Cinadon36 12:24, 18 March 2020 (UTC)

I will try to look for something related to this soon, although there was advice against using NSAIDs and steroids very early on when there were almost no cases outside China, and I think those recommendations were based upon previous experience with SARS or MERS. It has also struck me that we don't discuss the length of individual symptoms. I am under the impression that the fever only exists for a short time at the beginning of the symptomatic period, but I can't find any good sources on that at the moment. Dekimasuよ! 19:17, 18 March 2020 (UTC)

The WHO has specifically stated via their official Twitter account that they are NOT recommending against taking ibuprofen. https://twitter.com/WHO/status/1240409217997189128 69.59.196.6 (talk) 00:39, 19 March 2020 (UTC)

Meanwhile, on the same day: “WHO urges against ibuprofen use for virus”. I will look at this again ASAP. Dekimasuよ! 04:03, 19 March 2020 (UTC)

This may be helpful as background, but is probably difficult to use while avoiding synthesis. Dekimasuよ! 04:09, 19 March 2020 (UTC)

Someone please double check

In the section "Course and Complications" there is a reference (currently #44) that states "Blood markers of damage to the heart (Troponin I) are increased in more than 50% of severe cases of COVID-19, and abnormal heart rhythms leading to cardiac arrest have been described."

I could find no such statement in the referenced articles and this may be information out of context.

While there is plenty of written evidence that "Blood markers of damage to the heart in severe cases..." has been found, the specificity of 50% may need to be removed (or corrected) for factual clarity, especially in light of the present urgency and need for reliable numbers.

Someone please doublecheck the reference and confirm or otherwise. I went over the reading material several times and I cannot find that specific reference.

Thanks, Waz (talk) 00:28, 19 March 2020 (UTC)

Waz, thank you for pointing this out. I fixed it. Also, I don't know what the utility of the 'Course and Complications' section is currently and wonder if we can salvage some of the information for 'Signs and Symptoms' without needing another section. The last part is completely unsourced. @Doc James and Dekimasu:, thoughts? Moksha88 (talk) 04:12, 19 March 2020 (UTC)

I would move some to “Prognosis” and remove some as uncited/overdetailed for the purposes of this article. Dekimasuよ! 04:15, 19 March 2020 (UTC)

I am not sure that this was in the right direction. (Clinical) Course has a different meaning from "prognosis" and I feel we are mixing them. Cinadon36 08:57, 19 March 2020 (UTC)

No it has the same meaning as in "the likely course of a medical condition."Graham Beards (talk) 09:00, 19 March 2020 (UTC)

Prognosis refers to the outcome of a disease, Clinical course refers to how the disease behave. Cinadon36 09:15, 19 March 2020 (UTC)

No, you are wrong, it's tautology.Graham Beards (talk) 09:25, 19 March 2020 (UTC)

Nope, they are quite disctinct entities. Prognosis refers to the outcome of the disease. "Prognosis is the prediction of the probable outcome of an individual's current medical condition" source. Clinical features, complications etc is something different. Lets see what other editors think. Cinadon36 09:39, 19 March 2020 (UTC)

favipiravir

Another Chinese press conference giving qualitative descriptions of clinical tests for a therapy; this time favipiravir. Apparently it's effective while the viral load is still low. Any hints of a real preprint or even better, a peer-reviewed paper? Boud (talk) 14:05, 19 March 2020 (UTC)

US case fatality rates

Hello, on 3/18/2020 Case Fatality Rates for the United States were published. If someone can add to page. Reference = https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm — Preceding unsigned comment added by 107.14.54.1 (talk) 13:51, 19 March 2020 (UTC)

thank you for posting--Ozzie10aaaa (talk) 23:25, 19 March 2020 (UTC)

Eyes?

This article on the BBC mentions that a sufferer had 'burning eyes'. I myself had eye pain and slight photophobia (amongst other symptoms) for two days this week, hence my interest in the matter. A friend who caught Covid 19 has confirmed the eye pain. Yet, I can't really find anything on this issue on the net. Has anyone else come across it? Malick78 (talk) 21:49, 19 March 2020 (UTC)

I have not personally come across anything indicating that burning eyes is a common symptom of COVID-19 at this point. If anyone does have any reliable sources indicating this, I would be interested to see it. TylerDurden8823 (talk) 00:54, 20 March 2020 (UTC)

Semi-protected edit request on 20 March 2020 re mechanical ventilation development effort

Add to the mechanical ventilation section a reference to the Forbes article covering the development and production of a low cost, open source ventilator. https://www.forbes.com/sites/alexandrasternlicht/2020/03/18/theres-a-shortage-of-ventilators-for-coronavirus-patients-so-this-international-group-invented-an-open-source-alternative-thats-being-tested-next-week/#57eea62c3ba0 Jeffoire66 (talk) 03:20, 20 March 2020 (UTC)

Semi-protected edit request on 20 March 2020

Please change the case fatality rate from the 3.4% number cited in the last sentence of the opening paragraph which I believe is CDC number for crude case fatality rate with 1.4% symptomatic case fatality rate, based on new work published today in Nature Medicine . Additionally, please add in that the actual infection fatality rate which will accounts for asymptomatic infections, is likely much lower. . Recent studies have reported asymptomatic infections at a magnitude of 20% of total infections 73.164.99.53 (talk) 03:31, 20 March 2020 (UTC)

References

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• Covid-19-curves-graphic2-stopthespread-v3.gif

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References

Ibuprofen, ACE inhibitors/ARBs, and ACE2

Friendly reminder to all that the Lancet Respir Med letter describing a purported risk of ACE inhibitors, ARBs, ibuprofen and TZDs is a non-peer-reviewed description of a hypothesis in a letter to the editor. It is not even a primary source and falls pitifully short of WP:MEDRS standards. As the World Health Organization, European Medicines Agency, and numerous medical societies have stated, there is absolutely no evidence of interactions between these drugs and the ACE2 receptor. Fvasconcellos (t·c) 03:44, 20 March 2020 (UTC)

• I can only guess at the idea the author of this section is trying to get across. I believe the author means that the list of drugs isn't related to worse outcomes in Coronavirus disease which he relates to the ACE2 receptor which is where the Corona Virus binds. This is an oversimplification. The topic is too complicated for a short entry. I offer the following information.

