Talk:COVID-19

Discretionary sanctions on the use of preprints

I am appalled by the use of preprints to support content in this article. The website MedRxiv displays a clear disclaimer:

Caution: Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Lets be clear about this; preprints aren't even suitable for newspapers, let alone an encyclopedia whose purpose is "to present a neutrally written summary of existing mainstream knowledge in a fair and accurate manner" (WP:AIM).

I'm giving notice that tomorrow I intend to place a general sanction on the page to prohibit the use of preprints as sources in this article. This ought to be simply a matter of respecting our guidelines on WP:Reliable sources and WP:MEDRS, but it now seems necessary. I'm naturally willing to hear reasons why discretionary sanctions should not be necessary to enforce our basic sourcing guidelines. --RexxS (talk) 21:51, 11 May 2020 (UTC)

• Support, obviously. Boing! said Zebedee (talk) 22:08, 11 May 2020 (UTC)
• Support. We should not be using preprints EVER. MartinezMD (talk) 22:53, 11 May 2020 (UTC)
• This is a WP:point, against WP:5P5, WP:5P4, WP:5P3 and potentially WP:5P2. This is an article about a current event. Our main source in the contested chapter (IFR) say I quote loosely : "Since yesterday [...] one research group has provided a correction of their estimate of the Infection-Fatality Ratio (IFR)". Since yesterday... Is that the pinnacle of peer review we strive for ? We have to deal with research that change daily, there is no need to put the big administrator boots and add yet another banner on top of this page. Just to state the obvious that peer reviewed source would be preferable. Everyone here agree. Iluvalar (talk) 22:56, 11 May 2020 (UTC)
• Oppose. What we’re up against are bat shit crazy conspiracy theories. That’s the reality of the situation. We’re also at risk of irrelevancy due to the 24-hour news cycle and social media.
  And then I’d ask, How often really does a professional journal make substantial changes to a pre-print? I mean, if we’re going to make big sacrifices to piously remain on the sidelines, that’s kind of an important question. Especially when a clear better alternative is to say “According to a preliminary study . . ” or something of this sort, or even add “(pre-print, not yet subject to peer review)” if we feel that’s necessary. FriendlyRiverOtter (talk) 04:12, 12 May 2020 (UTC)

You might want to read up on WP:NOTNEWS and maybe The road to hell is paved with good intentions MartinezMD (talk) 04:46, 12 May 2020 (UTC)

Let me throw the question back to you. If a colleague said “a preprint showed . . ” pertaining to a real live patient under the care of both of you, would you try to pretend you never heard it, or would you cautiously take it into account? FriendlyRiverOtter (talk) 05:06, 12 May 2020 (UTC)

As an example :

“For several weeks from January and February, a preliminary study from China found that approximately 13% of transmission from pre-symptomatic persons.”

Du, Zhanwei; Xu, Xiaoke; Wu, Ye; et al. (June 2020). "Early Release — Serial Interval of COVID-19 among Publicly Reported Confirmed Cases". Emerging Infectious Diseases. doi:10.3201/eid2606.200357. PMID 32191173.

This compares similarly to the Korean CDC finding that 20% of patients with confirmed cases remained asymptomatic during their hospital stay.

And not sure early release is quite the same as a pre-print. FriendlyRiverOtter (talk) 05:01, 12 May 2020 (UTC)

I'm better qualified than someone from the general public reading WP to differentiate non-peer reviewed information and put it in proper perspective. Otherwise I'd have been using hydroxychloroquine which I haven't because I felt the reports were too premature. Even let's say we're dealing with someone who has good logic, unless they're a medical professional dealing with these cases, do they really need the inclusion of non-reviewed data? Can't they wait a couple weeks? MartinezMD (talk) 05:31, 12 May 2020 (UTC)

To me, the overall issue of whether we remain relevant, or not, is huge. And in that context, a couple of weeks can be a big deal.
So, a professional journal is okay with a pre-print, with the qualification of course, but for us, Oh no. We have to outdo them and be more goody two-shoes, more by-the-book, seemingly more everything.
Dr. Martinez, I compliment you on bringing up the specific issue of hydroxychloroquine (not sure why people thought an anti-malaria drug might work in the first place). We need more healthy yin-yang between the specific and the general. Too often here at Wiki, we seem to rabbit-hole and focus on policy and abstract principle only.
And frankly, we seem to view a lot of participation as a “problem” to be managed. Don’t quite get that. FriendlyRiverOtter (talk) 21:16, 12 May 2020 (UTC)

• Re: " If a colleague said “a preprint showed . . ” pertaining to a real live patient under the care of both of you, would you try to pretend you never heard it, or would you cautiously take it into account?'""... How medical professionals deal with patients and how an encyclopedia is written are worlds apart. Medics are necessarily at the leading edge of developments, while an encyclopedia should be at the trailing edge and only include content that's made its way through to WP:MEDRS compliance. We are *not* here to try to guide medics or to try to guide treatments - that would be irresponsible. Boing! said Zebedee (talk) 10:58, 12 May 2020 (UTC)

Yes, I asked the question, but it’s not my intention to make a philosophic treatise out of it or anything of the sort. Generally, it’s my view that we go with our references, no more, no less. And it’s amazing how a view as straightforward as this has run into opposition.
I urge you not to decide ahead of time that we’re going to relegate ourselves to the trailing edge. I’ve had two friendly acquaintances who have gone off into the wild blue yonder of Coronavirus conspiracy theory. Holy cow. Look around, and ask around. You may know a couple, too.
So, yeah, we stay middle-of-the-read, providing good medical journal quality information, and we can do a world of good. And people will take notice and say, hey, Wikipedia did pretty alright regarding COVID-19, rather than a grudging, did okay I guess.
Deciding we’re going to have a “better” standard than a medical journal comes with a cost. And that cost is some erosion of our relevance. FriendlyRiverOtter (talk) 05:25, 13 May 2020 (UTC)

The decision to be "trailing edge" on reporting breaking news was made a long time ago by Jimbo when he decided to start a project that was an encyclopedia, not a newspaper. Keeping up with CNN has never been one of Wikipedia's goals. The reason so many people now respect Wikipedia as a counter-balance to misinformation is precisely that we are so careful to only write what is well accepted mainstream fact. in the case of statements about the effects or symptoms of diseases or the efficacy of treatments for them, for example, we insist on only reporting what has become accepted by good quality secondary sources that have taken the time to review the field and to analyse it. So many primary studies are never reproduced that we've learned to wait until a source does the checks for us. If we don't have the reassurance that gives us, it is far better to say nothing. --RexxS (talk) 15:23, 13 May 2020 (UTC)

I was going to explain that the decision to "relegate ourselves to the trailing edge" was deliberate and is, in my view, exactly what an encyclopedia should do. But RexxS has explained it, so I don't need to (except that I just did). Boing! said Zebedee (talk) 15:29, 13 May 2020 (UTC)

