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Coronavirus Those who ignore history are doomed to repeat it

#201 User is offline   shyams 

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Posted 2020-March-22, 12:26

View Postcherdano, on 2020-March-22, 10:35, said:



Sky News (UK) also covered the situation in Bergamo a couple of days ago. The doctors in Bergamo wanted to convey a message: "watch this and take heed"
https://youtu.be/_J60fQr0GWo

(Caution: the video makes difficult and stressful viewing)
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#202 User is offline   pescetom 

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Posted 2020-March-22, 12:31

Today's statistics in Italy: positive 46638 (+9%), dead 5476 (+13%), no longer infected 6027 (+16%). Intensive care 2857 (+5%). Fatality rate 10.5%.
Starting to look like a real downturn in growth rate, but we will only see for sure in next few days.


View Postcherdano, on 2020-March-22, 10:35, said:


Unfortunately it is true. As it points out, there was a bad decision not declare a red zone for Bergamo and the more generalized problem that the current regimen allows testing only of people who show up at a screening area at the hospital with severe symptoms, missing people who are sick at home. This has been the subject of fierce debate in Italy, with many experts wanting to test people confined to home and also known contacts of infected people but others defending the current policy which they sometimes claim is mandated by WHO.
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#203 User is offline   barmar 

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Posted 2020-March-22, 14:35

View Postpescetom, on 2020-March-22, 03:10, said:

Well when I travel internationally I feel younger ;)
Your specific point is right of course, but I suspect the business travel between Germany and north Italy far exceeds number of skiers.

More than 2/3 of the early known cases in Massachusetts were linked to a single conference a month ago. Ironically, it was hosted by Biogen, a leading biotech company.

#204 User is offline   pescetom 

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Posted 2020-March-22, 15:38

View Postbarmar, on 2020-March-22, 14:35, said:

More than 2/3 of the early known cases in Massachusetts were linked to a single conference a month ago. Ironically, it was hosted by Biogen, a leading biotech company.


The South Korean outbreak was almost entirely due to one religious sect that visited China. Codogno probably developed in one hospital ward. Bergamo certainly in one bar. Identifying and tracing such centres is critical in the early phase, unfortunately standard protocols are not in place and authorities are usually still in denial/economic protection mode at that point.
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#205 User is online   Cyberyeti 

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Posted 2020-March-23, 04:27

Unfortunate side effect of Trump's quest for quinine:

https://www.propubli...abYiJCHGe2pS5kU
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#206 User is offline   Winstonm 

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Posted 2020-March-23, 07:16

Eye-opening:

Quote

Toby Melville/Reuters

An intensive-care expert has demonstrated just how infectious the new coronavirus is, as people are urged to self-isolate across the world.

A person with the common flu will on average pass it to 1.4 people, Professor Hugh Montgomery told Channel 4's "Dispatches" on Sunday. If there are 10 cycles of that interaction, there will be 14 cases of the flu, he calculated.

But the coronavirus is three times as infectious as the flu. So if one person with the coronavirus passes it onto three people, and those three people pass onto three more people for ten cycles, there will be 59,000 infections, he said.

"If you are irresponsible enough to think that you don't mind if you get the flu, remember it's not about you, it's about everybody else," Montgomery said.

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#207 User is offline   y66 

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Posted 2020-March-23, 07:30

From Clive Cookson at FT (Sunday March 22):

Quote

The latest UK government strategy to slow the coronavirus epidemic could lead to between 35,000 and 70,000 excess deaths over the next year, according to an instant analysis by scientists from University College London, the University of Cambridge and Health Data Research UK.

The team of clinicians, statisticians and epidemiologists says the UK measures do not go far enough in stopping the spread of the disease or identifying the most vulnerable high-risk groups. The government should “do more in the pursuit of suppressing the epidemic whether through enforced lockdowns or enforced social distancing rather than voluntary measures”, they add. 

The study — a rapid analysis not yet published in a peer-reviewed journal — estimates the excess number of deaths caused by Covid-19 in relation to underlying medical conditions and age, using NHS health records from 3.8m adults in England. 

Dr Amitava Banerjee of UCL, the lead author, said: “The UK government is currently following a partial suppression policy of population-wide social distancing, combined with home isolation of cases, as well as school and university closures, but this is currently not [mandatory]. 

“Our study indicates that the government should implement more stringent suppression at population level to avoid not just immediate deaths but also long-term excess deaths,” he said. 

