Talk:COVID-19/Archive 9

Remdesivir
Before we get any more additions based on news sources like this, I want to state my objection in advance to including "breaking news" that makes biomedical claims based on nothing more than a bunch of US Officials waxing lyrical on the results of a single study. A single study isn't a WP:MEDRS compliant source, nor are the proclamations of politicians, even those with medical credentials. --RexxS (talk) 00:10, 30 April 2020 (UTC)

Postscript: I see that "Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial" (another trial) finds no statistically significant benefit. It's really too soon to be drawing conclusions, much as I'd like to hear good news. --RexxS (talk) 00:21, 30 April 2020 (UTC)
 * The FDA is medrs. They are allowed to use a single study, btu they don't they used all available data including unpublished data to make the determination, like we say on remdesivir. --Almaty (talk) 14:30, 3 May 2020 (UTC)
 * The FDA is only one nation's agency and this is an emergency approval, not full approval which requires a stronger level of review. If it has an effect, why haven't all other national agencies authorised its use – I'm unaware of any other agencies that agree with the claim of efficacy –  and why hasn't the WHO recommended it? Is it perhaps that no respectable expert is willing to make recommendations based on a single study and other unpublished primary sources? --RexxS (talk) 00:53, 4 May 2020 (UTC)
 * The FDA is only one nation's agency and this is an emergency approval, not full approval which requires a stronger level of review. If it has an effect, why haven't all other national agencies authorised its use – I'm unaware of any other agencies that agree with the claim of efficacy –  and why hasn't the WHO recommended it? Is it perhaps that no respectable expert is willing to make recommendations based on a single study and other unpublished primary sources? --RexxS (talk) 00:53, 4 May 2020 (UTC)

Put the WHO recommendation first as it is more global thus adjusted the text to:

"According to the World Health Organization, there are no available vaccines nor specific antiviral treatments for COVID-19. On May 1st 2020, the United States gave Emergency Use Authorization to the antiviral remdesivir for people hospitalized with severe COVID-19."

Doc James (talk · contribs · email) 08:12, 4 May 2020 (UTC)

Semi-protected edit request on 4 May 2020
Please change "In New York City, with a population 'if' 8.4 million..." to "of" because the it is a typo and I believe it should be "of". John Oliver Rivera (talk) 13:25, 4 May 2020 (UTC)
 * ✅. Thanks. Boing! said Zebedee (talk) 13:32, 4 May 2020 (UTC)

Reinfection details unclear
I don't want to fix this myself but this sentence is grammatically incorrect and I'm not sure what it should say: "At least one long running research report showed that some of the other in humans circulating coronaviruses are often capable of reinfection after roughly a year.".— Vchimpanzee  •  talk  •  contributions  •  18:13, 3 May 2020 (UTC)
 * Adjusted to "One long running research report has found that some of other coronaviruses circulating people are capable of reinfection after roughly a year." Doc James  (talk · contribs · email) 07:49, 4 May 2020 (UTC)
 * Still not right, but I think I know how to fix it.— Vchimpanzee  •  talk  •  contributions  •  15:57, 4 May 2020 (UTC)

COVID-19 causes unique rashes according to new study?
I don't particularly feel qualified to make additions myself to such a topically critical article, but the BBC today had an article about a Spanish study that tracked unique rash-like symptoms in COVID patients, including a variant being referred to as "Covid Toe". Seeing as this appears to be being described as a unique aspect of this disease I feel it is probably worth at least a mention here, although the article as it currently stands doesn't mention the word "rash". BlackholeWA (talk) 09:21, 3 May 2020 (UTC)
 * This is a list of symptoms dermatologists observed from patients WITH covid. It have no correlation power at all knowing that covid is fairly common now. This look much more like cases of intolerance or overuse of bleach and disinfectant then anything else. It will take much more study before we add this to the already long long long list of very odd claimed symptoms. Iluvalar (talk) 15:50, 3 May 2020 (UTC)
 * The NYTs https://www.nytimes.com/2020/05/01/health/coronavirus-covid-toe.html uses a picture from Wikipedia for chilblains Doc James  (talk · contribs · email) 07:51, 4 May 2020 (UTC)
 * The presence of a rash may be a part of the illness, but it seems like it is still not well defined and actually a mix of true rashes with incidents of ischemia (low oxygen or blood flow damage). Injury to the toes is not unique to COVID, as it can happen with any severe illness to the toes and fingers as well (see Meningococcal disease). If we have a decent secondary MEDRS source, I support including it. It just has to be clear what is being described. MartinezMD (talk) 16:11, 4 May 2020 (UTC)