Regarding accuracy . . . we don’t check legacy material!! I mean, someone will summarize a source and post. And then weeks or months later, someone else will rewrite this according to their idea of how an encyclopedia should sound, without going back and checking the source. And maybe person #3 will come along and rewrite. It’s a very dicey process. It truly is a weakest-link-in-the-chain process.
Fortunately, we don’t have as many mistakes as one might think, because a lot of stuff isn’t rewritten even once, a lot of the rewrites are minor tweaks, etc. But the risk is there. I think we can help by talking up the importance of checking older material, and by making things inviting for beginning members so we can have more sets of eyes.
And I’m skeptical of philosophy and the meta, as if our goal is to never again have to think? We’re never going to reach there and it’d probably be a poor idea if we ever did.
I mean, in the time we’ve discussed all this, we probably could have worked through references 91, 284, 287 from the Implementation section (the ones sourced to MedReiv).
As an aside on philosophy, I remember a part from Richard Feynman’s bio in which he attended a grad seminar on philosophy and the professor asked him if he thought an electron was an “essential object” (term put forward by a British philosopher). Feynman said he first wanted to ask if a brick was an “essential object,” and the grad students had widely differing viewpoints! His second question was going to be if the inside of a brick . . . but he never even got to it.
That’s rather how I feel about some of our more abtract discussions. Again, I’m the person who says, let’s summarize what a good source says, no more, no less. FriendlyRiverOtter (talk) 00:12, 14 May 2020 (UTC)

@FriendlyRiverOtter: Please read WP:MEDRS and come back to the discussion once you have understood it. --RexxS (talk) 00:41, 14 May 2020 (UTC)

• Support This is essential to keep Wikipedia free from inaccuracies. Thank you for agreeing to take on this work. Replace with / adjust to secondary sources when and as able. Doc James (talk · contribs · email) 06:59, 12 May 2020 (UTC)

Implementation

As no compelling argument has been brought forward to explain why this article should be an exception to our reliable sourcing requirements, I've imposed the following specific restriction:

• Editors are prohibited from adding preprints as sources for content in this article.

I've logged that at Wikipedia:General sanctions/Coronavirus disease 2019 and included edit notices and a notice on this talk page. After being made aware of the general sanctions applicable to this page, any editor breaching the prohibition may be sanctioned by any uninvolved administrator, as authorised at WP:GS/COVID19#GS.

There are currently three citations (91, 284, 287) sourced to MedRxiv. These should be removed and the text adjusted as necessary to maintain WP:V.

I ask all editors to respect our sourcing guidelines: sources failing WP:MEDRS should not be used to support any biomedical content; sources failing WP:RS should not be used to support any content at all. This is an encyclopedia, and we should not be trying to compete with news outlets to bring the latest information to readers. We have a sister project, Wikinews, whose purpose is to do that. We should be striving to bring the most accurate information as possible to readers, and that means working only within our sourcing policies and guidelines. I hope that editors will remove sources that fail these guidelines and not restore any challenged material without first discussing it on the talk page.

If it proves necessary, I'll consider a further sanction to prohibit the use of primary sources and animal studies to support biomedical content. --RexxS (talk) 19:25, 12 May 2020 (UTC)

No compelling argument, eh? I’m not sure one should both energetically champion a viewpoint, and neutrally sit as a judge. Perhaps most of all, when one is largely right! Ironic how life often works out that way.
Okay, I will continue as a good citizen in the Wiki Universe. I do reserve the right, however, to revisit this issue if I feel a specific case is important enough.
And I always thought one of the goals of a consensus process is more democratic discussion. Not sure it always works out that way in practice. FriendlyRiverOtter (talk) 22:33, 13 May 2020 (UTC)

@FriendlyRiverOtter: The viewpoint I'm "championing" is sticking with our sourcing policies and guidelines, and the only actions I'm taking are reasonable measures that an enforcing administrator would believe are necessary and proportionate for the smooth running of the project. The consensuses involved here are the project-wide ones that established WP:RS and WP:MEDRS, and if you want to change those, you are free to start a discussion at their talk pages to do so – that's the democratic process. In the meantime, you will respect those consensuses. The only things I'm asking you or anyone else to do is to stop adding unreliable sources to the article and to stop adding primary sources to support biomedical content. Editors in every other medical topic can abide by our sourcing policies and guidelines, and there's no reason why editors here should fail to do so. --RexxS (talk) 00:24, 14 May 2020 (UTC)

Now, whether we’re really going to go the route of secondary sources only, that’s an entirely separate discussion. I don’t think WP:MEDRS is that hardcore about it. Yes, I have read it before, but it’s been a while. FriendlyRiverOtter (talk) 17:04, 14 May 2020 (UTC)

Prohibiting preprints seems like a reasonable thing to do, but I have hesitations about whether this is an appropriate use of general sanctions, so I'd appreciate clarification from RexxS about what specifically this does. As I understand them (and my understanding may be wrong, so please educate me if that's needed), the general sanctions are intended to target editors who "repeatedly or seriously fail to adhere to the purpose of Wikipedia, any expected standards of behavior, or any normal editorial process". Do we have cases of editors warring to try to include preprints as sources? Does this mean that if a well-meaning editor who has been alerted to the sanctions due to an unrelated matter accidentally adds a preprint (perhaps not knowing it was such, or perhaps not knowing preprints are disallowed), they could get blocked? What makes this something we should implement as a general sanction, rather than just something to add to the COVID-19 WikiProject current consensus list? {{u|Sdkb}} ^talk 00:18, 14 May 2020 (UTC)

@Sdkb:

1. "Do we have cases of editors warring to try to include preprints as sources?" Yes.
2. "Does this mean that if a well-meaning editor who has been alerted to the sanctions due to an unrelated matter accidentally adds a preprint (perhaps not knowing it was such, or perhaps not knowing preprints are disallowed), they could get blocked?" Yes.
3. "What makes this something we should implement as a general sanction, rather than just something to add to the COVID-19 WikiProject current consensus list?" WP:RS is not a local consensus;it's a project-wide consensus, and in the opinion of at least three administrators, it's needed to protect the smooth running of the project.

If you disagree with it, please feel free to question my judgement at WP:AN or WP:AE. I'm willing to defend the measure vigorously. --RexxS (talk) 00:34, 14 May 2020 (UTC)

Pinging the referenced admins @Doc James and Boing! said Zebedee: Is your support above for implementing this measure as a general sanction, or just for the measure itself? Is there anything you'd want to add to RexxS's response to my inquiry? {{u|Sdkb}} ^talk 00:55, 14 May 2020 (UTC)

In my opinion it is reasonable to warn someone regarding the use of preprints. If they continue not to heed the warnings than escalating edit limitations would be reasonable. Doc James (talk · contribs · email) 02:18, 14 May 2020 (UTC)

Yes, I think the use of general sanctions is warranted here. And if someone uses a preprint as a source (even accidentally) after having been warned, a block is a reasonable response. The same is true of all general/discretionary sanctions/policy prohibitions, that people can be blocked for accidentally breaching them after having been warned. I'd expect someone responding "Sorry, that was accidental, I hadn't properly checked and didn't realise it was a preprint" to be unblocked quickly. Oh, and no, I have nothing of any substance to add to RexxS's position - I fully agree with it. Boing! said Zebedee (talk) 05:40, 14 May 2020 (UTC)

I'm confused about this. What does this have to do with DS? I remove pre-prints from articles as a matter of practice. Does this mean you treat pre-prints differently than other unreliable sources? Natureium (talk) 02:26, 14 May 2020 (UTC)

My take is that we have people arguing that preprints are valid sources for medical articles, meaning we need to make it explicit that preprints are considered unreliable sources and should not be used. That is, it clarifies that we do not treat preprints differently from other unreliable sources. Boing! said Zebedee (talk) 05:37, 14 May 2020 (UTC)

I actually agree with @RexxS: 90% of the way. It’s only that last 10%. On an occasional, sparring basis, with the qualifier “a preliminary study shows . . , ” I don’t think we should immediately dismiss using a pre-print. And I ask the Emperor’s clothing question, how often is a pre-print really changed in any kind of major way before publication?

