WHO WILL ACCEPT US

[lvz2cruz]

1 hour ago, phoenix_dream said:

I'm honestly not trying to be a troll here, but look at what you just said.  Yes, Mexico is statistically behind the US.  But how pathetic is it that the US has only tested 2,250 per million!  That has to improve drastically before sailing can begin (not to mention other openings).  I do agree we have a better medical infrastructure and resources, but our testing remains awful.

I don't understand a need for more tests when over 90% tested are negative.

   It seems like we are covered.  

[npcl]

2 hours ago, phoenix_dream said:

I'm honestly not trying to be a troll here, but look at what you just said.  Yes, Mexico is statistically behind the US.  But how pathetic is it that the US has only tested 2,250 per million!  That has to improve drastically before sailing can begin (not to mention other openings).  I do agree we have a better medical infrastructure and resources, but our testing remains awful.

Not sure where you are getting your numbers from but as of today the US has tested 12,651 per million.  Which ironically is higher in tests per million than is indicated for South Korea (11,318).  The US has run approximately 3,795,300 tests, which is actually rather amazing to go from initial creation of tests to actually performing almost 4 million of them in around 2 months.   Other countries have run considerably more per million population, but they also have much smaller populations. For example Iceland leads the list at 128,445 per million, but its total population is only around 364,000 so it has run about 45,000 tests.

 

Testing only really makes a difference when you get the number of cases down low enough, such that whenever a case is identified, contract tracing can be performed and all of the contacts tested quickly/quarantined. Also as part of this process you also need access to rapid results.

 

Doing that successfully means a lot of labor.  Unfortunately there is a lot of focusing on testing, and very little about working on beefing up the contact tracing systems and procedures.  I have not heard of any counties that are adding and training people to their health departments for supporting contact tracing.

[MarLieb]

4 hours ago, hcat said:

 

 

3 hours ago, phoenix_dream said:

I'm honestly not trying to be a troll here, but look at what you just said.  Yes, Mexico is statistically behind the US.  But how pathetic is it that the US has only tested 2,250 per million!  That has to improve drastically before sailing can begin (not to mention other openings).  I do agree we have a better medical infrastructure and resources, but our testing remains awful.

 

I absolutely agree with you!!  No worries on trolling, LOL!  Our testing does remain awful and that is why I also wonder, who would want us right now?!  I absolutely wouldn't blame any country from shutting their borders to us until we ramp up our testing and tracing.

 

 I guess I was just trying to make the point that I don't trust Mexico's numbers and certainly would not want to travel there to embark or disembark on a cruise under our current circumstances.  We were actually supposed to travel to the Riviera Maya from March 13 - March 20, but I was afraid something would happen, one of us would get sick or we would get stuck there (they closed the border on March 21!) and I researched hospitals in that area - what I read did not instill confidence.  

[MarLieb]

1 hour ago, Tapi said:

Thank you, I’m fully aware of the travel restrictions since I work in the airline industry. I’ve flown between the US and Mexico several times during the last month.

True. The US and Mexico aren’t currently in a position to resume leisure travel or cruising. But we are not talking about today, we are talking about the future, once starts settling down. I believe that when that day does come, Mexico will be one of the first to accept cruise ships. Why? First because we share a physical border that is still semi open. Second because, even though restricted, air travel between the two countries is already in place (and believe me, more than just essential travel is occurring). That bridge hasn’t been closed. With that already in place, it seems to me that I will be much easier to open Mexico to leisure travelers than other countries. Several ports in Mexico live off tourism, more specifically the cruise industry. I’m confident that they will be eager to accept cruise ships as soon as they start sailing again. 

 

 

Totally valid points!!!  Yes, they definitely have the infrastructure to do it.  I thought you meant cruising now!!  So sorry about that.

