PRINCESS SHIPS & CORONA VIRUS

[fountainpen]

13 hours ago, Cairn Mom said:

https://www.thestandard.com.hk/breaking-news/section/4/141062/Two-more-preliminary-positive-cases-for-coronavirus
The cruise passenger was on the 1/17 sailing of the Diamond Princess. He potentially infected all the passengers and crew on his sailing. He went to the buffet, stood in crowded elevators and went to shows.Think about these people. Hopefully Princess contacted them and gave their names to the appropriate health authorities so the could be monitored, They are still in the incubation period. They were in all sorts of public places and visiting with family and friends. They may, unknowingly,have infected thousands of other people. 

From various reports,here is the timeline:

Jan 10 from HK to China few hours is cross border shopping.Return to HK

Jan 15 or Jan 19 developed cough,take your pick,who doesn't have a slight cough in winter sometimes.

Jan 17 fly from  HK to Tokyo then pre cruise tour

Jan 20 boarded Diamond Princess.Never saw MD.(the Standard article is wrong where it put the date as 21)

Jan 25 disembark ed HK along with approx 200 other passengers,including the famous radio celebrity To Kit and at least another journalist.

Jan 30 sicker hospitalised.Confirmed new SARs Feb 1.

Now Princess can say he acquired the virus in HK after he disembark ed.Everything can be swept under the carpet.My Carnival shares would be OK.

Or they can adhere to science and say there is a high possibility that it was acquired on the 10th,he was a low or a symptomatic carrier on board. What would you pick as the medical advisor to Princess?

Edited February 3, 2020 by fountainpen

[marci22]

22 minutes ago, fountainpen said:

Now Princess can say he acquired the virus in HK after he disembark ed.Everything can be swept under the carpet.My Carnival shares would be OK.

Or they can adhere to science and say there is a high possibility that it was acquired on the 10th,he was a low or a symptomatic carrier on board. What would you pick as the medical advisor to Princess?

https://www.nasdaq.com/articles/japan-to-quarantine-cruise-ship-on-which-virus-patient-sailed-2020-02-03

[milolii]

10 minutes ago, marci22 said:

https://www.nasdaq.com/articles/japan-to-quarantine-cruise-ship-on-which-virus-patient-sailed-2020-02-03

I wish the passengers, crew and that patient well.  Others must be in transit or waiting for an assume embarkation tomorrow. 

[fountainpen]

more details:

 

https://english.kyodonews.net/news/2020/02/084cd1b786d8-abe-says-japan-developing-rapid-test-kit-for-new-coronavirus.html

After the ship -- which can carry about 2,700 passengers and 1,100 crew members -- arrived at the port of Yokohama on Monday evening, a passenger told Kyodo News that it was announced the planned departure time from Yokohama would be delayed for 24 hours.

wow

Edited February 3, 2020 by fountainpen

[Steelers36]

16 hours ago, Cairn Mom said:

He potentially infected all the passengers and crew on his sailing.

Seems a little far-fetched, but he surely may have passed on the virus.  Transmission is supposed to be via "intimate" or "close" contact I believe I have read.

 

https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html

 

[chankahon]

13 minutes ago, Steelers36 said:

Seems a little far-fetched, but he surely may have passed on the virus.  Transmission is supposed to be via "intimate" or "close" contact I believe I have read.

 

https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html

 

 

Traces of virus have been found in feces samples from patients in Macau and Shenzhen:

https://www.scmp.com/news/china/politics/article/3048611/coronavirus-scientists-identify-possible-new-mode-transmission

 

This actually is consistent with the pattern observed in the SARS coronavirus, which spread across a housing estate through drainage pipelines. 

 

But again the Hong Kong man is more likely to have caught the virus in Hong Kong post-disembarkation. Media reports suggest a vast majority of those onboard are from Japan. If he got the virus on the ship, it could indicate a local outbreak was already underway in Japan prior to Jan 20.

Edited February 3, 2020 by chankahon

[Steelers36]

4 minutes ago, chankahon said:

 

Traces of virus have been found in feces samples from patients in Macau and Shenzhen:

https://www.scmp.com/news/china/politics/article/3048611/coronavirus-scientists-identify-possible-new-mode-transmission

 

This actually is consistent with the pattern observed in the SARS coronavirus, which spread across a housing estate through drainage pipelines. 