So, we’re going to have a “higher” standard than JAMA, are we? JAMA makes pre-prints available — with a qualification of course (key point!). And we’re going to do this as if super “high” standards are some kind of unalloyed good thing. I’ve learned that when organizations proclaim unrealistically high standards, there are problems. Or, you give in other areas. And dear reader, you may have observed some of the same.

And no, I’m not crazy about blocking people for an innocent mistake when they most likely would have appreciated a heads up and being brought up to speed. FriendlyRiverOtter (talk) 17:23, 14 May 2020 (UTC)

@FriendlyRiverOtter: Which bit of

Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

makes you think that they are reliable sources for any content at all? JAMA presently makes preprints available for researchers to see what cutting edge research is happening and what effect it might have on their own research. It does not make it available to facilitate amateur reporters seizing on any headline-grabbing findings and attempting to cram them into an encyclopedia.

Neither you nor I have any idea how many changes occur between pre-print and publication overall. I can only add anecdotally that the last paper I was an author on required several changes and clarifications during the peer-review process. So your rhetorical question can only be seen as a veiled attempt to undermine our insistence on peer-review or similar editorial quality control for reliable sources. Please stop that. It simply encourages wannabe journalists to ignore our accepted policies and guidelines. Our higher standards for medical content as laid out in WP:MEDRS are agreed project-wide and I'm reaching the end of my patience with your tendentious challenges to those standards.

There's no reason for anyone to be blocked if they simply self-revert their mistake when notified of the problem, and do their best not to repeat the error. That's not what discretionary sanctions are for, but that's just my personal opinion on DS, and you still run the risk of sanctions from any admin if you breach them. --RexxS (talk) 17:55, 14 May 2020 (UTC)

Prepints undergo several revisions. In my brief life in academia, I've been a reviewer and had authors make changes. I've had my own papers revised from reviewers' suggestions as well. I'll repeat that preprints and any paper that has not been peer-reviewed have no business on WP as a source. They are simply unreliable. Now if someone makes a simple error, I think we all agree a simple reversion is all that's required. MartinezMD (talk) 18:05, 14 May 2020 (UTC)

• Re with the qualifier "a preliminary study shows...": One problem is that you can't really say that from a preprint, because a preprint isn't even a reliable source for what the preliminary study actually shows. The problem is not that the study is preliminary, it's that the words in the preprint are preliminary. It needs the review stage to check it's correctly reporting what the preliminary study actually does show. "An unreviewed preliminary claim indicates that a study might show that..." is possibly the strongest level of claim I think we could make from a preprint. And that's no use at all. Oh, and, @FriendlyRiverOtter: Wikipedia's WP:MEDRS policy and the consensus here are very firmly against you. Preprints will not be used in Medical articles. You need to learn when to listen and move on. Boing! said Zebedee (talk) 18:24, 14 May 2020 (UTC)

Just to be clear before we close this, Jmv2009 didn't change a single comma on the content of the article. He just happened to add yet another estimation of the IFR in a chapter already full of it and well inside the spectrum of the other estimations. I felt like it was somewhat useful in the context of the IFR chapter in constant rewriting. At least, it shouldn't be reverted out of silly principle. Was it a great source ? Obviously not, it's the IFR chapter, what you expect... We still wait for better meta analysis. I might be wrong... but I truly hope that the admin that will apply this new sanction will look at the context calmly before applying it blindly. I was expecting someone else to revert me if needed, not a big banner on my talk page and this big vote/talk about obvious shortcomings of preprints. That's all I mean. Now, let's go edit and close this chapter. Iluvalar (talk) 01:57, 15 May 2020 (UTC)

Regarding "Preprints will not be used in Medical articles", Boing! said Zebedee appears to be incorrect. Please see https://doi.org/10.1096%2Ffj.202000919, it references Medrxiv six times. Robbymcd (talk) 11:41, 5 June 2020 (UTC)

I meant (and I thought it was obvious) that preprints will not be used as sources in *Wikipedia Medical articles*. That secondary sources, reviews, etc, might use them does not change that. (As an aside, I wouldn't be surprised if you could find a preprint used somewhere in one of our articles, but if there are any they should be removed.) Boing! said Zebedee (talk) 11:49, 5 June 2020 (UTC)

@Robbymcd and Boing! said Zebedee: A Wikipedia search in articles for insource:medrxiv.org/ currently gives 44 results, but not all are necessarily being used as sources. I'll make a start on removing any that are. --RexxS (talk) 20:08, 5 June 2020 (UTC)

Update: No content is now sourced to MedRxiv, apart from mentions about the site itself and a case where it is cited to show that the author wrote the preprint. It was interesting to see that apart from one use on Multiple sclerosis, every use of MedRxiv was in connection with CoViD-19. Also, a couple of authors had been citespamming their preprints in multiple articles. Let's see if we can persuade editors to take the "reliable, independent, published sources with a reputation for fact-checking and accuracy" seriously. --RexxS (talk) 22:30, 5 June 2020 (UTC)

Thanks for keeping things unbiased RexxS and for explaining Boing! said Zebedee however I think a much larger issue is where medical advice is given based on a news source that uses the preprint as its source. Much harder to search for this sort of thing. WP:MEDPROP says its generally not good to use news sources that refer to preprints but I've seen many and very few objections to them. Robbymcd (talk) 03:51, 6 June 2020 (UTC)

On a related question if the preprint is an observational study. If the study talks about experimental treatment that took place at hospitals should that at least be mentioned as a historical fact related to the drug being treated with rather than medical advice? Surely just the fact that this took place is worth mentioning even if the results of that study are too soon to share? The same regarding a on ongoing clinical trial, surely it can be mentioned what they are trying to prove as long as it is not used as "proof" itself for the use of that medication? Robbymcd (talk) 03:51, 6 June 2020 (UTC)

As a pragmatic individual, I added the following Johns Hopkins ref. about Coronavirus and kidney damage:

https://en.wikipedia.org/w/index.php?title=Coronavirus_disease_2019&diff=956757733&oldid=956755174

And then, I deleted the following MedRxiv ref. and summary expressly because it is a pre-print not yet fully peer-reviewed:

https://en.wikipedia.org/w/index.php?title=Coronavirus_disease_2019&diff=next&oldid=956758149

Two other MedRxiv sources are currently footnoted 290 and 293. FriendlyRiverOtter (talk) 05:05, 15 May 2020 (UTC)

I strongly feel that this doesn’t need specific sanctions, just normal sanctions for edit warring when they are challenged and removed.