Edited April 22, 2020 by MarLieb

[MarLieb]

26 minutes ago, npcl said:

Not sure where you are getting your numbers from but as of today the US has tested 12,651 per million.  Which ironically is higher in tests per million than is indicated for South Korea (11,318).  The US has run approximately 3,795,300 tests, which is actually rather amazing to go from initial creation of tests to actually performing almost 4 million of them in around 2 months.   Other countries have run considerably more per million population, but they also have much smaller populations. For example Iceland leads the list at 128,445 per million, but its total population is only around 364,000 so it has run about 45,000 tests.

 

Testing only really makes a difference when you get the number of cases down low enough, such that whenever a case is identified, contract tracing can be performed and all of the contacts tested quickly/quarantined. Also as part of this process you also need access to rapid results.

 

Doing that successfully means a lot of labor.  Unfortunately there is a lot of focusing on testing, and very little about working on beefing up the contact tracing systems and procedures.  I have not heard of any counties that are adding and training people to their health departments for supporting contact tracing.

 

I'm the one who initially posted the number which I got from an article published on April 1, so it must be out-of-date at this point.  Thanks for the update.

[MarLieb]

1 hour ago, lvz2cruz said:

I don't understand a need for more tests when over 90% tested are negative.

   It seems like we are covered.  

 

I think when people refer to testing they are talking about not only testing for the virus but also anti-body testing which can tell you if you've had the virus or were exposed.  I, personally, would love to be able to take an anti-body test as I believe I may have had the virus weeks ago but did not qualify for testing because, at the time, I did not fit the CDC's criteria.  

[Pushka]

US has a very low rate of testing compared with Canada, Australia, Germany and New Zealand plus many other western countries. A slow start to testing hasn't helped to flatten the curve. 

[lvz2cruz]

35 minutes ago, MarLieb said:

 

I think when people refer to testing they are talking about not only testing for the virus but also anti-body testing which can tell you if you've had the virus or were exposed.  I, personally, would love to be able to take an anti-body test as I believe I may have had the virus weeks ago but did not qualify for testing because, at the time, I did not fit the CDC's criteria.  

I agree.   I’d love to know if I had it so I could get out helping more without worrying about getting it or spreading it. 

Our state had a tornado in Nashville in March and one in Chattanooga in Easter. So many more could be out helping if they knew they were safe from covid. 

[npcl]

6 minutes ago, Pushka said:

US has a very low rate of testing compared with Canada, Australia, Germany and New Zealand plus many other western countries. A slow start to testing hasn't helped to flatten the curve. 

On the other hand the US has more tests per million than Finland, South Korea, UK, Netherlands, France, etc. Considering that South Korea is considered to be one of the countries that set the standard in Covid-19 management.

 

Testing has a place when you are at a stage where you can identify and do contact tracing.  The key to flattening the curve once you get beyond that stage is more due to distancing and other mitigation prctices.

 

Takes a bit of time to ramp up infrastructure to perform over 4 million tests, especially considering that some of the key components were not manufactured in the US when all of this started, that the US has performed to date, compared to Canada at 569,000 , Australia at 444,000,  and New Zealand at 95,000 tests.  

 

The only country anywhere close to having to find/manufacturer that many tests is German at 1.7 million tests.

[NoWhiners]

32 minutes ago, npcl said:

Takes a bit of time to ramp up infrastructure to perform over 4 million tests...

 

 Right, and that's just for 4 million tests. There are 330 million Americans and most of us will need a test, if not this instant then very soon. Testing and contact tracing will be key to us getting to the end. Yes, a vaccine would be nice but not a given. There are plenty of viruses that have no vaccine and they are much better understood. Possibly, pharmaceutical companies will find a useful form of treatment but they aren't off to a good start. Too many 'let's try this' with no science to back it up. And I worry that even if they find a treatment, it may end up being cost prohibitive.

 

I think there is a lot of uninformed speculation here, which is fine since this ins't a medical or infectious disease forum. Science, facts, and data are what is needed and until we have a better understanding of the science, we won't make much actual progress.

 

Peace.

