All available evidence, and the history of coronaviruses jumping to humans, indicate that it popped out of an exotic animal market.

Actually, that's very unlikely. Remember that the virus in the outbreak was unidentified until researchers sequenced the genome for the first time. Unless you believe that Chinese researchers had been working with what came to be called 2019-nCoV but not sharing with fellow researchers around the world with whom they are in regular and routine contact, there's no reason to think it has been seen before this outbreak. That sort of secrecy is pretty much limited to biowarfare research and, as you point out, this coronavirus, or any of its known relatives, would make a really poor weapon.

Of course, the virus is now being grown in cell cultures in any number of labs, so escape is definitely possible. But the people who do this work are skilled and careful.

Government response certainly didn't help, but the combination of transmissibility and latency period probably means that the outbreak was unstoppable by the time anyone really understood what was happening.

Anybody have information on any link between 2019-nCoV and "cytokine storms"? I'd sort of assumed there would be,
but the high average age of the fatalities suggest not.

https://www.scripps.edu/news-and-eve...tonerosen.html
A cytokine storm is an overproduction of immune cells and their activating compounds (cytokines), which, in a flu infection, is often
associated with a surge of activated immune cells into the lungs. The resulting lung inflammation and fluid buildup can lead to
respiratory distress and can be contaminated by a secondary bacterial pneumonia—often enhancing the mortality in patients.

This little-understood phenomenon is thought to occur in at least several types of infections and autoimmune conditions, but it
appears to be particularly relevant in outbreaks of new flu variants. Cytokine storm is now seen as a likely major cause of mortality
in the 1918-20 “Spanish flu”—which killed more than 50 million people worldwide—and the H1N1 “swine flu” and H5N1“bird flu” of
recent years. In these epidemics, the patients most likely to die were relatively young adults with apparently strong immune
reactions to the infection—whereas ordinary seasonal flu epidemics disproportionately affect the very young and the elderly.

Your assumption was on-target. Most investigation to date indicates cytokine storms developing in many/most COVID-19 (WHO's new official name for the disease caused by 2019-nCoV) cases that become fatal.

Knowing that may not be all that useful in a clinical sense, because there aren't really any good, established ways to deal with cytokine storms.

I don't think the fact that the fatalities are typically in older patients argues against the relationship. Remember, cytokine storms are explosive but ineffective immune responses that develop in later-stage illness.

A Google search for "coronavirus cytokine storm" will return many of the most useful results. This Lancet brief and the papers cited in it is a good place to start and has been widely cited in the short time since publication: https://www.thelancet.com/journals/l...305-6/fulltext

[QUOTE=Peter H;10687677]Anybody have information on any link between 2019-nCoV and "cytokine storms"? I'd sort of assumed there would be,
but the high average age of the fatalities suggest not.

Chinese doctors suggest that the cytokine storm is a consequence of oxygen starvation and consequent cell death in the lungs. Essentially, the body's clean up ,squad working overtime, if I understand it correctly.
Their focus is to ensure adequate oxygenation of the patient, even by forced oxygen ventilation, with the hope that eventually the victim recovers. Absent a drug option, this kind of supportive treatment is all that is available.
Hence the efforts to use the blood plasma of recovered patients as well as experimental drugs such as remdesivir, we are groping in the dark.

I wonder how many mechanical ventilators are available per 100K population. I couldn't find a number for China in a quick search but the median for the US, per a National Institutes of Health study about a decade ago, was under 20.

[QUOTE=etudiant;10687703][QUOTE=Peter H;10687677]

Chinese doctors suggest that the cytokine storm is a consequence of oxygen starvation and consequent cell death in the lungs. Essentially, the body's clean up ,squad working overtime, if I understand it correctly.
Their focus is to ensure adequate oxygenation of the patient, even by forced oxygen ventilation, with the hope that eventually the victim recovers. Absent a drug option, this kind of supportive treatment is all that is available.
.../QUOTE]

What equipment are well financed “preppers” gathering?

Cylinders of 02?

mjb

Excellent article on current state of COVID-19, symptoms, course of infection, mortality, treatment (this is brand new), and possible vaccination. Not paywalled.

Excellent article. Shame about the source.

That is perhaps the least of our worries if the virus is not arrested.
There is no large scale domestic production capacity for even basics such as face masks or medications, much less a surge potential or a national stockpile. Most of that supply is now sourced from lower cost areas such as China or India.
So the US and Europe would be no better off than China in terms of dealing with this outbreak if it continues to build. Thus far, we have the reported number of victims still rising on a weekly doubling pace outside of China. That is very troubling.
At this rate, we are headed for a very different and less well connected world.

WHY?

Excellent article.

Interesting statistics:

• ACE2 expression has a relationship to the SARS CoV2 corona virus causing Covid-19.
• A significant positive correlation exists between ACE2 and smoking.
• PRC Doctor smoking stats are similar to the overall smoking stats for the general PRC population.

Reference:

[1] Cai, G. Tobacco-Use Disparity in Gene Expression of ACE2, the Receptor of 2019-nCov. Preprints2020, 2020020051 (doi: 10.20944/preprints202002.0051.v1).