One can cite a pre print if it isn’t to make a medical claim for instance, I have inserted several, such as that Wuhans lockdown was arguably successful which stood for at least a week. That was a preprint. Not a medical claim and appropriately balanced. But it was still a preprint in the lead

Just got to enforce edit warring Almaty (talk) 05:27, 16 May 2020 (UTC)

In fact I think this article isn’t getting updated as much as it should be and more newcomers would help. Might be time to revisit protection and stuff Almaty (talk) 05:30, 16 May 2020 (UTC)

@Almaty: The community decided that Wikipedia:General sanctions/Coronavirus disease 2019 are to be applied here. The community discussion found overwhelming support for the measures, so your opinion is noted, but has no validity.

"One can cite a pre print if it isn’t to make a medical claim for instance". No you can't. They don't even pass WP:RS and are unsuitable to support any content outside of an article about pre-prints. I'd be grateful if you'd stop encouraging other editors to breach GS restrictions and our sourcing policies and guidelines. If you insert a pre-print again, you'll be sanctioned.

The enforcement of edit-warring restrictions will still happen, but with general sanctions in force, we're a long way past that. If experienced editors are failing to enforce policy, removing semi-protection would result in anarchy. That's not going to happen. --RexxS (talk) 02:16, 17 May 2020 (UTC)

10% in boston (city employees). [1] with this quote : "Walsh says the 10% figure is lower than what he would have expected in Boston. He suggests the actual number of people, in a larger sample size, might be 15-20%. ". (bold from me) I love this guy, my new champion <3 lol. @Doc_James

RexxS, trust me we understand what you say, but at the same time you got a wide array of opinion at this point. We are all dealing with questionable sources due to the topic. And apparently many of us don't seem very excited by an admin applying guidelines blindly. There is plenty of us who proofread the article daily. Iluvalar (talk) 04:19, 17 May 2020 (UTC)

@Doc James, Boing! said Zebedee, El C, and Ymblanter: - admins active in this topic area. Do I have to put up with continued insults from Iluvalar (talk · contribs · deleted contribs · page moves · block user · block log)? They have just called my efforts to uphold RS and MEDRS for the sourcing on this article "an admin applying guidelines blindly". This page is littered with attacks from Iluvalar on our sourcing guidelines, and with tendentious comments aimed at the admin actions I've taken so far. I'm willing to topic ban him myself, but no doubt we'd get more drama with wikilawyering about what constitutes WP:INVOLVED. --RexxS (talk) 20:09, 17 May 2020 (UTC)

Not sure why RexxS read everything I say like direct personal attacks. He said "I'm only involved here in an administrative capacity" to FriendlyRiverOtter a little lower in the talk page. I'm just following the conversation. Is he an admin applying rules as is, or a contributor bringing opinions about the value of those sources ? He can't really be both at the same time. Iluvalar (talk) 20:47, 17 May 2020 (UTC)

Ok, I am clearly an uninvolved admin (I believe I have never posted on this page before), and I confirm this decision (prohibition to cite preprints).--Ymblanter (talk) 21:13, 17 May 2020 (UTC)

Iluvalar, those sources were already prohibited by WP:MEDRS, and the discussion here was just to confirm that specifically about preprints. It's now time for you to shut up and stop whining about it, and stop casting aspersions about admins "applying guidelines blindly". Boing! said Zebedee (talk) 21:23, 17 May 2020 (UTC)

Sure, this thing is over. No one want bad sources in this article. Sorry to have you "involved" in this Ymblanter. Iluvalar (talk) 01:57, 18 May 2020 (UTC)

Please also consider the considerable impact of preprints. [2] Sometimes, preprints or news is so obviously clear that they present the best information on hand. On the other hand, many preprints are published which contain obvious faults or do not provide the complete picture. Sceptical about the role of peer preview generally: Sometimes a dozen authors are on a paper. Peer reviewers are independent, but they will often not catch errors either. These days, thousands of people are reviewing the preprints as well, which we have seen can play a significant role. Jmv2009 (talk) 11:11, 21 May 2020 (UTC)

According to this recent news report the chinese government is "tightening its grip" on covid research. This has been a controversial measure, that could censor both "bad research" and research that suggests negligence of the chinese regarding the origin of the spread of the virus. Although I appreciate the spirit of the sanctions measure, I suggest that we relax it regarding preprints from chinese scientists in the eventual case that RS report that they were censored by the chinese government, in which case their information can not physically proceed to the peer review stage despite any merit. In other words, I suggest we reconsider an exception to the rule of being harsh on citing preprints (the details of this relaxation we can discuss later) given that there is an exceptional situation (according to Nature) that could be distorting the regular channels of science publication in China.Forich (talk) 04:43, 22 May 2020 (UTC)

We should add that reference, then. Erkin Alp Güney 05:32, 26 May 2020 (UTC)

Hmm, I don't know what I think about some of the arguments here. You have arguments that go preprints are terrible and always bad, etc etc etc. But at the same time, the process of scientific publication and review of it has changed due to covid. You have faster publicaction, with less oversight, and a far larger body of scientists watching what is going on.

This article addresses this change in the publication process: https://undark.org/2020/04/01/scientific-publishing-covid-19/

"In the context of an outbreak, Michael Johansson, a biologist at the Centers for Disease Control and Prevention and an epidemiology lecturer at the Harvard T.H. Chan School of Public Health, wrote in an email to Undark that “traditional review methods are too slow.”"

'A month later, Sarvenaz Sarabipour, a postdoctoral fellow at Johns Hopkins University, and eight other scientists published a rebuttal arguing that given responsible reporting practices, “preprints pose no greater risk to the public’s understanding of science than do peer-reviewed articles.”'

“In one respect, what seemed like a failure of preprints was actually a success, because within 24 hours, the error had been spotted by the community,” said Sever, “and then within about 48 hours [the authors] made a formal withdrawal.” The paper is still on the bioRxiv website, under a bright red banner explaining that it has been withdrawn.

Sever said that even in cases where the preprint isn’t egregiously misleading, the community is still pretty good at picking up on smaller mistakes, like an incomplete methods section or a dataset that wasn’t posted.

--Talpedia (talk) 04:10, 27 May 2020 (UTC)

Great source Talpedia, sourcing even our discussions <3 . So what do we do now ? We had the superseding sources for almost a week now [3]. Iluvalar (talk) 19:16, 1 June 2020 (UTC)

Obesity

Obesity is commonly suspected to be a significant risk factor but the article currently seems to say nothing about this. Here's an example of a source: Obesity and impaired metabolic health in patients with COVID-19. I suggest that we put something in the epidemiology section where we currently have sections for sex differences and ethnic differences. Andrew🐉(talk) 11:35, 14 May 2020 (UTC)

The source says nothing that connects obesity with COVID risks. Read it more thoroughly. This is why WP:MEDRS requires secondary sources. MartinezMD (talk) 16:39, 14 May 2020 (UTC)

The first sentence of that source is "Preliminary data suggest that people with obesity are at increased risk of severe COVID-19." And, of course, there are other sources such as Obesity could shift severe COVID-19 disease to younger ages. Andrew🐉(talk) 20:51, 14 May 2020 (UTC)