[critterchick]

23 hours ago, BigAl94 said:

Nobody mentions the fact that it is impossible to get travel insurance with Covid 19 pandemic cover so who would risk travel without it?

 

What isn't covered is the cost of the cruise vacation - if your vacation is cancelled and a vendor refuses to refund your payment, or if you incur additional expenses trying to get home from an already-started vacation, then you won't get any reimubursement from your insurance, although you may find that they can help you get home by rebooking your flights. If you contract Covid 19, your travel insurance would kick in for medical care, evacuation, etc.

 

To me, the biggest risk is still being stuck for an indefinite period of time on a ship that can't find a port and/or being quarantined for two weeks away from home, although home quarantine seems to have become the order of the day with Coral Princess passengers who disembarked in Florida earlier this month.

[Pickels]

23 hours ago, Jim_Iain said:

While not an option on Celebrity, river cruising may be the first to open up.   I've never done one but Iain has been wanting to do one for years.

 

may try that also, but wife loves the Caribbean!

[phoenix_dream]

13 hours ago, lvz2cruz said:

I agree.   I’d love to know if I had it so I could get out helping more without worrying about getting it or spreading it. 

Our state had a tornado in Nashville in March and one in Chattanooga in Easter. So many more could be out helping if they knew they were safe from covid. 

Unfortunately, they really don't know yet if having antibodies will prevent us from catching the virus again.  Most experts believe that it will, but too early to have facts on that, sadly.

[npcl]

13 hours ago, NoWhiners said:

 

 Right, and that's just for 4 million tests. There are 330 million Americans and most of us will need a test, if not this instant then very soon. Testing and contact tracing will be key to us getting to the end. Yes, a vaccine would be nice but not a given. There are plenty of viruses that have no vaccine and they are much better understood. Possibly, pharmaceutical companies will find a useful form of treatment but they aren't off to a good start. Too many 'let's try this' with no science to back it up. And I worry that even if they find a treatment, it may end up being cost prohibitive.

 

I think there is a lot of uninformed speculation here, which is fine since this ins't a medical or infectious disease forum. Science, facts, and data are what is needed and until we have a better understanding of the science, we won't make much actual progress.

 

Peace.

Not sure where you are getting that the pharmaceutical companies are not getting off to a good start.  We are only a little over 3 months into it (the world really did not see what was coming until mid January).  In that time you have over 40 vaccine candidates, with one already in humans in phase 1 testing and with several others expected to be out of animal testing and into phase one within a couple of months.  

 

So far the therapeutics that have been tested have been existing drugs.  Not ones developed for this virus.  By my last count there are at least 120 different therapeutics that are in testing and development.

 

This is actually an totally unheard of rate of development.  Kind of the pharmaceutical equivalent to the Manhatten project.

 

To put this into perspective the normal time from the identification of a new chemical entity, to the approval of the FDA for launch into a commercial product is normally 8-10 years with 6-7 years being the normal time frame for clinical trials.

 

 

Edited April 22, 2020 by npcl

[NoWhiners]

11 minutes ago, npcl said:

Not sure where you are getting that the pharmaceutical companies are not getting off to a good start.  We are only a little over 3 months into it (the world really did not see what was coming until mid January).  In that time you have over 40 vaccine candidates, with one already in humans in phase 1 testing and with several others expected to be out of animal testing and into phase one within a couple of months.  

 

 

Here are some pertinent paragraphs from at least one story I read, I will put the link at the bottom, there are others. Activity doesn't equate to actual effectiveness.

 

"For weeks Dr. Fauci has stressed the lack of scientific evidence to back up any potential treatment, and this new document, which includes the expertise of more than a dozen federal agencies and professional groups, underscores his reasoning.

 

In a separate interview before the guidelines were released, Dr. Fauci said there were many clinical trials underway. “Right now, it is premature to say if something is going to be a home run or not,” he said. “Right now there are no early indications of a home run anywhere. There’s nothing that has been dramatic at all.”