Aside from ibuprofen, losartan may be beneficial via ACE2: "Some doctors theorize that the use of losartan will reduce how aggressive and deadly a COVID-19 infection is, by disrupting how the virus binds to the body at the molecular level. An NIH funding application for that study is in the works, and the trial protocol is still under development."

http://www.startribune.com/university-of-minnesota-to-test-three-drugs-for-covid-patients/568766632/

The clinical trial:

https://clinicaltrials.gov/ct2/show/NCT04312009

A letter suggesting that losartan or valsartan may be helpful:

https://www.bmj.com/content/368/bmj.m406/rr-2

A letter that suggests ACE inhibitors as a risk factor:

https://www.bmj.com/content/368/bmj.m810/rr-2

Ibuprofen, ACE inhibitors and angiotensin receptor blockers:

https://www.unibas.ch/en/News-Events/News/Uni-Research/Ibuprofen-and-COVID-19-Setting-the-record-straight.html

— Preceding unsigned comment added by 173.153.239.106 (talk) 12:49, 20 March 2020 (UTC)

Prognosis and clinical course

Article mixes prognosis and clinical course/features.

• "Prognosis is the prediction of the probable outcome of an individual's current medical condition" source, Nature.com

• I was not able to find a textbook definition of clinical course, or features. But discussing the course, the stages or the complications of the disease, seems that it does not fall under "prognosis". "Course", a much simpler, non technical word, was used in the article to describe complications and how the disease progress. "Prognosis" seems inappropriate. Cinadon36 14:39, 19 March 2020 (UTC)

@Cinadon36:, I think what's confusing here is that prognosis depends on the course and complications. For simplicity, we ought to call either have Prognosis or Course and Complications. Influenza and SARS only have Signs/symptoms and Prognosis, for example. Just now, I removed content under Signs/symptoms about children because it's already covered succinctly under Prognosis. I'm also tagging @Dekimasu, Graham Beards, and Doc James: for comment. Moksha88 (talk) 16:03, 19 March 2020 (UTC)

I strongly prefer prognosis. It is possible that the order of the sections on the page could be rearranged to better reflect the progress of the disease as well. For example, it could be arranged cause–signs and symptoms–management–prognosis (logical progression), followed by epidemiology (progress on a community level) and then avoidance (prevention–research), with terminology (meta) at the bottom. But maybe the order is set according to the MOS? Dekimasuよ! 16:19, 19 March 2020 (UTC)

Ok, it just feels too awkward. Cinadon36 16:00, 20 March 2020 (UTC)

Semi-protected edit request on 27 March 2020

Can we add a section on Covid-19 Lessons Learned or examples of how government / policy makers may have mishandled? These are apparent now with 20/20 hindsight. Hoping to have a space for crowdsourcing ways to improve responses to future pandemics. Examples of responses to Covid-19 that may have been mishandled or have unintended harmful consequences.

https://www.theguardian.com/world/2020/mar/24/anatomy-of-a-coronavirus-disaster-how-2700-people-were-let-off-the-ruby-princess-cruise-ship-by-mistake https://www.macleans.ca/opinion/i-have-breast-cancer-and-cant-be-treated-because-of-the-coronavirus/ https://www.technologyreview.com/f/615369/uk-dropping-coronavirus-herd-immunity-strategy-250000-dead/ Emhui (talk) 00:55, 27 March 2020 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. @Emhui: We do not know what exactly what edits you want made. You gotta make it specific like insert this because...", remove this because..., change X to Y. That way, we know what you want changed, and we'll do it on your behalf. {{SUBST:replyto|Can I Log In}}PLEASE copy and paste the code to reply(Talk) 16:48, 27 March 2020 (UTC)

men at risk

https://www.theguardian.com/world/2020/mar/26/men-are-much-more-likely-to-die-from-coronavirus-but-why

This could be included in the epidemiology section, thank you. 2001:14BA:984A:F200:0:0:0:8EA (talk) 09:51, 26 March 2020 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. {{SUBST:replyto|Can I Log In}}^{PLEASE copy and paste the code to reply}(Talk) 16:37, 27 March 2020 (UTC)

Semi-protected edit request on 26 March 2020

change "This article is about the disease caused by SARS-CoV-19" to "This article is about the disease caused by SARS-CoV-2" Thiosin (talk) 09:41, 26 March 2020 (UTC)

 Done - thanks! — soupvector (talk) 11:16, 26 March 2020 (UTC)

some stuff about UV rays to disinfect

currently not in the article

The Westin Houston Medical Center's LightStrike robot uses UV light to disinfect hotel rooms.
https://news.yahoo.com/hotels-using-technology-mitigate-covid-19-103220513.html

Device uses UV light to fight spread of germs and viruses, such as COVID-1 “Actually, even ebola is an easy virus to kill for UV,” Said Berland.

The UV machines Violet Defense sells should not be used on your hands or body. It is just to clean surfaces.
https://www.fox35orlando.com/news/device-uses-uv-light-to-fight-spread-of-germs-and-viruses-such-as-covid-19

China cleans bank notes in bid to limit coronavirus COVID-19 spread
Last week, China's central bank, the People's Bank of China, announced it would be cleaning thousands of bank notes by using ultraviolet light or high temperatures to cut off the spread of infection through money exchanges.
https://www.abc.net.au/news/2020-02-21/china-cleaning-money-limit-coronavirus-covid-19/11983364

DMBFFF (talk) 05:56, 18 March 2020 (UTC)

Ultraviolet germicidal irradiation#Air disinfection DMBFFF (talk) 04:55, 20 March 2020 (UTC)

Masks could be simply left out in the sun for a day before reuse, right? Something else that I do not know where to put: is it "trouble waking" or "trouble walking". I think the latter is more likely. Is there any way to mark such questions directly in the text? Bio-CLC (talk) 11:09, 23 March 2020 (UTC)

1. It might even be sterile—at least in regards to Covid-19—if left out long enough, day or night.

2. It depends on the latitude, maybe elevation, cloudiness, and that we might need shorter UV rays.

3. WHO says not to use UV on skin. WHO says nothing about whether things could be sterilized.

4. Sources can't be that hard to find. What's there to test? Put the germs on a platter and zap them. If they're dead, it works.