The research adjusts the deaths likely to be caused directly by the epidemic, taking account of the fact that some would have died anyway from other causes. So far almost all Covid-19 deaths in the UK have occurred in people who were either elderly or suffering from underlying disease. 

Even so, the study comes up with what the authors regard as an unacceptably high number of excess deaths for the current government policy: 35,000 to 70,000.

The researchers appealed to the NHS to make more data available for studies like theirs. Harry Hemingway, UCL professor of clinical epidemiology, said: “Legislation is urgently needed to free up nationwide NHS data so that clinicians and services can rapidly learn ways to tackle the consequences of the epidemic, both in those with and those without the virus.

“The current regulatory and legislative environment around NHS data hampers the public health emergency response to the Covid-19 pandemic.”

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#208 User is online   Cyberyeti 

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Posted 2020-March-23, 08:07

View PostWinstonm, on 2020-March-23, 07:16, said:

Eye-opening:




I'll gloss over the fact that he got the first calculation wrong (1.4^10 is 29 not 14, the 59K is correct, but uses the upper estimate for how many people are infected by each coronavirus case, if you use the lower estimate of 2.5 it's about 9.5K) but it makes the point and also indicates why the UK got their response wrong initially, as they underestimated the number of people the average case infects (they used a number from another virus as a best initial estimate), not sure which or what the number was and were slow to update it.

It also shows the difficulty of these calculations, dropping the estimate by as little as 3 to 2.5 divides the number of cases by 6 after 10 cycles and more as time elapses, and this can be critical as to whether it completely explodes or can be controlled as people recover (or die for more lethal things like ebola). If you assume people will recover and be immune then this effect can get changed also.

I studied some of the maths of this in my degree, and you can see there's an ongoing simulation you can run, but it's only as good as the parameters you put in.

How many people does the average case infect per cycle
How many cycles are you infectious for
The death rate
Whether you can catch it again or carry it after you've had it
How many if any people are naturally immune

I can't remember if there are more factors, but if you get any one of them wrong, you can get completely erroneous results.
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#209 User is offline   pescetom 

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Posted 2020-March-23, 08:11

View PostWinstonm, on 2020-March-23, 07:16, said:

A person with the common flu will on average pass it to 1.4 people, Professor Hugh Montgomery told Channel 4's "Dispatches" on Sunday. If there are 10 cycles of that interaction, there will be 14 cases of the flu, he calculated.

But the coronavirus is three times as infectious as the flu. So if one person with the coronavirus passes it onto three people, and those three people pass onto three more people for ten cycles, there will be 59,000 infections, he said.


It's eye opening that a Professor cannot do simple math.
In the first case there will be about 32 cases, not 14, and in the second case many more than 59,000 because three times 1.4 is 4.2, not 3.
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#210 User is offline   FelicityR 

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Posted 2020-March-23, 08:54

The medical statisticians dealing with epidemiology are excellent at what they do, but instead of making projections - we all know how bad this pandemic is, and how much worse it can get - they should be using their brilliant minds to work out why some people have mild symptoms, and other die of covid-19.

Underlying health problems is not the only cause as younger people are dying now, even healthy ones, but there's a whole mass of data that can be analysed about blood types - it has already been suggested that people with blood group A may get worse symptoms - to diet, alcohol intake and type, smoker/non-smoker, genetics, occupations, location, age, family history, and how people tried at home to tackle the virus and medications used, etc., etc.

To me, analysing this data makes sense, because covid-19 is randomly killing some people whereas with others they have some inbuilt immunity to see off the virus. If they can unlock the 'mystery' factor in all this, then they will have a platform possibly to change the course of the illness beyond social distancing measures. Which everyone must do now.
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#211 User is offline   kenberg 

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Posted 2020-March-23, 09:31

View PostWinstonm, on 2020-March-23, 07:16, said:

Eye-opening:




A correction and a comment.
The correction: The prof did not say that "the coronavirus is three times as infectious as the flu", he said that the rate is about 3 rather than 1.4 .

The comment: This can be used to illustrate features of exponential growth. 3 is a bit more than twice 1.4 (we all agree with this) but the numbers surely are not known exactly so, just for the moment, suppose the rate for the corona virus is just twice the rate for the flu, suppose the spread is exponential, and suppose we look at the spread after 10 days. The result for the growth rate of 2.8 will be about 1000 times the result for the growth rate of 1.4. This is because, as your calculator will tell you, 2^10=1024. The important point is the assumption that the growth rate for the corona virus is twice that of the flu. The rates could be 1.3 versus 2.6 or 1.8 versus 3.6, as long as the corona rate is twice the flu rate, the spread after 10 days for corona will be about 1000 times the spread for the flu.