• Today's front page story in The Times is timely: Boris Johnson to launch war on fat after coronavirus scare. The PM was naturally persuaded by his own experience but the article cites recent research based on large numbers of NHS records. Looking for the underlying studies, I find Liam Smeeth; Ben Goldacre (7 May 2020), OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients (PDF), doi:10.1101/2020.05.06.20092999. There's lots of good material here and note that the paper has a CC licence so we can freely reuse it. Regarding obesity, there's a table of hazard ratios which have been adjusted by age/sex and also by a fully-adjusted model. The results by body mass index are:

BMI class	hazard ratio (adjusted for age/sex)	hazard ratio (fully adjusted)
Not obese	1.00 (ref)	1.00 (ref)
Obese class I (30–34.9 kg/m²)	1.57	1.27
Obese class II (35–39.9 kg/m²	2.01	1.56
Obese class III (≥ 40 kg/m²)	2.97	2.27

As this seems to be the largest cohort studied so far – over 17 million people – these findings seem quite significant. We should list obesity as a risk factor in the article. Andrew🐉(talk) 16:19, 15 May 2020 (UTC)

Can you also add unadjusted data in the table? Erkin Alp Güney 08:55, 25 May 2020 (UTC)

The first two words of the article's page say "medRxiv preprint". Can you please stop disrupting the talk page with preprints and non-secondary sources? MartinezMD (talk) 20:04, 15 May 2020 (UTC)

@RexxS: for your opinion. MartinezMD (talk) 01:08, 16 May 2020 (UTC)

We can't use preprints. That's not just my opinion.

For MEDRS sources, Trip finds some secondary sources that mention obesity. For example:

• "More recent data from a cohort of 5700 hospitalized patients with COVID-19 within a large healthcare system in New York City revealed common comorbidities including hypertension (56.6%), obesity (41.7%) ...[4]
• "Staff who should avoid involvement in airway management ... Current evidence would include in this group, older staff ... cardiac disease, chronic respiratory disease, diabetes, recent cancer and perhaps hypertension and obesity" [5]

The secondary sources don't call obesity a risk factor, but it is understood to be a comorbidity. The problem with trying to draw any stronger conclusion is that cardiovascular disease and diabetes are commonly associated with obesity, and the evidence is clear that people with the those underlying conditions develop more severe symptoms of COVID-19 and have higher fatality rates. Because BMI is not usually measured and recorded in the same way as CVD and diabetes are, we only have patchy evidence to examine. I think that this review from the Norwegian Institute of Public Health does a good job of describing what we know – see the Results section starting on page 6. Hope tha helps. --RexxS (talk) 01:50, 16 May 2020 (UTC)

Looks like an association but uncertain if independent. MartinezMD (talk) 02:18, 16 May 2020 (UTC)

I agree. To answer those sort of questions, we'd have to have reviews of studies that found severity or mortality among obese people who had no other comorbidities different from those who did. We may be some distance from that right now. --RexxS (talk) 02:47, 16 May 2020 (UTC)

• Here's another source: Prevalence of obesity among adult inpatients with COVID-19 in France. Andrew🐉(talk) 09:22, 20 May 2020 (UTC)

Get a secondary source. MartinezMD (talk) 15:08, 20 May 2020 (UTC)

Latest evidence on obesity and COVID-19 lists several studies. In particular, it notes that the CDC gives "severe obesity" as a risk factor. Andrew🐉(talk) 23:27, 21 May 2020 (UTC)

Shortly before the implementation of strict medical / sanitary safety standards. Us Wikipedia users. Managed . In a playful, laid-back form. Make an offer for improvement. Pages dedicated to <Corona Viris>. In Chinese.

If the aliens. Abandoned to Earth "Crown Virus". Do not stop their Vershörung. That, we will make an offer to improve the Wikipedia page in English.

(In sense. Why COVID 19. And, not COVID 2019?)213.181.48.96 (talk) 16:51, 30 May 2020 (UTC)

Semi-protected edit request on 25 May 2020

The first paragraph of the "Other animals" section ends with a discussion of minks. Please add the sentence "Concerns were raised that some people were infected by minks." This can be sourced to https://www.dutchnews.nl/news/2020/05/second-person-catches-covid-19-from-a-mink-minister-is-preparing-measures/ 147.161.14.48 (talk) 14:32, 25 May 2020 (UTC)

 Not done We are sticking to WP:MEDRS on this article. That's not a MEDRS source. —DIYeditor (talk) 14:38, 25 May 2020 (UTC)

Is it time to state more directly the risk of airborne transmission and that the use of masks and face coverings is recommended?

See https://science.sciencemag.org/content/early/2020/05/27/science.abc6197.full

Relevant parts: However, a large proportion of the spread of coronavirus disease 2019 (COVID-19) appears to be occurring through airborne transmission of aerosols produced by asymptomatic individuals during breathing and speaking (1–3). Aerosols can accumulate, remain infectious in indoor air for hours, and be easily inhaled deep into the lungs.

And: However, many countries have not yet acknowledged airborne transmission as a possible pathway for SARS-CoV-2 (1). Recent studies have shown that in addition to droplets, SARS-CoV-2 may also be transmitted through aerosols. Aerosol transmission of viruses must be acknowledged as a key factor leading to the spread of infectious respiratory diseases.

And finally: Thus, the option of universal masking is no longer held back by shortages. From epidemiological data, countries that have been most effective in reducing the spread of COVID-19 have implemented universal masking, including Taiwan, Hong Kong, Singapore, and South Korea.

I know this point is contentious so this source might not be enough. -- {{u|Gtoffoletto}}  ^talk 17:24, 28 May 2020 (UTC)

This is not a great source https://science.sciencemag.org/content/early/2020/05/27/science.abc6197.full

It is often transmitted through the air when people are in close contact but is not generally technically airborne.

More and more organizations are recommending face coverings as these are effective for droplets. I agree we should reflect this.

Simple face masks are likely sufficient however as the disease is not technically generally airborne and thus an N95 or PAPR is not usually needed. Doc James (talk · contribs · email) 08:15, 29 May 2020 (UTC)

Lots of countries recognize that airborne transmission can occur during aerosolizing medical procedures such as intubation. Just that this true airborne transmission is not the usual.

Masks are not just recommended for airborne transmission (in fact they are not sufficient for airborne transmission) they are also recommended for droplet transmission were they work fairly well. And thus they are recommended in this condition. Doc James (talk · contribs · email) 08:20, 29 May 2020 (UTC)

@Doc James:, just the phrase “true airborne transmission” . . . almost sounds like we’re back in the Middle Ages debating whether someone is a “true” Christian or whether infant christening counts as “true” baptism.

Medical science tried to use the everyday word “airborne” in a narrow technical sense, and then it sounds like this mistake was compounded. FriendlyRiverOtter (talk) 19:35, 31 May 2020 (UTC)

@Doc James: why not a great source? The source does specify that it is not "airborne" but that "airborne transmission through aerosols" is a major pathway. Maybe we could specify it just like that? Something like "transmitted through aerosols produced during breathing and speaking"? Yeah the article should just say masks are recommended in general. I think we should fix statements like There is limited evidence for or against the use of masks (medical or other) in healthy individuals in the wider community.[7]. The evidence is clearly in favour at this point. -- {{u|Gtoffoletto}}  ^talk 21:44, 29 May 2020 (UTC)

It is a perspective piece. We have the CDC, WHO, and ECDC .