5. While we're at it, how about heat treatment? Put the germs on a platter. Subject them to, say, 40°C (104°F) for 20 minutes. Are they dead? Again, such a test shouldn't be hard, and thus unlikely tried and thus no sources supporting it or not. (It's also interesting how in the worldometer, countries within the tropics generally don't seem to have it as bad.)

6. Ultraviolet light can kill the novel coronavirus – COVID-19
https://www.khmertimeskh.com/50701725/ultraviolet-light-can-kill-the-novel-coronavirus-covid-19
March 15, 2020

Buses undergo UV disinfection in China during COVID-19 outbreak
https://www.youtube.com/watch?v=pJo1p-RDKc4
0:52

DMBFFF (talk) 01:56, 24 March 2020 (UTC)

California: Gov Newsom states more than half of the population of the state "could become infected" 3/19/2020

COVID-19 is reported to be highly contagious and to have spread like wildfire. The Gov of California is merely speculating based on (hopefully) the best data. However, it is accurate to say a very precise number of infected can't be determined without testing most or all of the population - a condition that won't be met based on the speed of new infections and the likelihood that many will not be tested based on symptoms or don't seek medical care. The media has amplified the idea of social distancing and flattening the curve coinciding with massive shutdowns over most of the United States. There is no way to determine a precise number of the infected but if estimates eventually suggest most of the country has been infected what behavior will be proscribed or prescribed from authority. This is worth entry into the article with a historical or after the facts entry at a future date. — Preceding unsigned comment added by 173.153.161.115 (talk) 02:12, 20 March 2020 (UTC)

I think it would be more appropriate to include in 2020 coronavirus pandemic in the United States. OhKayeSierra (talk) 02:20, 20 March 2020 (UTC)

Actually, the experts cited in this article disagree that Newsom is basing that claim on the "best data." Ioannidis is especially harsh in his criticism. Global Cerebral Ischemia (talk) 17:44, 23 March 2020 (UTC)

Notable death section/pagr

I've looked and I can't find one, but is it time to make a page or a section of notable persons covid19 deaths? I notice on the Deaths in 2020 page, when notables are listed who have died from the virus, it's listed as the cause. P37307 (talk) 04:18, 23 March 2020 (UTC)

List of deaths from the 2019–20 coronavirus pandemic. Juxlos (talk) 14:02, 23 March 2020 (UTC)

Semi-protected edit request on 23 March 2020

I suggest changing

as he is been informed by mobile phone operators.[129]

to

as provided by mobile phone operators.[129] Gf4pp (talk) 03:31, 23 March 2020 (UTC)

Thank you for identifying the poorly formed sentence. I believe that I have improved the sentence now.--Literaturegeek | T@1k? 03:54, 23 March 2020 (UTC)

Semi-protected edit request on 23 March 2020

The second case fatality table should have a first column of "85+" the same as the one above it. ">85" and excludes 85. Bpotato (talk) 06:35, 23 March 2020 (UTC)

 Done Source uses an "or equal to" symbol (i.e. ≥85), so have used that instead of 85+. Little pob (talk) 12:40, 23 March 2020 (UTC)

New fully-protected edit request on 23 March 2020

Replace "30-66" with "30–66" in the table. ―Justin (koavf)❤T☮C☺M☯ 19:05, 23 March 2020 (UTC)

 Partly done: Changed to "30 to 66" for uniformity. JTP ^{(talk • contribs)} 22:03, 23 March 2020 (UTC)

Protected edit request on 23 March 2020

Minor edit: under Prognosis, second sentence, remove the word "Italian" before the name of the institution. It already links to the relevant Wiki article and so makes it redundant noisyoldwalrus 19:16, 23 March 2020 (UTC)

 Done here. -- LuK3 (Talk) 22:34, 23 March 2020 (UTC)

Semi-protected edit request on 21 March 2020

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

The origin of Coronavirus has not been confirmed yet, so the so-called Wuhan pneumonia or Wuhan Coronavirus is absurd. I believe, as a world-wide and scientific encyclopedia, Wikipedia agrees that what some brash president said does not exactly represent what the truth is. Therefore, please delete Wuhan pneumonia or Wuhan Coronavirus from "other name" item. 86.163.180.250 (talk) 19:56, 21 March 2020 (UTC)

 Not done for now: please establish a consensus for this alteration before using the {{edit semi-protected}} template. The name is common enough to have it listed. Please gain consensus for its removal before using this template. EvergreenFir (talk) 20:03, 21 March 2020 (UTC)

See Talk:Coronavirus_disease_2019#Remove_"Other_names"_section_infobox

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

The virus' viability on various surfaces.