Nobody knows the growth rate for the corona virus, or at least I doubt that they do, but it is most likely to be more than twice that of the flu, and the numbers for twice are bad enough.

And of course the number 10 was just chosen from a hat.

The specifics of the numbers are not apt to be right. Small perturbations, as cyber says, make a huge difference in the results. For those engaged in planning, they must do the best that they can but the results, again as cyber says, are just too sensitive to the input to be dependable. This definitely does not mean that "we have it all under control". Quite the opposite. We are in for a tough time as was predictable and is now happening. Exactly how bad is not so predictable, but bad. And acting sensibly can bring the numbers down substantially, this again follows from the fact that small changes in the input numbers lead to huge changes in the result.


Added: These transmission rates they use are not god given, or devil given, numbers. They are heavily dependent on the number of interactions a person has. Hence the emphasis on isolation and on identifying who is infected.



Ken
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#212 User is offline   akwoo 

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Posted 2020-March-23, 12:28

View PostFelicityR, on 2020-March-23, 08:54, said:

The medical statisticians dealing with epidemiology are excellent at what they do, but instead of making projections - we all know how bad this pandemic is, and how much worse it can get - they should be using their brilliant minds to work out why some people have mild symptoms, and other die of covid-19.


Unfortunately, that takes biology, not math.

Math is in some ways quite easy. You just figure out what the assumptions are, figure out the right way to calculate, and you get an answer. You can change the assumptions a bit, calculate again (with the help of a computer) and get another answer. Computers are fast at calculating.

Biology is hard. To figure out what's going on, you can't just calculate or think. You have to actually do experiments. Experiments take time; nature works at its own pace, and you can't speed it up by thinking harder.
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#213 User is offline   Winstonm 

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Posted 2020-March-23, 12:53

View Postkenberg, on 2020-March-23, 09:31, said:

A correction and a comment.
The correction: The prof did not say that "the coronavirus is three times as infectious as the flu", he said that the rate is about 3 rather than 1.4 .

The comment: This can be used to illustrate features of exponential growth. 3 is a bit more than twice 1.4 (we all agree with this) but the numbers surely are not known exactly so, just for the moment, suppose the rate for the corona virus is just twice the rate for the flu, suppose the spread is exponential, and suppose we look at the spread after 10 days. The result for the growth rate of 2.8 will be about 1000 times the result for the growth rate of 1.4. This is because, as your calculator will tell you, 2^10=1024. The important point is the assumption that the growth rate for the corona virus is twice that of the flu. The rates could be 1.3 versus 2.6 or 1.8 versus 3.6, as long as the corona rate is twice the flu rate, the spread after 10 days for corona will be about 1000 times the spread for the flu.

Nobody knows the growth rate for the corona virus, or at least I doubt that they do, but it is most likely to be more than twice that of the flu, and the numbers for twice are bad enough.

And of course the number 10 was just chosen from a hat.

The specifics of the numbers are not apt to be right. Small perturbations, as cyber says, make a huge difference in the results. For those engaged in planning, they must do the best that they can but the results, again as cyber says, are just too sensitive to the input to be dependable. This definitely does not mean that "we have it all under control". Quite the opposite. We are in for a tough time as was predictable and is now happening. Exactly how bad is not so predictable, but bad. And acting sensibly can bring the numbers down substantially, this again follows from the fact that small changes in the input numbers lead to huge changes in the result.


Added: These transmission rates they use are not god given, or devil given, numbers. They are heavily dependent on the number of interactions a person has. Hence the emphasis on isolation and on identifying who is infected.




Thank you Dr. Berg.
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#214 User is online   Cyberyeti 

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Posted 2020-March-23, 12:57

View Postakwoo, on 2020-March-23, 12:28, said:

Unfortunately, that takes biology, not math.

Math is in some ways quite easy. You just figure out what the assumptions are, figure out the right way to calculate, and you get an answer. You can change the assumptions a bit, calculate again (with the help of a computer) and get another answer. Computers are fast at calculating.

Biology is hard. To figure out what's going on, you can't just calculate or think. You have to actually do experiments. Experiments take time; nature works at its own pace, and you can't speed it up by thinking harder.


Example, how do you work out whether the antibodies produced by the virus will keep you safe from reinfection and for how long ?