 

But again the Hong Kong man is more likely to have caught the virus in Hong Kong post-disembarkation. Media reports suggest a vast majority of those onboard are from Japan. If he got the virus on the ship, it could indicate a local outbreak was already underway in Japan prior to Jan 20.

Sure, but I was just making a point that he was unlikely to have infected ALL crew and passengers.  No more than someone passing through an airport is unlikely to infect everyone in the airport terminal.

[mcrcruiser]

41 minutes ago, Steelers36 said:

Sure, but I was just making a point that he was unlikely to have infected ALL crew and passengers.  No more than someone passing through an airport is unlikely to infect everyone in the airport terminal.

The problem is that  cruise ships are very much  inclosed  & infections can more readily spread in that kind of environment  .This is why the CDC requires cruise ships to report Noro  if it impacts 2.5% of total pax including the workers or greater ,on any ship 

[npcl]

1 hour ago, Steelers36 said:

Seems a little far-fetched, but he surely may have passed on the virus.  Transmission is supposed to be via "intimate" or "close" contact I believe I have read.

 

https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html

 

Corona transmission is via both the lungs (coughing, sneezing like the flu) and fecal routes ( such an noro) no intimate contact required. Can be passed by breathing in airborne particles as well as surface contact transfer (hand to mouth) so to speak.

[npcl]

1 hour ago, chankahon said:

 

Traces of virus have been found in feces samples from patients in Macau and Shenzhen:

https://www.scmp.com/news/china/politics/article/3048611/coronavirus-scientists-identify-possible-new-mode-transmission

 

This actually is consistent with the pattern observed in the SARS coronavirus, which spread across a housing estate through drainage pipelines. 

 

But again the Hong Kong man is more likely to have caught the virus in Hong Kong post-disembarkation. Media reports suggest a vast majority of those onboard are from Japan. If he got the virus on the ship, it could indicate a local outbreak was already underway in Japan prior to Jan 20.

considering the up to 14 day incubation time and the fact that the cruise ended 6 days before the diagnoses make it unlikely he contracted after the cruise.

[kearney]

On 2/1/2020 at 9:57 PM, npcl said:

 

 

Not sure where you are getting your information from.  But the medical community is  trying to use antiviral compounds that are used for HIV, as well as others that were somewhat effective for SARS to try and treat Corona, but do not have any real measure of effectiveness of any of those compounds. 

The labs that developed vaccines for SARS are also planning to test them to see if they have any effectiveness in helping with immune response for Corona, but I have not see anything that indicates that the Corona outbreak consists of more than one virus.  China released the genetic code back on January 10.

 

From the Lancet the genome characterization.

 

The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic analysis revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homology modelling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues.

 

Would be interested in seeing any references that indicates any relationship in the genome to HIV and for that matter SARS other then Corona viruses as a class are considered to be SARS like.

I am not a scientist... but I think the paper that caused all the HIV discussion is the one attached. I think it has not actually been published and there seems to be some discussion challenging it... but I thought you might be able to understand and perhaps translate....  Indian paper making the rounds on twitter

[mcrcruiser]

18 minutes ago, kearney said:

I am not a scientist... but I think the paper that caused all the HIV discussion is the one attached. I think it has not actually been published and there seems to be some discussion challenging it... but I thought you might be able to understand and perhaps translate....  Indian paper making the rounds on twitter

Wow highly technical  & yes needs a translation into  easy to read sentences 

[voljeep]

 … 🦄

Edited February 3, 2020 by voljeep

[fountainpen]

1 hour ago, mcrcruiser said:

Wow highly technical  & yes needs a translation into  easy to read sentences 

in any case whoever wants to try it so soon will likely be a guinea pig in humanoid form, unless ones dying and there is no alternatives.

That is why  new medicine or trials are usually available earlier in less developed countries first to see whether it works and it works without major sideeffects. Dead or iatrogenicically harmed patients in third world countries  are less likely to sue the pharmaceutical companies.

Edited February 3, 2020 by fountainpen

[npcl]

1 hour ago, kearney said:

I am not a scientist... but I think the paper that caused all the HIV discussion is the one attached. I think it has not actually been published and there seems to be some discussion challenging it... but I thought you might be able to understand and perhaps translate....  Indian paper making the rounds on twitter

Interesting.  It does show similarities in 4 groups.  Unclear if it is a case of viral genetic swapping or if it is a case of mutation that explains its affinity for humans.  Viruses that are contagious in humans that activate specific cell receptors tend to have structural similarities. Since both have jumped from animals to humans. 