This article, "New Coronavirus SARS-CoV-2 Stable for Hours to Days on Surfaces", gives information from: "a new study from National Institutes of Health, CDC, UCLA and Princeton University scientists in The New England Journal of Medicine." https://globalbiodefense.com/2020/03/17/new-coronavirus-sars-cov-2-stable-for-hours-to-days-on-surfaces/

"...detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel." [emphasis is from the article]

Thank you, Wordreader (talk) 12:17, 22 March 2020 (UTC)

 Done--Calthinus (talk) 16:12, 22 March 2020 (UTC)

Anti-inflammatory drugs are possibly implicated in worsening of coronavirus disease

French minister for health Olivier Véran recently tweeted that anti-inflammatory drugs such as ibruprofen and cortosine may worsen the disease. Is there any official source on this that can be used as a reference, and how may we include it in this article ? JMS Hunt 2020 (talk) 17:55, 14 March 2020 (UTC)JMS Hunt 2020

Can't help with that. Have come across information that Chinese figures show administration of steroids is highly correlated with bad outcomes, but no reliable source. Shtove 19:58, 15 March 2020 (UTC)

Anti-inflammatories may aggravate Covid-19, France advises - The Guardian, 2020-03-14. This might be a reason for the high CFRs in Italy due to NSAID use, and in Iran due to steroids. -- Jeandré, 2020-03-18t05:04z

This article from Global Biodefense will provide the World Health Organization's current thinking on ibuprofen, "Ibuprofen and COVID-19 Symptoms – Here’s What You Need to Know" - https://globalbiodefense.com/2020/03/19/ibuprofen-and-covid-19-symptoms-heres-what-you-need-to-know/

In part: "After initially recommending people avoid taking ibuprofen to treat symptoms of the new coronavirus disease, as of March 19 the WHO now does not recommend avoiding ibuprofen to treat COVID-19 symptoms." Thank you, Wordreader (talk) 10:56, 22 March 2020 (UTC)

Citations lacking

"This is why social distancing is so important to saving the lives of others, not just to preserving one's own healthy status. This fact falsifies the argument that a young healthy adult can simply ignore the need for social distancing, accept a mild flu-like illness, recover, and move on: the problem with that otherwise-logical plan is that the person meanwhile serves as a link in the chain of wider transmission, causing more new cases to arise elsewhere, dooming some vulnerable people who might otherwise avoid infection long enough to survive past a burnout of the epidemic."

-This passage seems judgmental and speculative to me and is lacking in direct citations. At best it should be summarizing the arguments of a published source. — Preceding unsigned comment added by 2604:2000:1382:C0C6:F562:E72:60D8:9211 (talk) 23:39, 14 March 2020 (UTC)

Have toned it down some. Doc James (talk · contribs · email) 00:16, 15 March 2020 (UTC)

Till now about 100+ in India only. Pandya101 (talk) 12:38, 15 March 2020 (UTC)

Now cross 115. Worry. God bless. Pandya101 (talk) 13:33, 16 March 2020 (UTC)

Now India cross 500. Very worry worry. God bless. I am worry very much. Pandya101 (talk) 19:21, 23 March 2020 (UTC)

Now 550 cross. less worry. Modiji save. Thank u. Pandya101 (talk) 18:24, 24 March 2020 (UTC)

Now 650 cross . Slow grow. Thank u. — Preceding unsigned comment added by Pandya101 (talk • contribs) 10:17, 26 March 2020 (UTC)

Now 900. I sick. Not know what. Worry worry. — Preceding unsigned comment added by Pandya101 (talk • contribs) 14:45, 28 March 2020 (UTC)

Concerns of citing non peer-reviewed research eg arXiv etc

While I understand that wikipedia cites both primary sources and reliable secondary sources (eg news articles), I have some concerns about manuscripts being cited that are not peer-reviewed in the context of COVID-19. Pre-print servers such as arXiv play a vital role in science but papers may not yet be peer-reviewed. The risk that if someone sees 'A study has shown this' and a citation to arXiv most reader will think this is a peer-reviewed study. I'm not saying we should remove the citations but should we state 'a non peer-reviewed study' when referring to these? Genesis12~enwiki (talk) 14:38, 18 March 2020 (UTC)

perhaps--Ozzie10aaaa (talk) 23:33, 19 March 2020 (UTC)

Given the rate and volume of new research and the urgency in disseminating new findings, there's definitely a lot of attention given to preprint papers by news outlets. I think we can take these studies on a case by case basis or just wait a week or two for a reputable journal to publish it. Wikipedia does not need to be the first to report on every study. For example the French hydroxychloroquine study was not really a study at all. In cases when we do cite a preprint paper, I agree with the importance of noting that it is preprint and "not yet peer reviewed." - Wikmoz (talk) 01:24, 24 March 2020 (UTC)

Proposed key addition to "Chloroquine and hydroxychloroquine" section

I would like to add the following important new information, which has attracted considerable public attention, especially in France, I've been asked to explain why it should be added. I consider it fair, accurate, scientifically-balanced and non-emotive. I also believe it is highly relevant to the topic and of genuine potential value. It contains numerous citations, however these have disappeared in the pasting process. There has been no suggestion from fellow editors that it is 'fake news'.

On 16 March 2020, advisor to the French Government on COVID-19, Professor Didier Raoult, announced that a trial involving 24 patients from the south east of France supported the claim that hydroxychloroquine was an effective treatment for COVID-19.[1] An amount of 600 mg of hydroxychloroquine (brand name Plaquenil) was administered to these patients every day for 10 days. The drug appeared to be responsible for a "rapid and effective speeding up of their healing process, and a sharp decrease in the amount of time they remained contagious".[2] The study also suggested that taking chloroquine in combination with the antibiotic azithromycin - which is known to be effective against complications from bacterial lung disease - led to even better outcomes.[3] Professor Raoult said the results showed there was "a spectacular reduction in the number of positive cases with the combination therapy.[4] At 6 days, among patients given combination therapy, the percentage of cases still carrying SARS-CoV-2 was no more than 5%". [5] The French Health Minister, Olivier Véran, was reported as announcing that "new tests will now go ahead in order to evaluate the results by Professor Raoult, in an attempt to independently replicate the trials and ensure the findings are scientifically robust enough, before any possible decision might be made to roll any treatment out to the wider public".[6] The French media also reported that the French pharmaceutical company Sanofi had offered French authorities millions of doses of the drug for use against COVID-19.[7] — Preceding unsigned comment added by Rhadamanthis (talk • contribs) 08:26, 19 March 2020 (UTC)

Nothing new. There already is a section on Chloroquine in the article under Research. It's been under test for months in various parts of the world. If a sound new study appears let's add that source with the essential results reported. --Gtoffoletto (talk) 08:45, 19 March 2020 (UTC)