Well it is indeed true their is little direct evidence for masks in otherwise healthy people, based on the precautionary principle and the physics of disease spread mask use is perfectly reasonable.

We also have sources such as https://pubmed.ncbi.nlm.nih.gov/32353901/?from_term=masks+COVID19&from_ac=no&from_user_filter=Review&from_schema=none&from_pos=6

Doc James (talk · contribs · email) 04:29, 30 May 2020 (UTC)

Have trimmed from the lead as it needs to be put into greater context which can be done in the body of the article. Doc James (talk · contribs · email) 05:16, 30 May 2020 (UTC)

@Doc James: I rewrote the lead [6] mostly using CDC Recommendation Regarding the Use of Cloth Face Coverings as a source. I've made a clearer distinction between "cloth face coverings" and "medical grade" masks with some simple examples to keep it short but clear. Seems clearer and more in line with the sources. Haven't touched the body yet. What do you think? -- {{u|Gtoffoletto}}  ^talk 09:48, 31 May 2020 (UTC)

Yes, agree, and sciencemag is a good source. But perhaps a new type of masks is coming: see here. My very best wishes (talk) 14:51, 31 May 2020 (UTC)

@Gtoffoletto: if I wear a mask, it’s my understanding that the mask is only mediocre in protecting myself, but it’s great in protecting others in case I’m asymptomatic or pre-symptomatic, or even if I have the classic symptom of a dry cough, it’s still great at protecting others. Is this the case? FriendlyRiverOtter (talk) 21:25, 31 May 2020 (UTC)

@FriendlyRiverOtter: That seems to be what the sources are suggesting yes. An extra physical barrier for the virus to overcome basically. So you spread it less AND it's slightly harder to inhale it AND you inhale less of it (lowered viral load might mean even if you get sick you will get sick "less" or at least that's what virologists are saying in Italy right now given the big drop in grave cases since masks were made mandatory. Also it might make the virus penetrate the lungs less "deeply"). So sources are suggesting it has positive effects on "both sides" although the main advantage is "reducing travel distance and spread" of the virus from infected individuals. -- {{u|Gtoffoletto}}  ^talk 09:03, 1 June 2020 (UTC)

@Gtoffoletto: okay, so we look up a reference, and that’s where I used to run into trouble . . . . . because references aren’t like ordering a la carte in a diner. I can pick a promising reference, but then, I kind of have to go with the flow. I have to dive in and summarize what it is saying the main points are. But then, once I start getting four or five references, it’s sometimes like lines intersecting on a map, and all the references together are hitting what I think are the main points. Perhaps your experiences have been similar. FriendlyRiverOtter (talk) 22:13, 1 June 2020 (UTC)

I think the studies are fairly clear and long recognized (in bacterial cases for sure) that the cloth mask reduces the infectiousness of the person wearing it. As a physical barrier, the cloth can stop some droplet particles as well, but smaller airborne particles not so much. However, once you inhale enough particles, you get the illness. However, whatever the Italians are saying they see, they are not stating it correctly. Reducing your inhaled particles doe not reduce your output. Once your infected, viruses take over your cells manufacturing processes and produce millions of copies, no matter how few it took to get you infected. WHO just came out with a statement about the Italians' reckless statement also. The Italian medical community might be seeing less cases, but I suspect that's a combination of mitigation measures, such as social distancing, and the fact that so many of them have already had the illness. MartinezMD (talk) 22:26, 1 June 2020 (UTC)

@MartinezMD: WHO just came out with a statement about the Italians' reckless statement. Who are those "Italians" you speak of and what statement? If you could provide some sources. It sounds like you are saying Italians are reckless which is a generalisation I would object to (as an Italian myself).

The initial amount of virus you are exposed to can have an effect on outcome (see Lancet). Imagine if you get infected by breathing in the cough of an infected individual. Or if you get infected by touching an infected surface and then your eyes. Obviously the initial viral load will be very different. The virus will replicate within you body at the same exponential speed but starting at 1 or at 1000 will make a difference. Your body will have less time to respond in the second case. There is clear evidence in Italy that wearing masks reduces that initial viral load (for example small towns such as Vo Euganeo that were the initial epicentres were forced to wear masks immediately and measured every day. The number of infected didn't change much but most patients had very mild symptoms). Lower initial viral load has been associated to less severe clinical symptoms. The virus is the same. But the results are different. Most ICUs in Italy are empty at the moment. Infections are milder and most agree it is due to those measures. -- {{u|Gtoffoletto}}  ^talk 13:10, 2 June 2020 (UTC)

There is no clinically significant evidence that the initial amount of virus you contract can have any effect on outcome, and the primary study in the Lancet article you cite says nothing about initial infection. For the rate of growth of an infection in general, please take a look at a respectable secondary source like Medical Microbiology by Bernard Roizman - you can read the chapter on 'Multiplication' online. A single infected cell can generate from a few thousand to a hundred thousand viruses in a single reproductive phase, so starting at 100 or 100,000 makes very little difference. There is no evidence in Italy (or anywhere else) that a lower initial infection results in milder symptoms. That's just your speculation and original research.

I wouldn't use it as a MEDRS-source, but there's a popsci article by New Scientist Does a high viral load or infectious dose make covid-19 worse? that discusses the question for COVID-19 and points out how the evidence is unclear, but seems different from what can happen with influenza. The fact is that we just don't know. --RexxS (talk) 20:13, 2 June 2020 (UTC)

@RexxS: Of course we don't know for sure yet. But we have evidence in that sense from observations made by virologists in Italy and elsewhere that are in the early stages of making that determination. And we have influenza, SARS and MEDRS that behave like that. The Lancet article also states DCt values of severe cases were significantly lower than those of mild cases at the time of admission. Now, I'm no expert in RT-PCR but from my understanding lower DCt means more virus detected. It's therefore not my speculation but theirs. In any case I'm not sure why you are pointing that out. It's not something we should add to the article at the moment and I don't think anyone is arguing that.-- {{u|Gtoffoletto}}  ^talk 23:24, 2 June 2020 (UTC)

@Gtoffoletto: We don't have evidence in any sense from anywhere until it gets published in a good quality reliable source, and we don't use it to make biomedical claims until the evidence has been analysed by a good quality reliable secondary source. Influenza was shown to exhibit some correlation in one Chinese study. That's not MEDRS. The behaviour in SARS and MERS is equally uncertain. You're confusing viral load (estimated by Direct Coombs TestDelta Ct) with the infectious dose and the strength of the initial infection. By the time you're measuring viral load at the time of admission, you're a long way past the initial infection and can't use results at that point to estimate it. It should not be surprising that people with high measured viral loads tend to have more pronounced symptoms at that point, but that says nothing about initial infections. Your assumption that a higher initial infection of COVID-19 leads to higher viral loads has no basis in evidence. That's the speculation and it's all yours. I assume you remember writing "The initial amount of virus you are exposed to can have an effect on outcome" three comments above. Why are you now pretending nobody is arguing that? --RexxS (talk) 23:57, 2 June 2020 (UTC)