 

Experts have collected insufficient data to recommend either for or against the use of any antiviral drug or medication that affects the immune system in patients with Covid-19 who have mild, moderate, severe or critical illness, according to the guidelines. "

 

https://www.nytimes.com/2020/04/21/health/nih-covid-19-treatment.html?action=click&module=Top%20Stories&pgtype=Homepage

 

[npcl]

13 hours ago, NoWhiners said:

 

 Right, and that's just for 4 million tests. There are 330 million Americans and most of us will need a test, if not this instant then very soon. Testing and contact tracing will be key to us getting to the end. Yes, a vaccine would be nice but not a given. There are plenty of viruses that have no vaccine and they are much better understood. Possibly, pharmaceutical companies will find a useful form of treatment but they aren't off to a good start. Too many 'let's try this' with no science to back it up. And I worry that even if they find a treatment, it may end up being cost prohibitive.

 

I think there is a lot of uninformed speculation here, which is fine since this ins't a medical or infectious disease forum. Science, facts, and data are what is needed and until we have a better understanding of the science, we won't make much actual progress.

 

Peace.

The key is first to get the number of cases down to a low enough level that contact tracing is possible.  One of the main reasons that you will not be any tourism in the near future is that to perform contact tracing you do not want people moving around between different areas.

 

The level of testing needed is not to test everyone for the illness.  The level of testing needed is to be able to get quick response on anyone showing symptoms with easy enough access, that anyone that shows any symptoms can and will get tested.  Then to follow up on any of their contacts for isolation and with testing at 3 stages, immediate, mid, and at the end of the isolation period.  Unfortunately even with testing this is a bad one that one can be infected, but still test negative, until the virus multiplies enough for the test to detect it.

 

Even then contact tracing, without distancing is difficult since it could have been picked up as far as two weeks earlier.

 

The very nature of this virus is that without a vaccine, or effective therapeutics in the tool box, even with testing, and good contact tracing, and some degree of isolation the best that will probably happen is to keep the spread down to a slow level.

 

Take a look at places that did an excellent job when the virus first broke, like Singapore and Japan.  Singapore is now getting new cases at a rate faster than during their initial outbreak.  Japan is also showing new signs of an increasing rate.

Here in the US the move to start relaxing restrictions without putting appropriate practices in place will not have a good outcome.  I would guess that in the US, outside of the couple places where they are mandatory (NY) mask use is pretty low.

[npcl]

18 minutes ago, NoWhiners said:

 

Here are some pertinent paragraphs from at least one story I read, I will put the link at the bottom, there are others. Activity doesn't equate to actual effectiveness.

 

"For weeks Dr. Fauci has stressed the lack of scientific evidence to back up any potential treatment, and this new document, which includes the expertise of more than a dozen federal agencies and professional groups, underscores his reasoning.

 

In a separate interview before the guidelines were released, Dr. Fauci said there were many clinical trials underway. “Right now, it is premature to say if something is going to be a home run or not,” he said. “Right now there are no early indications of a home run anywhere. There’s nothing that has been dramatic at all.”

 

Experts have collected insufficient data to recommend either for or against the use of any antiviral drug or medication that affects the immune system in patients with Covid-19 who have mild, moderate, severe or critical illness, according to the guidelines. "

 

https://www.nytimes.com/2020/04/21/health/nih-covid-19-treatment.html?action=click&module=Top%20Stories&pgtype=Homepage

 

What Fauci is saying is very simply that the clinical trials must be completed prior to a decision is made about any treatments.

 

That is exactly what the industry is doing now.  That takes time.  The industry is compressing what is normally a 10 year process into what hopefully will be a 1-2 year process.

 

In the mean time some of those efforts are testing ANY existing drug that either might be of benefit in treating the worst of the symptoms such as Kevzara which would be to limit the cytokine storm which is actually what causes the massive inflammation that does much of the damage, as well as the various antivirals, one of the most promising is a drug approved in Japan Avigan (Favipiravir) which has completed one clinical trial in China and which has clinical trials underway in Japan.  This testing process involve in vitro, animal models, the human trials.  Those that have been previously approved get to skip phase one (safety profile is already known) and go immediately into phase two trials.  That is what is taking place now.