I agree with Gtoffoletto. We already cover chloroquine in the article. We don't need so many details on early stage trials, as per WP:NOTNEWS and WP:MEDRS. Bondegezou (talk) 09:35, 19 March 2020 (UTC)

P.s. this section is being copy pasted in many other articles. The same approach probably should be applied there too Rhadamanthis--Gtoffoletto (talk) 10:21, 19 March 2020 (UTC)

I've removed a couple. Rhadamanthis: please observe WP:BRD and discuss this content here before adding all over the place. Bondegezou (talk) 10:25, 19 March 2020 (UTC)

See now also this new article as background about Didier Raoult and his IHU lab in general, and problems with this hydroxychloroquine research in particular (e.g. "the paper was peer-reviewed in less than 24h, it probably helped that the journal’s Editor-in-Chief is both the paper’s coauthor and Raoult’s IHU subordinate Jean-Marc Rolain").

I think we made the right call in removing it from this article last week. That said, the current version still highlights a different paper by Raoult, Rolain et al. from the same journal where Rolain is editor-in-chief (International Journal of Antimicrobial Agents), this time extolling the potential benefits of teicoplanin. I'm going to remove this too for now. Please discuss if you think it should be re-added.

Regards, HaeB (talk) 01:43, 28 March 2020 (UTC)

Guangdong expert consensus article on chloroquine (in Chinese)

section heading added by HaeB (talk) 01:43, 28 March 2020 (UTC)

THIS IS ON OPEN INTERNET ACCESS; google "chloroquine coronavirus" and it is #4 or #5 down as a pdf; a bit choppy as it is translated from the Chinese dated 9 days ago 3/12/2020:

[Article in Chinese, abstract available from the publisher]

zhonghua jie he he hu za zhi 2020 mar 12;43 (3): 185-188

At the end of December 2019 , a novel coronavirus (COVID-19) caused an outbreak in Wuhan, and has quickly spread to all provinces in China and 26 other countries around the world, leading to a serious situation for epidemic prevention. So far, there is still no specific medicine. Prevention studies have shown that chloroquine phosphate (chloroquine) had a wide range of antiviral effects, including anti-coronavirus. Here we found that treating the patients diagnosed as novel coronavirus pneumonia with chloroquine might improve the success rate of treatment , shorten hospital stay and improve outcome. In order to guide and regulate the use of chloroquine in patients with novel coronavirus pneumonia, the multicenter collaboration group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia developed this expert consensus after extensive discussion. It recommended chloroquine phosphate tablet, 500 mg twice per day for 10 days for patients diagnosed as mild, moderate and severe cases of novel coronavirus pneumonia and without contraindications to chloroquine.

I typed this verbatim as it appears in the release translated on the pdf.

There is substantial in vitro (lab data) implying the hydroxychloroquine related drug is as or more effective. Treatment in virtually every other disease state is initiated before severe dysfunction especially in infectious circumstances. Prospective data is forthcoming on a number of fronts but the on the ground treatments that are working in other countries should not be ignored to await confirmation when drugs with a known profile and FDA approval are available to be prescribed off label under morbid conditions. This is a morbid condition.

I wish the powers that be would emulate the Chinese and south Korean medical authorities vigorous control and treatment efforts that appear to have substantially reduced mortality among the known risk groups. — Preceding unsigned comment added by Michael plotnick (talk • contribs) 01:38, 22 March 2020 (UTC)

Can someone add tables showing CFR by Complicating Conditions

Studies of CFR often have the stats by age and by complicating conditions (comorbidity)

Adding a table from a reference already used here Twrobins (talk) 14:45, 19 March 2020 (UTC)

As of February 17, the Chinese Center for Disease Control and Prevention published a study of mainland China cases reported up to February 11th, 2020, of 72,314 people, 1023 died with an overall case fatality rate of 2.3%. Rates varied by age as follows:

Age	CFR
0-9	No deaths
10-19	.2%
20-29	.2%
30-39	.2%
40-49	.4%
50-59	1.3%
60-69	3.6%
70-79	8.0%
80+	14.8%

Rates varied by Comorbidity (Complicating Conditions) as follows:

Condition	CFR
No Comorbidity	0.9%
Cardiovascular Disease	10.5%
Diabetes	7.3%
Chronic Respiratory Disease	6.3%
Hypertension	6.0%
Cancer	5.6%

--Twrobins (talk) 14:46, 19 March 2020 (UTC)

All such figures are contextual. Those were the fatality rates then, in that context. They don't necessarily generalise. Ergo, I question how useful it is to go into this level of detail. We can usefully safe mortality is substantially elevated in the listed conditions and leave it at that. Bondegezou (talk) 15:29, 19 March 2020 (UTC)

This is already in the article in the pictures. No we do not need to duplicate it. Doc James (talk · contribs · email) 14:27, 21 March 2020 (UTC)

References

Requesting a section on Typology of patients

And for sub-section "Typology by blood group", this paragraph can be used as such: A recent study (preprint of March 16, 2020) carried out in China on different hospitals (Wuhan, Schengzen) shows that people in group A have a higher risk than the other groups, while people in group O have a lower risk than the other groups. In this study the distribution of group B and AB patients with Covid-19 is the same as in a healthy population sample. Laconis71 (talk) 02:39, 21 March 2020 (UTC)

References

 Not done There is a cultural penchant to attach far too much value to blood type. It is likely irrelevant, and that poor quality source using erroneous scientific terminology ("Normal people") does not convince me of anything else. It is not even peer reviewed and under no circumstance passes WP:MEDRS, so no: it won't be included. Carl Fredrik ^talk 05:42, 21 March 2020 (UTC)

I understand your concern about this study. However a general typology (age, sex, previous pathology, etc.) could be of some interest ? --Laconis71 (talk) 02:43, 23 March 2020 (UTC)