Well you take the closest thing to a human (rhesus monkey) infect them, verify they respond similarly, then nurse them through it, then try to reinfect them after a certain period, and keep doing it. So far (after a month) the antibodies are working, will they continue, we'll have to wait and see.
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#215 User is offline   y66 

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Posted 2020-March-23, 13:31

From "New coronavirus monitoring program launched in Seattle based on home-test kits" at Seattle Times:

https://www.seattlet...er%20Subscriber

Quote

“The basic question that it’s going to be answering for us is what’s below the tip of the iceberg,” he said.

Clinical testing so far has mainly identified people sick enough to seek medical care, but many more are harboring the virus and potentially spreading it to others, even though they might have no symptoms themselves, Duchin said.

Officials hope to learn more about infection levels among different age groups and geographic areas. The data will also be valuable for modelers trying to forecast how the pandemic is likely to progress.

If you lose all hope, you can always find it again -- Richard Ford in The Sportswriter
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#216 User is offline   pescetom 

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Posted 2020-March-23, 15:27

Today's statistics in Italy: positive 50418 (+8%), dead 6077 (+11%), no longer infected 7432 (+23%). Intensive care 3204 (+12%). Fatality rate 10.8%.
The establishment is enthusiastic about the drop in positive rate, I prefer the slight drop in death rate and the significant jump in intensive care (which is now a measure of capacity, not demand).

As from today the excellent Argcis database offers a simple graph (on bottom right) of positives per selection - global or nation. It is enlightening, with a dramatically steep curve in the last few days for good part of the world (the WHO declared pandemic just in time to save face). In these terms Italy is by no means the worst, although NL, DK, Norway and Japan are flatter, to name a few and for whatever reason. The sobering thing is that if you refresh the page, the red blobs now design a fairly precise map of the world before the continental coastlines are visible.
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#217 User is offline   gerry 

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Posted 2020-March-23, 16:11

It will certainly be interesting to see what financial measures will eventually be put in place in the US. In, for example, Australia and New Zealand parties from all sides have given support for measures such as wage subsidies for employers and help for people who will no doubt become redundant. these measures are happening quickly and without any significant opposition.

As for the US, current actions by the Federal Reserve supporting all businesses are necessary and sensible. Good.

Now federal response, well I'm all a-tingle, what will happen? We're all on the edge of our seats... Will they give huge anonymous gifts to any corporations that secretary Mnuchin decides or will they help everyone who needs it? Also the GOP as going to give the unemployed a whole extra month of benefits before they are (to quote blackadder) "permitted to starve to death in one of Her Majesty's parks". As a sporting spectacle its unrivaled. What a brilliant idea having two groups of legislators who have to agree on legislation!
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#218 User is offline   thepossum 

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Posted 2020-March-23, 19:10

View Postakwoo, on 2020-March-23, 12:28, said:

Unfortunately, that takes biology, not math.

Math is in some ways quite easy. You just figure out what the assumptions are, figure out the right way to calculate, and you get an answer. You can change the assumptions a bit, calculate again (with the help of a computer) and get another answer. Computers are fast at calculating.

Biology is hard. To figure out what's going on, you can't just calculate or think. You have to actually do experiments. Experiments take time; nature works at its own pace, and you can't speed it up by thinking harder.


I will preface this with my: I am not a doctor, epidemiologist, virologist, public health official etc etc

However

Some may argue that it may take experiments to establish the stongest evidence of causes of things. However there are many other methods that give strong indications of risk factors/associations. And as far as I m aware, from my perhaps limited knowledge of medical reesearch and epidemiology, experiments that require giving people viruses to test what it is that kills you are not commonly accepted scientific practice - for obvious reasons I would hope.

Therefore people tend to rely on other methods.

One recent report from Italy posted in a discussion on Twitter abut comorbitiesMy link has a number of interesting statistics and tables that give some indications of risks (or associated factors), not causal risks I hasten to add but strong associations with mortality

In that report one of the most discussed numbers were comorbities(pre-existing conditions) with Covid - section 3 of the report

It is clear from the numbers that without making any statement of cause there are very strong risk factors associated with 1 or more pre-existing medical conditions - that is reading the data and discussion. Not medical opinion or anything before anyone has a go. However I do actually have a masters in biostatistics and some understanding of the field Please read the report.
Hopefully doctos or other experts will clarify. Also these are risks/associations - not causal relationships

Table 1.Most common comorbidities observed in COVID-19 positive deceased patients