[2] Haga S, Yamamoto N, Nakai-Murakami C, Osawa Y, Tokunaga K, Sata T, Yamamoto N, Sasazuki T, Ishizaka Y (2008) Modulation of TNF-alpha-converting enzyme by the spike protein of SARS-CoV and ACE2 induces TNF-alpha production and facilitates viral entry. Proc Natl Acad Sci USA 105:7809–7814

[3] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. https://doi.org/10.1016/S0140-6736(20)30183-5

[4] Jia HP, Look DC, Tan P, Shi L, Hickey M, Gakhar L, Chappell MC, Wohlford-Lenane C, McCray PB Jr (2009) Ectodomain shedding of angiotensin converting enzyme 2 in human airway epithelia. Am J Physiol Lung Cell Mol Physiol 297:L84–L96

[5] Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, Huan Y, Yang P, Zhang Y, Deng W et al (2005) A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med 11:875–879

[6] Oakes, J. M., Fuchs, R. M., Gardner, J. D., Lazartigues, E., & Yue, X. (2018). Nicotine and the renin-angiotensin system. American journal of physiology. Regulatory, integrative and comparative physiology, 315(5), R895–R906. https://doi.org/10.1152/ajpregu.00099.2018

[7] Parascandola, M., & Xiao, L. (2019). Tobacco and the lung cancer epidemic in China. Translational lung cancer research, 8(Suppl 1), S21–S30. https://doi.org/10.21037/tlcr.2019.03.12

[8] Smith, D. R., Zhao, I., & Wang, L. (2012). Tobacco smoking among doctors in mainland China: a study from Shandong province and review of the literature. Tobacco induced diseases, 10(1), 14. https://doi.org/10.1186/1617-9625-10-14

[9] Yao, T., Ong, M., Lee, A., Jiang, Y., & Mao, Z. (2009). Smoking knowledge, attitudes, behavior, and associated factors among Chinese male surgeons. World journal of surgery, 33(5), 910–917. https://doi.org/10.1007/s00268-009-9938-0

[10] Yilin, Z., Yandong, N., Faguang, J., (2015) Role of angiotensin-converting enzyme (ACE) and ACE2 in a rat model of smoke inhalation induced acute respiratory distress syndrome. NCBI. Burns. 2015 Nov;41(7):1468-77. doi: 10.1016/j.burns.2015.04.010. Epub 2015 May 14

Chart 2

https://cimg1.ibsrv.net/gimg/pprune....dbfc045be7.png



Prevalence of smoking for males in the Asia Pacific region in 2016

https://cimg8.ibsrv.net/gimg/pprune....5f4c4b0f9e.png

1st laugh of the day

Do I have to draw you a map? It's a climate change denial website. Run by an ex-T.V. weatherman with an apparent idealogical axe to grind. And as such would be overlooked by the majority of thinking people. That’s why I wrote “shame about the source”.

Odds and Ends update
 

1523 people dead from Covic-19 in China as of Friday. 143 died during the day.

300 odd US pax to be evacuated from the Diamond Princess at Yokohama. 67 fresh cases there yesterday and 286 total now (CNN)

Second doctor in Japan tested positive. A man in Japan positive - had been on a trip to Hawaii but not to China.

mods: time to change the thread title?
 

Thanks to all who replied about cytokine storms.

I asked because I vaguely remember a SARS related article that talked about the use drugs to dampen this misplaced immune response.
In particular the repurposing of already-approved off-the-shelf drugs. Although I've seen mention of -- often new -- anti-virals I've not seen
mention of anti-immune-response ones. (Maybe because it's so old-hat that it's not worth mentioning.)

PS Re the query about the origin of the virus, I've seen suggestions that the virus may have originated in bats (cf Elboa?).
As a thread search for bats was unsuccessful, here's a quickly-chosen ref:
https://www.businessinsider.com/wuha...20-1?r=US&IR=T

For more than you want to know, see Flutrackers.com. It provides links to most aspects of the outbreak, including links to the health measures attempted as well as the virus research.

The virus is very transmissible, as evidenced by a case in China where 2 families were infected in a restaurant simply by sitting next to a third family which had an asymptomatic but infected member.
If China does not manage to control this outbreak despite measures akin to martial law, a pandemic is probable, because society in other countries is less rigorously controlled.

In addition to the last comment, here in England and more so in London specifically the hospitals can't cope on a good day because of the Tory decimation of public services. Any epedimic here will be the end of rule of law.

Yes, yes, all true. If you read my post again and note what I was responding to, you'll see that I was pointing out -- perhaps not in sufficiently clear and simple terms -- that the cited Chinese clinical practice of ventilating patients in advanced respiratory distress simply isn't going to be possible -- in China or anywhere else.

And I have made it clear, in this thread, that I doubt any nation is capable of adequately addressing an outbreak on the scale of the one China is dealing with.

That’s too bad because the article content is beyond excellent. Had to let my Dr wife read it (she spent a great deal of her early career in labs) to get a firm grip on the gist. Regardless, the writer is obviously another doctor or scientist who has extrapolated some telling specifics. The biggest news is the testing revelation so we get a much better picture of the overall impact. The coming days should see exponential numbers being reported but mainly due to better testing, not further spreading.