Adding link to COVID-19 drug repurposing research

Hi folks, I've made a page specific to the promising research direction of COVID-19 drug repurposing research. What's the best way to link it here? Thanks ProbablyAndrewKuznetsov (talk) 20:11, 21 March 2020 (UTC)

I don't see the point of a separate page and would support merging back here. The current page is less than a stub COVID-19 drug repurposing research and violates WP:MEDRS all over the place. We cover the same material here already. Bondegezou (talk) 10:41, 22 March 2020 (UTC)

WikiProject COVID-19

I've created WikiProject COVID-19 as a temporary or permanent WikiProject and invite editors to use this space for discussing ways to improve coverage of the ongoing 2019–20 coronavirus pandemic. Please bring your ideas to the project/talk page. Stay safe, ---Another Believer _(Talk) 16:38, 15 March 2020 (UTC)

thanks--Ozzie10aaaa (talk) 14:38, 21 March 2020 (UTC)

Higher incidence of digestive symptoms than previously thought

Pinging @Dekimasu and Robertpedley: -- our page currently has (in the chart) digestive symptoms at low rates -- diarrhoea 3.7%, nausea/vomiting 5%. But this is challenged by recent research on cases in Wuhan conducted from January to late February 2020, here [[3]] (in the news : [[4]]). Result summary : We found that 99 patients (48.5%) presented to the hospital with digestive symptoms as their chief complaint. Patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms (9.0 days v s. 7.3 days)... As the severity of the disease increased, digestive symptoms became more pronounced. Patients without digestive symptoms were more likely to be cured and discharged than patients with digestive symptoms (60% vs 34.3%). --Calthinus (talk) 20:32, 21 March 2020 (UTC)

I suppose I have my doubts about what I at least would call a small sample size here (N=204) and that nearly 84% had "anorexia" as a symptom... must be some typo? (As you may realize I am not an expert on gastroenterology.) But the media is reporting widely on this and seem to consider the study something worth informing the public about [[5]] [[6]] [[7]] etc. What do you guys think? Cheers, --Calthinus (talk) 20:32, 21 March 2020 (UTC)

(edit conflict) N=204 isn't too shabby right now, and as for "anorexia", it isn't anorexia nervosa, just a lack of appetite — and completely accurate terminology. However, we should still wait for this to be picked up in secondary sources before including it here. Carl Fredrik ^talk 20:38, 21 March 2020 (UTC)

The study was small and the sources are not WP:MEDRS compliant. Caution is called for. Graham Beards (talk) 20:36, 21 March 2020 (UTC)

Yeah that's why I posted here Graham. Here are some secondary reports in specifically medical/biology-focused media: Gastroenterologyadvisor [[8]] MedScape [[9]] --Calthinus (talk) 20:44, 21 March 2020 (UTC)

This is not surprising at all, the closely related original SARS coronavirus from 2002 infects the gastrointestinal tract and causes gastroenteritis. There have been laboratory tests which showed that SARS-CoV-2 can infect the small intestine and live SARS-CoV-2 virus has been recovered from the stool. Further, a large percentage of patients who have SARS-CoV-2 have positive PCR for the same virus in their stool. Plus patient presentation confirms gastroenteritis. All lines of evidence point towards this virus causing gastroenteritis and should be included in this wiki article. It is a new pandemic so we cannot follow MEDRS strictly as most information, even contained in secondary sources, is preliminary and low to medium quality. High quality data will take many months or more to emerge. We don’t have time for that as people are dying. Although obvious garbage data should be excluded, obviously. Lots of competent medical editors here to do that. Failure to include this information increases the spread of the virus via fecal-oral and respiratory to respiratory route as people will think it is not COVID-19, it is a stomach bug I have.--Literaturegeek | T@1k? 20:53, 21 March 2020 (UTC)

Agree. Anecdotal evidence but most people I know with the virus have diarrhoea as the main symptom (I'm from Milan). There are definitely several WP:MEDRS compliant sources that support this. --Gtoffoletto (talk) 01:52, 22 March 2020 (UTC)

This source reports 10.1% for diarrhoea (N=138) https://www.sciencedirect.com/science/article/pii/S0924857920300674#bib0008 --Gtoffoletto (talk) 02:14, 22 March 2020 (UTC)

Other sources reporting 10-14% https://link.springer.com/article/10.1007/s11606-020-05762-w --Gtoffoletto (talk) 02:20, 22 March 2020 (UTC)

"Clinical Characteristics of SARS-CoV-2 Infected Pneumonia with Diarrhea": 31% out of N=84 patients have diarrhea. Also reporting worse symptoms and longer duration. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3546120 --Gtoffoletto (talk) 02:33, 22 March 2020 (UTC)

I've added some of those sources to the article. Please review but I think if we only present the WHO reported symptoms from the old report we may mislead significantly: 3% vs 10-30% reported in more recent studies --Gtoffoletto (talk) 02:56, 22 March 2020 (UTC)

@Gtoffoletto what is your analysis on the literature with regard to nausea as a symptom? Here is something else I've read (disclaimer I am by no means an expert) -- this review of prior research notes more recent reports putting nausea at 10% [[10]], twice our current 5% on the table. On the other hand this study has it at 4% [[11]] (published only 10 days ago but it has now been cited 8 times at time of writing, take it as you will) -- perhaps we should convert to a range 5-10% (or 4-10%, if others deem that latter study usable?)? This is not as big a difference, but perhaps still worthwhile? Cheers, --Calthinus (talk) 04:43, 22 March 2020 (UTC)

Anything about different symptoms depending on age? Gastrointestinal symptoms seems to be more common in younger patients. Don't have time to go looking right now, but wanted to put it out there. Carl Fredrik ^talk 08:53, 22 March 2020 (UTC)