I will repeat: I don't think anybody is arguing this should be added to the article so I'm not sure what you are arguing about and what your point is. By the way: ∆Ct does not stand for Direct Coombs Test. It stands for Delta cycle threshold and is used to measure the amounts of target nucleic acids in real time PCR. And no, I'm not talking of minimal infectious dose but of viral load. -- {{u|Gtoffoletto}}  ^talk 00:28, 3 June 2020 (UTC)

And I'll tell you again: you spouted nonsense on this page in your reply to MartinezMD, and I simply corrected you. Just the same as you corrected my mistake about dCT, except that I'm thanking you for pointing that out, not repeating the mistake as you seem determined to. You're welcome. --RexxS (talk) 00:42, 3 June 2020 (UTC)

Except I do not agree with your assessment that I "spouted nonsense" and "made a mistake", nor with your poor manners. In any case, this discussion is useless. Have a good day. -- {{u|Gtoffoletto}}  ^talk 00:48, 3 June 2020 (UTC)

You're entitled to delude yourself, but not to misinform others. That's the only lack of manners here. At least you're showing the sense not to pursue the nonsense any further. --RexxS (talk) 00:53, 3 June 2020 (UTC)

@Gtoffoletto: our article currently uses the following CDC source, which seems good, but I think we need to update the title and date, and most of all, make sure that we’re doing a solid, A-1 job of summarizing it.

—> "Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission". Centers for Disease Control and Prevention (CDC). 11 February 2020. Retrieved 17 April 2020.{{cite web}}: CS1 maint: url-status (link)

< ref name="cdc-cover" > is the ref name (without spaces for the angle brackets of course). FriendlyRiverOtter (talk) 20:13, 2 June 2020 (UTC)

@FriendlyRiverOtter: Yup that's what I used for the edits. I've also gone through the "Prevention" section. Let me know what you think of the summary of the source I did. I kinda mixed it with the ECDC and WHO source recommendations when it seemed appropriate and when they seemed to agree in order to solidify it a bit and avoid repetition. -- {{u|Gtoffoletto}}  ^talk 23:24, 2 June 2020 (UTC)

@Gtoffoletto: I think it’s fine to group ECDC, WHO, CDC when they’re saying the same thing, as well as a few other sources such as Harvard Public Health. And when they differ, we just need to be very matter-of-fact about it: “WHO says . . ” “CDC says . . , ” that kind of thing.
Now, if I have any special trait, it’s patience. So, I’m going to first take a good long look at the above CDC source and see how we do summarizing it. FriendlyRiverOtter (talk) 13:45, 3 June 2020 (UTC)

————————————

Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission

My summary:

Don’t give up social distancing of 6 feet, but face masks are recommended for when it’s hard to maintain this distance (such as grocery stores) “especially in areas of significant community-based transmission.”

A “significant portion” of persons infected with Coronavirus are asymptomatic. Persons can also spread the virus while pre-symptomatic.

This recommendation can “help people who may have the virus and do not know it from transmitting it to others.” That is, the mask is a benefit to others, and not directly to yourself.

These can be homemade masks.

Please don’t hog surgical masks or N-95 respirators that healthcare workers need. This article states that such “must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.”

And then there is a short video in which U.S. Surgeon General Jerome Adams shows how to make a mask using an old cloth and two rubber bands.

Title: Recommendations for Cloth Face Covers [shorter than old title]

Date: April 3, 2020

This is currently our reference # 26, although that can change as ones are added or deleted above it.

And, this is my first pass — and with a few tweaks, looks good at second pass. FriendlyRiverOtter (talk) 14:53, 3 June 2020 (UTC) FriendlyRiverOtter (talk) 18:23, 3 June 2020 (UTC)

The updated reference:

CDC (2020-04-03). "Recommendations for Cloth Face Covers". Centers for Disease Control and Prevention. Retrieved 2020-06-03.{{cite web}}: CS1 maint: url-status (link)

✅ I checked our article’s summary, and it looks good. FriendlyRiverOtter (talk) 00:44, 4 June 2020 (UTC)

@FriendlyRiverOtter: Thank you for double-checking! -- {{u|Gtoffoletto}}  ^talk 20:09, 4 June 2020 (UTC)

@Gtoffoletto: you’re welcome :-) FriendlyRiverOtter (talk) 20:29, 4 June 2020 (UTC)

———————————-

@Gtoffoletto: I've been away a couple of days. When I said Italians, I meant their medical officers making the reckless statements. Silvia Stringhini, an epidemiologist (early statements about it just being a "flu"), Dr Alberto Zangrillo, the head of the San Raffaele Hospital in Milan, Matteo Bassetti, head of the infectious diseases clinic at the San Martino hospital, stating the virus is losing it's strength [7] and the WHO had to issue a statement refuting them [8] MartinezMD (talk) 23:47, 3 June 2020 (UTC)

@MartinezMD: I would advise against generalisations based on nationality (a very slippery slope...) and also against blind trust of media reporting. There are many doctors all around the world saying very stupid things all day long. However, "the virus clinically no longer exists in Italy" is the quote by Zangrillo (translated). It is an accurate quote and statement. ICUs in Italy are empty at the moment (therefore clinically - which means within hospitals in Italian - it does not exist anymore). Zangrillo is not the head of San Raffaele. He is the head of the ICU units. [9] Reuters wrote an article stating that the "virus is loosing potency" which is not what Zangrillo said at all. And they also misidentified the person making the statement. Regarding Bassetti it is an incomplete quote. Original statements made to ANSA are here (in italian) [10]. He said the virus MAY be different. His hospital is also empty and the are observing directly that cases that arrive do not require the same kind of assistance that they did at the beginning. Please bear in mind that even if the statements were accurately reported (they clearly weren't and translated in a sensationalistic way with sensationalistic titles): those are but two of many doctors in Italy. It would be like saying that all Americans think that injecting disinfectant in their veins is a good idea just because their president said so. And at least out of basic respect, I would be extremely wary of calling senior professionals - that their life on the line every day and have seen thousands of patients die in their hands for the last few months due to this disease - "reckless" without double and triple checking it. Or you may turn out to be the one making a reckless statement. -- {{u|Gtoffoletto}}  ^talk 20:07, 4 June 2020 (UTC)

Semi-protected edit request on 1 June 2020

2409:4070:18B:2AB4:1CED:4116:D7E9:AB67 (talk) 09:47, 1 June 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. Naypta ☺ | ✉ talk page | 12:53, 1 June 2020 (UTC)

vasculotropic virus?

per ...Varga, Zsuzsanna; Flammer, Andreas J.; Steiger, Peter; Haberecker, Martina; Andermatt, Rea; Zinkernagel, Annelies S.; Mehra, Mandeep R.; Schuepbach, Reto A.; Ruschitzka, Frank; Moch, Holger (2 May 2020). "Endothelial cell infection and endotheliitis in COVID-19". The Lancet. pp. 1417–1418. doi:10.1016/S0140-6736(20)30937-5. Retrieved 2 June 2020....an unusual respiratory illness(introduces itself into the body, however its symptoms have vascular aspects....?)--Ozzie10aaaa (talk) 02:34, 2 June 2020 (UTC)