Ischemic heart disease 30.1% of fatalites
Atrial Fibrillation 22.0% of fatalities
Stroke 11.2% of ftalities
Hypertension 73.8% of fatalities
Diabetes 33.9% of fatalities
Dementia 11.9% of fatalities
COPD 13.7% of fatalities
Active cancer in the past 5 years 19.5% of fatalities
Chronic liver disease 3.7% of fatalities
Chronic renal failure 20.2% of fstalities

Number of comorbidities
0 comorbidities 1.2% of fatalities
1 comorbidity 23.5% of fatalities
2 comorbidities 26.6% fatalities
3 or more comorbidities 48.6% of fatalities

NOTE It should also be born in mind that many of these comorbities are common across the high risk groups anyway so no inference can be made that they are a factor involved in mortality (eg high blood pressure) - they could just be common comorbities in that population

DISCLAIMER Again I add I am not a doctor, epidemiologist etc but it seems that many of the risk factors are quite obvious and obviously common in older people - hence higher death rates. Also as far as I am aware most (if not all) the younger victims of Covid also had serious comorbities

HOWEVER Please note that this in no way downplays the infectiousness, seriousness of the illness, the load on health systems etc etc. And it is not expert comment. Just I happen to have some training and get rather upset sometimes at the lack of clarity in messages and discussion.

ALSO Just because there appears a very strong association between fatalities and comobrities no inference should be made about the seriousness of the illness for all the non fatal cases - or for people to think that they are ok, or they wont get a serious illness, or that they will die or any inference at all. That is also not medical opinion. Just common sense. But surely we can discuss some figures and likely risks

ALSO These figures are from one specific nation with a reasonably resourced health system, I have massive concerns for the effect in places with less resourced health systems. Thats a personal view knowing how much treatment is required

PLEASE Treat this information in the way it is intended. Do not misuse the figures. Do not Regard them as expert comment or causal in any way shape or form. But I am sure by now everyone is aware of these issues without having to be a medical expert to discuss it

PS Whenever I get abused for commenting on things I may know something about (yet am not expert in) I am somewhat heartened (or should I say dismayed) that I am in good company. Our Chief Medical Officer in Australia is regularly attacked via social media for not being a virologist - I believe since he has a different speciality in medicine he is not regarded as qualified to discuss anything either
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#219 User is offline   FelicityR 

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Posted 2020-March-23, 20:51

View Postakwoo, on 2020-March-23, 12:28, said:

Unfortunately, that takes biology, not math.

Math is in some ways quite easy. You just figure out what the assumptions are, figure out the right way to calculate, and you get an answer. You can change the assumptions a bit, calculate again (with the help of a computer) and get another answer. Computers are fast at calculating.

Biology is hard. To figure out what's going on, you can't just calculate or think. You have to actually do experiments. Experiments take time; nature works at its own pace, and you can't speed it up by thinking harder.


I agree with what you are saying. But there must be some mechanism that makes covid-19 more virulent, more dangerous for certain people. Why is covid-19 asymptomatic for some, and deadly for others? Or are there two 'isomers' of the virus, where one produces mild infection, and the other chronic infection, and the virologists haven't been able to identify them so far?

Possibly, and this is only a theory, people who have travelled and had vaccines for other illnesses like dengue fever, malaria, yellow fever, etc. have some advantage of fighting this illness than people who haven't. The reason I say this is that I now know of one person (a friend) who has had coronavirus, but only very mild symptoms, after returning from Asia. He is over 60, not 100% healthy, but he has travelled the world extensively, especially in Asia.

The brilliant minds of the medical statisticians, biologists and virologists could possibly find some explanation in the raw data of people's medical files, plus other factors.

And whilst, as I have said previously, I am not a fan of our Prime Minster, Boris Johnson, I have admiration for the speech he gave last night outlining the lockdown in the UK. It was truly statesmanlike.

https://www.msn.com/...ome/vi-BB11BmnU
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#220 User is offline   y66 

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Posted 2020-March-23, 21:47

Alicia Smith @Alicia_Smith19 Mon 11:13 PM ET said:

24 hour day-over-day increase/decrease in active coronavirus cases in following countries (3/22):
S.Korea: -3.06%
Italy: +8.10%
France: +27,78%
Japan: +3.15%
Germany: +16.18%
Spain: +20.67%
UK: +16.40%
U.S.: +30.15%
World: +16.13%


Ari Armstrong @ariarmstrong 11:16 PM ET said:

Aytu BioScience announced Monday that it will begin the distribution of the first 100,000 COVID-19 Rapid Tests throughout the US this week.Test delivers results in 2-10 mins at point of care and are for professional use only.

https://kdvr.com/new...ed-in-colorado/

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