 

Any that show effectiveness and a good risk/benefit profile based upon the result of those trials will then be added to the tool box for treating while waiting for the new, targeted therapeutics, as well as the vaccines to get developed and tested.

 

One thing that does make things look like the wild west is that if a drug is approved, individual doctors can and will decide to use it off label, for unapproved uses.  That is what is happening in many cases. 

Edited April 22, 2020 by npcl

[Pushka]

5 hours ago, npcl said:

 

 

To put this into perspective the normal time from the identification of a new chemical entity, to the approval of the FDA for launch into a commercial product is normally 8-10 years with 6-7 years being the normal time frame for clinical trials.

 

 

One thing that may cut short that approval process is if they are going to repurpose a drug that is already approved for medical treatments in other situations and has a history of being safe. Similarly with an immunisation - eg there is a trial of BCG (tuberculosis vaccine) being trialled amongst medical workers in our state and which is known as a safe vaccine just repurposed. 
 

This virus attacks different people in different ways - some clot so causes heart attacks, some have extreme Immune responses that butcher the lungs, so it's likely that in a clinical trial many treatments just may not show up as a good treatment but may in fact work on an individual basis. 
 

Im currently on Hydroxychloroquine for auto immune issues and a blood thinner for associated clotting issues. Likely I will get hit by a bus!

 

in Australia the curve began to  flatten within a couple of weeks. Less than 80 deaths country wide. We tested vigorously from the get go. I think we have one of the highest testing rate per population in the world. Now we just have to keep it that way. Our borders were halted almost a month ago. Cruise ships sadly figure very prominently in our deaths from Covid. Something like 30%. 

Edited April 22, 2020 by Pushka

[npcl]

25 minutes ago, Pushka said:

One thing that may cut short that approval process is if they are going to repurpose a drug that is already approved for medical treatments in other situations and has a history of being safe. Similarly with an immunisation - eg there is a trial of BCG (tuberculosis vaccine) being trialled amongst medical workers in our state and which is known as a safe vaccine just repurposed. 
 

This virus attacks different people in different ways - some clot so causes heart attacks, some have extreme Immune responses that butcher the lungs, so it's likely that in a clinical trial many treatments just may not show up as a good treatment but may in fact work on an individual basis. 
 

Im currently on Hydroxychloroquine for auto immune issues and a blood thinner for associated clotting issues. Likely I will get hit by a bus!

 

in Australia the curve began to  flatten within a couple of weeks. Less than 80 deaths country wide. We tested vigorously from the get go. I think we have one of the highest testing rate per population in the world. Now we just have to keep it that way. Our borders were halted almost a month ago. Cruise ships sadly figure very prominently in our deaths from Covid. Something like 30%. 

Australia is around 17,743 per million (33 on the list)  about 36% higher than the US rate (42 on the list)  at 13,045 per million but pretty far below the leaders such Iceland at 130,312 per million.  Germany (20 on the list) which has a larger population is at 24,738 per million.

 

Australia has a couple of advantages.  First no land borders, second the relative density of population, and most important they moved quickly and aggressively to cut off travelers from the outside.  If they are smart they will continue the restrictions on travelers to/from the country  for an extended period of time, until an effective therapy or vaccine exists.

 

 

[UnorigionalName]

5 hours ago, npcl said:

Not sure where you are getting that the pharmaceutical companies are not getting off to a good start.  We are only a little over 3 months into it (the world really did not see what was coming until mid January).  In that time you have over 40 vaccine candidates, with one already in humans in phase 1 testing and with several others expected to be out of animal testing and into phase one within a couple of months.  

 

So far the therapeutics that have been tested have been existing drugs.  Not ones developed for this virus.  By my last count there are at least 120 different therapeutics that are in testing and development.