Interesting CFCF. Haven't seen anything in studies I've read. Do you have one yourself? Calthinus I've inserted a range of 3% to 31% in the article. I'm not an SME either but from experience and studies I've read this is my analysis: the studies reporting lower values (~3-4%) were tiny or very early in the epidemic (the WHO mission report data was as of 20 February 2020). More recent sources report values between 10% and 30% of patients. The symptoms might also vary depending on several factors we are not taking into account (age, gender, ethnicity, etc.). Evidence seems to point to oral-fecal transmission and the virus often infecting gastrointestinal tissues (like other similar virus). We just don't know much yet and we might be severely underestimating the prevalence of this virus among the population as many might not be considering diarrhoea a symptom to worry about. Oral-fecal transmission is probably the next topic we should add to the article. Nice study/review I just found: http://hepatmon.com/articles/102729.html --Gtoffoletto (talk) 11:43, 22 March 2020 (UTC)

Made several edits adding sources for feral-oral transmission and gastrointestinal infection. --Gtoffoletto (talk) 13:27, 22 March 2020 (UTC)

Your work looks good^, for that and for the fecal-oral transmission info you added. This is also a good review article. I'm about to fix the chart with regard to nausea and vomiting per the ranges reported in the review (1-10% for nausea, 1-7% for vomiting). Btw, sadly, I think you missed it Gtoffoletto but this one at the Lancet [[12]] is not WP:MEDRS by itself and explicitly says so more or less at the top sadly (These preprint papers are not peer-reviewed and are posted here as part of a 12-month trial... These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed).

I had another concern with the table too. Currently it doesn't make clear that "abdominal discomfort"/stomach aches/etc are a symptom (I suppose "muscle/joint pain" could cover it if it were truly "abdominal" but my layman's understanding is that the discomfort is actually coming from the GI system...no?). But many of the papers in this thread are reporting as much. Should we fix this or I have I got it wrong? Cheers, --Calthinus (talk) 16:38, 22 March 2020 (UTC)

About to revert myself. Appears it is a predatory journal (see Hepatitis Monthly). :( --Calthinus (talk) 16:47, 22 March 2020 (UTC)

User:Calthinus Hepatitis Monthly was on Beal's list but doesn't seem to be on more recent lists anymore such as http://predatoryjournals.com Nevertheless it reports several studies in the review table. We can use those directly if more appropriate. --Gtoffoletto (talk) 16:52, 22 March 2020 (UTC)

Nevermind the PUBLISHER is. Should we swap it out and keep the underlying sources? --Gtoffoletto (talk) 16:54, 22 March 2020 (UTC)

Unsure. I'd rather call for input from editors more native to the topic area who were hopefully familiar with these journals before the COVID-19 outbreak. Pinging @CFCF and Graham Beards:. Cheers, --Calthinus (talk) 17:00, 22 March 2020 (UTC)

@Doc James: has removed major references to oral-fecal and diarrhoea with no edit comment here https://en.wikipedia.org/w/index.php?title=Coronavirus_disease_2019&diff=next&oldid=946814250 is there a good reason? Gastroenterology (journal) source is preproof but should be WP:MEDRS (https://www.gastrojournal.org/article/S0016-5085(20)30281-X/pdf)and the hepatitis monthly source is a review so even if that paper is rejected we can get all the papers mentioned within. Comments? Should we reintroduce the edits? --Gtoffoletto (talk) 17:11, 22 March 2020 (UTC)

Yes I moved diarrhea into the sentence before. And the fecal oral route belongs in the body. Doc James (talk · contribs · email) 17:13, 22 March 2020 (UTC)

Ok makes sense! I missed the source had been preserved and moved to the sentence above. --Gtoffoletto (talk) 17:23, 22 March 2020 (UTC)

Overlap of Research and Experimental treatment sections

Obviously all treatment at the moment is subject to research. How do we handle those two sections? It's really messy right now. The Experimental treatment section seems a bit cleaner but contains a lot of research almost necessarily. The Research section seems really messy with random quotes and questionable sources (why is Elon Musk in there? Love the guy but I wouldn't take medical advice from him honestly) --Gtoffoletto (talk) 11:42, 18 March 2020 (UTC)

I think we need to cut down on the news stuff (WP:NOTNEWS) and focus on medical literature (WP:MEDRS). That will help us focus. Bondegezou (talk) 11:50, 18 March 2020 (UTC)

I agree. Started cleanup. --Gtoffoletto (talk) 12:22, 18 March 2020 (UTC)

I've tried moving research to the Research section, and leaving the Management section to focus on actual recommendations for treatment (even if preliminary). More clean-up still needed! Bondegezou (talk) 15:44, 18 March 2020 (UTC)

I went in hard with the final clean up. I changed the name of the "Experimental Treatment" Section to just "Treatment" so that all research can be clearly moved to the appropriate section. No treatment is confirmed yet. There is a link from "Treatment" to "Research" to guide users. See: https://en.wikipedia.org/w/index.php?title=Coronavirus_disease_2019&diff=946249848&oldid=946248777 — Preceding unsigned comment added by Gtoffoletto (talk • contribs) 00:59, 19 March 2020 (UTC)

Some of my edits had been overwritten. I've added an invisible note to clear things up. Should a link to the research section be added? Anyone know what the appropriate method to do that is? I tried a link in the diff I linked above but can't find who removed it. Maybe there was a good reason? --Gtoffoletto (talk) 09:38, 20 March 2020 (UTC)

Used the "See also" template. Doc James looks like you modified my edits. Was it because the content still contained some Experimental Treatments at the time? Is it better now? Thanks --Gtoffoletto (talk) 09:54, 20 March 2020 (UTC)

User:Gtoffoletto which edit are you referring to? We need to be careful to not present ongoing research like standard treatment and thus details on experimental belong in the research section on the treatment section. We should not be providing false hope. Doc James (talk · contribs · email) 16:15, 20 March 2020 (UTC)

Absolutely agree Doc James. Edits are right in that direction. https://en.wikipedia.org/w/index.php?title=Coronavirus_disease_2019&diff=946465332&oldid=946464043 https://en.wikipedia.org/w/index.php?title=Coronavirus_disease_2019&diff=946464043&oldid=946463891 --Gtoffoletto (talk) 18:40, 20 March 2020 (UTC)

Doc James I thought we agreed but you changed the name of the section again. Don't you think this will confuse users? There should be a treatment section ONLY for confirmed treatments (there are none right now and that's what that section should say. Pointing out that some trials are undergoing). Research and experimental treatments should go in the appropriate section below. --Gtoffoletto (talk) 13:21, 21 March 2020 (UTC)

The second is an overview of experimental treatments as there are no well supported medications.Doc James (talk · contribs · email) 14:10, 21 March 2020 (UTC)

Exactly. Therefore we agree the titles I proposed are more appropriate I think:

• Management-Treatment: Only confirmed treatments. Currently: none, research is ongoing. (see next section)
• Research: all ongoing research on any kind of treatment.