 

 Will run a check of grateful med and see if there are any other papers in this area.

[npcl]

17 minutes ago, fountainpen said:

in any case whoever wants to try it so soon will likely be a guinea pig in humanoid form, unless ones dying and there is no alternatives.

That is why  new medicine or trials are usually available earlier in less developed countries first to see whether it works and it works without major sideeffects. Dead or iatrogenicically harmed patients in third world countries  are less likely to sue the pharmaceutical companies.

Not really.  You do have studies conducted in 3rd world countries, but that is because the studies go where there are patients are.  All studies done by pharmaceutical companies that ever want approval in the US, Europe, Japan, Canada or trials done under the auspices of WHO must follow ethical standards. Not sure about companies that are strictly in some small third world countries but even in those places I would expect ethical standards to be followed.  Even with Ebola in Africa those standards were met.  You will see some drugs that are approved for trials in humans sometimes tried in the case of severe outbreaks, but not a drug that has not gone through the necessary research steps to get an investigatory new drug (IND) submitted and approved by a regulatory authority.

 

For example Gilead is now trying one of its investigatory anti viral drugs in China to see if it works.  Apparently it was tried in one patient and that patient quickly responded so additional testing is being conducted. The Gilead drug, Remdesivir, was actual one that was developed for Ebola, but failed to be effective in that disease.  Will be interesting to see if it works.

[fragilek]

31 minutes ago, fountainpen said:

in any case whoever wants to try it so soon will likely be a guinea pig in humanoid form, unless ones dying and there is no alternatives.

That is why  new medicine or trials are usually available earlier in less developed countries first to see whether it works and it works without major sideeffects. Dead or iatrogenicically harmed patients in third world countries  are less likely to sue the pharmaceutical companies.

Not true - I am someone who filed the CMC section for clinical trials, worked on the EU clinical trails directive  and  filed drugs Drug product and Drug substance  requirements for FDA/MAA approval.  I can assure you trials are run (and have to be run) in many countries.

 

I am also someone whose life has been saved by being lucky enough to be ramdomised on a clinical trial to get the trial drug as apposed to the standard therapy for Leukemia as I wasn't given much chance if I had drawn that. PS the trial was being run in the UK and in the US.

[tk2fast]

Global cases by Johns Hopkins:

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

[fountainpen]

19 minutes ago, fragilek said:

Not true - I am someone who filed the CMC section for clinical trials, worked on the EU clinical trails directive  and  filed drugs Drug product and Drug substance  requirements for FDA/MAA approval.  I can assure you trials are run (and have to be run) in many countries.

 

I am also someone whose life has been saved by being lucky enough to be ramdomised on a clinical trial to get the trial drug as apposed to the standard therapy for Leukemia as I wasn't given much chance if I had drawn that. PS the trial was being run in the UK and in the US.

as a retired medical personnel, I can tell you that many times a drug is approved/available for use in Hk/UK prior to the USA eg ventolin

Edited February 3, 2020 by fountainpen

[fragilek]

S

12 minutes ago, fountainpen said:

as a retired medical personnel, I can tell you that many times a drug is approved/available for use in Hk/UK prior to the USA eg ventolin

 Yip your correct  sometimes it is but sometimes it is EU route first (used to be UK via MAA who knows what after Brexit it may be that again) sometimes USA then Canada  and nearly always Jap last.   Sometimes a drug will only be agreed in one of the regions  But that does not dictate where the trial are held so don't get your post.

[fountainpen]

19 minutes ago, fragilek said:

S

 Yip your correct  sometimes it is but sometimes it is EU route first (used to be UK via MAA who knows what after Brexit it may be that again) sometimes USA then Canada  and nearly always Jap last.   Sometimes a drug will only be agreed in one of the regions  But that does not dictate where the trial are held so don't get your post.

What I am saying is your phase II/III trial drug may have worked for you , but I have seen many failures in patients who did this kind of thing and even some FDA approved drugs eg 

Thiazolidinedione

that were later withdrawn due to side-effects. Newspaper always put sensational drug as headline as if they are approved and proven to work already. Caution is required.

Edited February 3, 2020 by fountainpen

[npcl]

16 minutes ago, fountainpen said:

as a retired medical personnel, I can tell you that many times a drug is approved/available for use in Hk/UK prior to the USA eg ventolin

Sometimes yes.  That is because each country has its drug approval process.  For example thalidomide was approved in Europe, but not approved in the US.