@Ozzie10aaaa: What change are you proposing? Keep in mind that the top of this talk page already cautions that this is not a forum. -- Tytrox (talk) 09:05, 2 June 2020 (UTC)

yes of course... however it may be wise to keep an eye on how this virus is defined (above article link) and [11][12]& Mehra, Mandeep R.; Desai, Sapan S.; Kuy, SreyRam; Henry, Timothy D.; Patel, Amit N. (1 May 2020). "Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19". New England Journal of Medicine. 0 (0): null. doi:10.1056/NEJMoa2007621. ISSN 0028-4793. Retrieved 3 June 2020.(though none are MEDRS) , thank you--Ozzie10aaaa (talk) 10:46, 2 June 2020 (UTC)

source for cytokine storm in COVID-19

https://www.sciencedirect.com/science/article/pii/S1359610120300927

anther scientific source about cytokine storm and covid 19

https://theconversation.com/blocking-the-deadly-cytokine-storm-is-a-vital-weapon-for-treating-covid-19-137690 — Preceding unsigned comment added by 79.182.207.77 (talk) 10:55, 3 June 2020 (UTC)

For new editors: how to read a coronavirus study

I thought this would be a good thing to post as adjunct advice for new editors just getting familiar with Wikipedia medical reliable sources.

• Zimmer, Carl (2020-06-02). "How to Read a Coronavirus Study, or Any Science Paper". The New York Times. Retrieved 2020-06-02.

Peaceray (talk) 15:55, 2 June 2020 (UTC)

General sanctions reminder

The notes at Wikipedia:General sanctions/Coronavirus disease 2019 #Application notes remind editors that:

• "Sources for any content related to medical aspects of the disease are expected to adhere to the standards laid down at WP:MEDRS."
• "the onus is on the editor seeking to include disputed content to achieve consensus for its inclusion. Any content or source removed in good faith and citing a credible policy-based rationale should not be reinstated without prior consensus on the article's talk page."

I remain concerned at the number of biomedical claims in some sections of this article that are sourced to primary studies or news outlets. MEDRS contains the following paragraph:

Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies. Primary sources should generally not be used for medical content – as such sources often include unreliable or preliminary information, for example early lab results which don't hold in later clinical trials.

It would be an improvement to remove biomedical claims that are sourced to primary studies, as well as those studies, and I believe that we should be taking that task seriously now. --RexxS (talk) 00:22, 3 June 2020 (UTC)

IFR section and local estimations

Some sources did a rule of 3 over data from particular regions (NYC and Bergamo). These are problematic because of age distribution in particular area can vary significantly . The amount of susceptible people from old age is particularly high in NYC. Also we can't exclude that NYC got flooded in cases and they experienced an exceptional situation. So it's not as simple as a rule of 3. I don't think the quality of the sources really hold in comparison with the others we have in that chapter. Iluvalar (talk) 19:24, 3 June 2020 (UTC)

IFR is not a fixed characteristic of a virus and can only be measured for a particular population. Not only is it affected by the age profile, but also by factors like health services being unable to cope with peak demand leading to deaths that would otherwise have been avoidable, which may have been true for example in Bergamo, which shows a high population fatality rate.

Nevertheless, it is an indisputable fact that the infection fatality rate cannot be less than the population fatality rate for a given population, and it is as simple as that. I don't understand what you're trying to say by "I don't think the quality of the sources really hold in comparison with the others we have in that chapter." Can you rephrase that into something more intelligible, please? Actually mentioning the sources you're comparing would be a kindness to other editors. --RexxS (talk) 20:10, 3 June 2020 (UTC)

First, I removed the 0.33% from the WHO's source because of the next day's report where they mention a change in the lower bound. For the "Firm lower limits" section, our first source is the brute data from NYC. I have no reason to doubt of the data, but there is no source to support the relevance of that data here. I don't feel like it's crucially relevant in any way. Regarding Bergamo the source ([13]) Have a warning on top redirecting to the CDC. "We don’t fact-check every story.". I don't feel like it compare to the WHO, CEBM and CDC combined. Iluvalar (talk) 00:30, 4 June 2020 (UTC)

Streamlining Prevention section

The second paragraph of our Prevention section ends with:

” . . After the implementationk of social distancing and stay-at-home orders, many regions have been able to sustain an effective transmission rate ("R_t") of less than one, meaning the disease is in remission in those areas.[128] In a simple model ${\textstyle \ln(R_{t})\approx R_{t}-1}$ needs on average over time be kept at or below zero to avoid exponential growth.”

[128] Systrom, Kevin; Krieger, Mike; O'Rourke, Ryan; Stein, Robby; Dellaert, Frank; Lerer, Adam (11 April 2020). "R_t Covid-19". rt.live. Retrieved 19 April 2020. {{cite web}}: Unknown parameter |name-list-format= ignored (|name-list-style= suggested) (help) Based on Bettencourt LM, Ribeiro RM (May 2008). "Real time bayesian estimation of the epidemic potential of emerging infectious diseases". PLOS ONE. 3 (5): e2185. Bibcode:2008PLoSO...3.2185B. doi:10.1371/journal.pone.0002185. PMC 2366072. PMID 18478118.{{cite journal}}: CS1 maint: unflagged free DOI (link)

———————————————

It first talks about ("R_t") being less than 1 and then basically talks about R - 1 needing to be less than 0. For the time being, I think we’d be better off without this second sentence. FriendlyRiverOtter (talk) 02:49, 4 June 2020 (UTC)

FriendlyRiverOtter, it sounds confusing, but I think it makes sense. If $R_{t}\leq 1$, then $R_{t}-1\leq 0$. It's another way of reading the first sentence, but describes it visually on a natural logarithm graph. —Tenryuu 🐲 ( 💬 • 📝 ) 15:31, 4 June 2020 (UTC)

I went and ahead removed it earlier today. I agree that it makes sense, but it’s redundant. Now, an actual graph might be more worthwhile if someone’s going to later add that. FriendlyRiverOtter (talk) 20:34, 4 June 2020 (UTC)

The point of the subtlety was that you don't need to keep R below 1 all the time. Just keeping the ln(R) below zero on average is enough to keep the disease from spiraling out of control over many generations of the virus. Remission and/or eradication can be another, but distinct policy goal. Jmv2009 (talk) 18:06, 5 June 2020 (UTC)

Primary source study postulating that a blood group type may be more susceptible to COVID-19 respiratory failure

Noting that the first citation is a primary source that has not yet been peer-reviewed that is ineligible for inclusion in this article because if fails to meet WP:MEDRS. Nonetheless, I ask that people keep an eye out for its inclusion in literature reviews or systematic reviews. The second citation is more of a lay summary.

• Ellinghaus, David; et al. (2020-06-02), The ABO blood group locus and a chromosome 3 gene cluster associate with SARS-CoV-2 respiratory failure in an Italian-Spanish genome-wide association analysis, Cold Spring Harbor Laboratory, doi:10.1101/2020.05.31.20114991
• Robertson, Sally (2020-06-03). "Blood group type may affect susceptibility to COVID-19 respiratory failure". News-Medical.net. Retrieved 2020-06-05.

Peaceray (talk) 19:03, 5 June 2020 (UTC)