Let me know if it makes sense to you too Doc James. And I will restore the section name change --Gtoffoletto (talk) 21:49, 21 March 2020 (UTC)

There are confirmed treatments and those are supportive and symptomatic management. Are their pills? No all those are experimental Doc James (talk · contribs · email) 16:05, 22 March 2020 (UTC)

Doc James Maybe the section shouldn't be called Treatment at all? Mechanical ventilation is a form of treatment after all. Maybe it would be more appropriate to call the section "Medication"? --Gtoffoletto (talk) 14:13, 23 March 2020 (UTC)

In children

This is a new study on the disease in children. May be of use to the article. Bondegezou (talk) 15:43, 23 March 2020 (UTC)

Regarding "personal protective equipment'...

Illustrating how the equipment is donned is all well and good, but the really tricky part is removing it once it's contaminated without contaminating yourself in the process, then disposing of it properly. A bit of education and practice is required in order to do it competently. Without that knowledge, only providing an illustration of how to put the stuff on without getting it off afterwards gives false confidence to a layperson. Sad, but true, Wordreader (talk) 10:21, 22 March 2020 (UTC)

therefore what source or text would you believe best to add to article?--Ozzie10aaaa (talk) 20:56, 22 March 2020 (UTC)

BACKGROUND ---

• Don't let this happen to you; insist on training: Infection Control Today, "Whistleblower: Personal Protective Equipment Training Not Given to HHS Coronavirus Responders" - https://www.infectioncontroltoday.com/personal-protective-equipment/whistleblower-personal-protective-equipment-training-not-given-hhs-coronavirus-responders
• Society for Healthcare Epidemiology of America, "Improper Removal of Personal Protective Equipment Contaminates Health Care Workers" [About 1/3+ of the heathcare workers in this study!] - "Given the high rate of hand contamination of those who used the gloves-first strategy, the authors recommend further research and possible reconsideration of this technique, as well as research to examine the impact of improved education for putting on and taking off PPE." - https://shea-online.org/index.php/journal-news/press-room/press-release-archives/652-improper-removal-of-personal-protective-equipment-contaminates-health-care-workers

TECHNIQUES ---

• CDC removal techniques (I have used example 2 for many years). See the shea-online.org article above for comments on the gloves-off-first technique. - https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf
  
• WHO removal technique. I disagree with the head covering removal method, though. Either pull it off by grasping the outer surface while you are still gloved OR slide your cleaned hand UNDER the covering at the back of your head and slide it off touching ONLY the uncontaminated inner surface - https://www.who.int/csr/disease/ebola/remove_ppequipment.pdf
  
• Infection Control Today magazine - https://www.infectioncontroltoday.com/personal-protective-equipment/donning-and-removing-ppe-infection-prevention

KEY POINTS ---

• Once used, gloves are considered contaminated on the outside and clean on the inside. Pay STRICT attention to the CDC Removal Example 1, Step 1 instructions, linked above, so you don't inadvertently contaminate yourself. Also, see the shea-online.org article above for comments on the gloves-off-first technique
• When you remove masks and goggles, pull them AWAY from your head at the same time you pull them off, with your ELBOW UP in the air. That way, if they swing, they can't strike you in the face or your arm and contaminate you.
• All sick clients should have their own single-person use stethoscopes, blood pressure cuffs, thermometers, etc. that are kept in their room with them and discarded when the client leaves.
• The best way to develop competency is with dry-run practices using the actual equipment in front of a human observer. That's the only way to ensure that you are doing it right and not contaminating yourself - a teacher can critique your technique and tell you specifically what you're doing wrong. It's not difficult to learn this; it just takes a few practice runs.

Been there, done that....Yours, Wordreader (talk) 18:49, 23 March 2020 (UTC)

Description of the acute respiratory disease syndrome, ARDS, component of COVID-19.

"A Medical Worker Describes Terrifying Lung Failure From COVID-19 — Even in His Young Patients: “It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube.”"

From an interview with an ICU Respiratory Therapist. Vetting is explained in the side-bar. - https://www.propublica.org/article/a-medical-worker-describes--terrifying-lung-failure-from-covid19-even-in-his-young-patients

Thank you, Wordreader (talk) 11:33, 22 March 2020 (UTC)

Definitely and interesting report, I read it yesterday — however, it is not a reliable medical source for Wikipedia (WP:MEDRS-compliant). Carl Fredrik ^talk 11:37, 22 March 2020 (UTC)

Well, thank you. P37307 (talk) 21:12, 23 March 2020 (UTC)

• This ProPublica article was designed to shock a lay audience. Shocking or horrifying an audience many of whom have never been in or much less worked in a hospital ICU. The tried-and-true method used here is controlling what an audience knows about Coronavirus before experiencing this particularly grisly story so that they can then be shocked. The audience typically doesn't know too much about intubation moreover the severe outcomes for many health conditions but most of the audience probably had an instantaneous, knee-jerk reaction to this second hand tale. Not too many other facts are provided. The reporter writes that the interviewed worker's identity can't be revealed which sounds somewhat likely but the fact was probably included to make the "pink froth" story a bit more lurid. The author also implies the medical "worker" might be an MD.