 

This is actually an totally unheard of rate of development.  Kind of the pharmaceutical equivalent to the Manhatten project.

 

To put this into perspective the normal time from the identification of a new chemical entity, to the approval of the FDA for launch into a commercial product is normally 8-10 years with 6-7 years being the normal time frame for clinical trials.

 

 

 

2 currently in the US in Phase 1.  Second is similar to the first, but DNA vaccine instead of RNA.

 

Internationally i think 6 started trials, tons want to start:

https://www.the-scientist.com/news-opinion/covid-19-vaccine-frontrunners-67382

Edited April 22, 2020 by UnorigionalName

[Pushka]

49 minutes ago, npcl said:

 

Australia has a couple of advantages.  First no land borders, second the relative density of population, and most important they moved quickly and aggressively to cut off travelers from the outside.  If they are smart they will continue the restrictions on travelers to/from the country  for an extended period of time, until an effective therapy or vaccine exists.

In the middle of March when we ramped our borders and controls our testing per 100,000 was ranked 10th in the world. Once we closed the borders and the impact of Ruby died down about 2 weeks ago the tests have been opened up for anyone even with a mild cold. This was designed to assess unknown illness in the community eg amongst young and mild symptom people. Weirdly the rate of positive detections dropped further. We have little community spread - it was all brought in from overseas and with strict isolation in quarantine facilities that has seemingly put it to remission. 

I think that our island situation is very likely to be true. NZ is similar but their restrictions have been extremely (too) high. We are lucky we have no land borders. And a good PM (head of Australia) although some local Premiers and Health Departments monumentally screwed up (NSW - Ruby Princess - 19 deaths and 700 infections) and the other states continue to remind them of that mess. Whenever a restriction is announced it is prefaced "we don't want another Ruby Princess on our hands" and straight away everyone understands the restrictions. 

In our state our schools never closed, shops could remain open as long as they socially distanced and whilst many worked from home, others if safe, could work. Our beaches never closed. Restaurants and cafes could only have takeaway food. 

 

Edited April 22, 2020 by Pushka

[ipeeinthepool]

More testing is important but if you listen carefully to Dr Fauci, testing everyone for the active virus doesn't really accomplish anything.  If you take a test today and it is negative for the virus that only means your negative at the instant you took the test.   You can easily walk out the door and get infected.  What is important is to test anyone with flu-like symptoms and isolate and trace the contacts of anyone with a positive result.  In addition you can have an impact if you test anyone in a vulnerable community like a nursing home.

 

Hopefully anyone that has contracted the virus will have some long term immunity.  If that turns out to be the case, then antibody testing will offer some additional freedoms to re-enter the community with the worry of contracting the virus.  In that case widespread antibody testing can be useful.

 

It's not clear to me when Australia, NZ or any other island nation that doesn't have community spread of the Covid-19 virus will allow cruise ships to visit their countries. 

[Pushka]

1 hour ago, ipeeinthepool said:

More testing is important but if you listen carefully to Dr Fauci, testing everyone for the active virus doesn't really accomplish anything.  If you take a test today and it is negative for the virus that only means your negative at the instant you took the test.   You can easily walk out the door and get infected.  What is important is to test anyone with flu-like symptoms and isolate and trace the contacts of anyone with a positive result.  In addition you can have an impact if you test anyone in a vulnerable community like a nursing home.

 

Hopefully anyone that has contracted the virus will have some long term immunity.  If that turns out to be the case, then antibody testing will offer some additional freedoms to re-enter the community with the worry of contracting the virus.  In that case widespread antibody testing can be useful.

 

It's not clear to me when Australia, NZ or any other island nation that doesn't have community spread of the Covid-19 virus will allow cruise ships to visit their countries. 

And for Australia and NZ test test test has been a key. Identify isolate. Flatten the curve. I don't think Dr Fauci gets a gig here. 

Edited April 23, 2020 by Pushka