 

Some companies will file in the EU prior than filing in depending upon how long that they expect it take for approval.  There are some classes of drug that Europe or other countries will approve, but the US FDA will not.  In general though most companies will file in the US first, establish a price, then go for approval in Europe, followed by Canada.  The price controls they do not want the Canadian price being factored into the EU price control equation.  Also a lot depends upon the size of the market. You also have difference in medical practice for example various morphine forms (inhaled for example) are approved and available in Canada and Australia but not in the US.

 

When I last was part of the ICH (International Conference on Harmonization) an organization consisting of the EU, US FDA, Japanese MHW, JPMA, PHRMA, and IPMA with the WHO and HPB Canada as observers, the EU was launching an investigation in why they were getting fewer new drug applications and those they were getting were well after US filings.

 

However, the approval sequence and process does not impact the need for ethical drug testing, which is what you implied that companies were bypassing by trial selection.

[fragilek]

5 minutes ago, fountainpen said:

What I am saying is your phase II/III trial drug may have worked for you , but I have seen many failures in patients who did this and even some FDA approved drugs that were later withdrawn due to side-effects. Newspaper always put sensational drug as headline as if they are approved and proven to work already.

That's the whole point of phase II.  I do agree that the tabloids have a lot to answer for when it comes to reporting many things, including future drugs.  As you will know most target molecules don't even make it through to Phase II never mind through to the end of Phase III. - However, I don't know the stats for vaccines as I was never involved in that area of research.

Edited February 3, 2020 by fragilek

[fountainpen]

6 minutes ago, npcl said:

Sometimes yes.  That is because each country has its drug approval process.  For example thalidomide was approved in Europe, but not approved in the US.

 

Some companies will file in the EU prior than filing in depending upon how long that they expect it take for approval.  There are some classes of drug that Europe or other countries will approve, but the US FDA will not.  In general though most companies will file in the US first, establish a price, then go for approval in Europe, followed by Canada.  The price controls they do not want the Canadian price being factored into the EU price control equation.  Also a lot depends upon the size of the market. You also have difference in medical practice for example various morphine forms (inhaled for example) are approved and available in Canada and Australia but not in the US.

 

When I last was part of the ICH (International Conference on Harmonization) an organization consisting of the EU, US FDA, Japanese MHW, JPMA, PHRMA, and IPMA with the WHO and HPB Canada as observers, the EU was launching an investigation in why they were getting fewer new drug applications and those they were getting were well after US filings.

 

However, the approval sequence and process does not impact the need for ethical drug testing, which is what you implied that companies were bypassing by trial selection.

from Wiki Salbutamol was patented in 1966, in Britain and became commercially available in the UK in 1969.^[10][11] It was approved for medical use in the United States in 1982.^[6] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.^[12] Salbutamol is available as a generic medication.^[6] The wholesale cost in the developing world of an inhaler which contains 200 doses is between US$1.12 and US$2.64 as of 2014.^[13] In the United States, it is between US$25 and US$50 for a typical month's supply.^[14] In 2016, it was the 10th most prescribed medication in the United States, with more than 47 million prescriptions.^[15]

[npcl]

14 minutes ago, fountainpen said:

What I am saying is your phase II/III trial drug may have worked for you , but I have seen many failures in patients who did this kind of thing and even some FDA approved drugs eg 

Thiazolidinedione

that were later withdrawn due to side-effects. Newspaper always put sensational drug as headline as if they are approved and proven to work already. Caution is required.

Drug approval always has trade offs.  There is always a risk benefit calculation.  Sometimes drugs are approved with specific instructions and limits (i.e. black box warning) only to find that actual use differences from the approval criteria.  Sometimes a drug will be removed, if a better choice becomes available.  

 

It is the reason why there are phase 4 clinical testing requirements for some approvals, and also why the drug approval agencies have adverse reporting systems.

 

Again not sure why an example of the systems working like they should, adverse event reporting resulting in drugs being pulled (though very few) and additional warnings being issued  compare to your earlier implications about companies not following ethical testing

 

Since you seem to be making a big thing about the Thiazolidinedione class, Rosaglitizone, which was the largest drug of that class was put under restrictions and withdrawn from the EU market due to some indications that it might lead to increased cardiac events.  However, after additional data was collected and reviewed those restrictions were removed in the US. 

 

 

Edited February 3, 2020 by npcl