Removing links to blank pages on head
Can someone with the technical skill please fix the article header so that the numbers of cases don’t link to blank articles? The header of the article has self-updating counts of the number of deaths and recoveries, but oddly, these are formatted as links to pages that do not exist. The error must be in the formatting, but I don’t know what wizardry is going on in those self-updating numbers so I don’t want to break it. Albertoeda (talk) 22:48, 5 May 2020 (UTC)
 * Those pages were renamed a couple of days ago. Discussion at Talk:COVID-19 pandemic cases . I've fixed this article. --RexxS (talk) 23:50, 5 May 2020 (UTC)
 * Those pages were renamed a couple of days ago. Discussion at Talk:COVID-19 pandemic cases . I've fixed this article. --RexxS (talk) 23:50, 5 May 2020 (UTC)

Move discussion in progress
There is a move discussion in progress on Talk:2019–20 coronavirus pandemic which affects this page. Please participate on that page and not in this talk page section. Thank you. Sawol (talk) 03:50, 2 May 2020 (UTC)
 * thank you for posting--Ozzie10aaaa (talk) 20:05, 2 May 2020 (UTC)
 * Because the article on the pandemic has been renamed to COVID-19 pandemic with "Clear WP:SNOW support for renaming other articles for consistency if the RM above passes",(comment from closer of related discussion) is there a reason not to implement the change here? —RCraig09 (talk) 16:52, 6 May 2020 (UTC)
 * My understanding is that consensus refers there to the article on the pandemic and all articles flowing from the pandemic. I don't think that it can flow upstream to the disease itself, which is a parent article to the pandemic. BD2412  T 17:20, 6 May 2020 (UTC)
 * , the general convention that I've seen is that the title of a disease should be written as full and abbreviations and acronyms are mentioned in the lead. The only exception I'm aware of is HIV/AIDS. — Tenryuu 🐲 ( 💬 • 📝 )  17:35, 6 May 2020 (UTC)

Update: The discussion has been closed and the page has been moved to COVID-19 pandemic.

Semi-protected edit request on 4 May 2020
Under Prognosis, add to:

"The Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available for review, 97.2% of sampled patients had at least one comorbidity with the average patient having 2.7 diseases.[219]"

the following:

"However, the number of comorbidities were found to be typical for the age group, in fact, researchers found that on average patients dying from COVID-19 in hospitals would have been expected to live around a decade longer (13 years for men and 11 years for women) even when comorbidities are taken into account."

Sources:

Primary - https://wellcomeopenresearch.org/articles/5-75/v1 Secondary - https://www.economist.com/graphic-detail/2020/05/02/would-most-covid-19-victims-have-died-soon-without-the-virus; https://www.wsj.com/articles/coronavirus-kills-people-an-average-of-a-decade-before-their-time-11588424401 Mrnifjc (talk) 12:13, 4 May 2020 (UTC)


 * ❌ - I’m having trouble understanding what this means and how it’s relevant. What “age group” are you referring to? What does that have to do with “living a decade longer”? “Longer” than what? Clarification is needed. — Tartan357  (Talk) 02:35, 6 May 2020 (UTC)
 * ❌ - I’m having trouble understanding what this means and how it’s relevant. What “age group” are you referring to? What does that have to do with “living a decade longer”? “Longer” than what? Clarification is needed. — Tartan357  (Talk) 02:35, 6 May 2020 (UTC)


 * His summary of the source is that the typical person dying of Covid had the average number of health problems and should've lived for another 10 years on average if not for them dying of this illness. Not sure if that's what he wants to add specifically or something else however. MartinezMD (talk) 02:54, 6 May 2020 (UTC)


 * Thank you MartinezMD, this is what I meant, apologies for not being clearer. The paragraph opens stating "Most of those who die of COVID‑19 have pre-existing (underlying) conditions" and my amendment was intended to highlight research that research shows that even when age and comorbidity are accounted for the predicted lifespan of the individuals who've died in hospital would have been over 10 years longer. — Preceding unsigned comment added by Mrnifjc (talk • contribs) 19:53, 6 May 2020 (UTC)

Airborne Transmission
SARS-CoV-2 can remain viable in aerosols for 3 hours, floating in the air getting inhaled by other people. This is the reason why SARS-CoV-2 is so highly contagious and spreads extremely fast. The WHO should inform itself about this fact and adapt its recommendations accordingly. If people keep believing in droplets falling to the ground soon, we will have no chance to manange this pandemia successfully. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. Sciencia58 (talk) 07:45, 4 May 2020 (UTC)
 * That is simple a letter to the editor. Yes there are AGMPs that create longer lasting aerosols but these are not a general occurrence. We should stick with the CDC and WHO and ECDC as source.
 * This is contagious yes, but this is not measles. Doc James  (talk · contribs · email) 07:46, 4 May 2020 (UTC)
 * The WHO and other authorities are so busy now with other things that they have no time to read new publications in time. If they want to look something up, they take a look at Wikipedia and read their own outdated nonsense. This is a vicious circle that only we can break. SARS-CoV-2 is more contagious than measles because people neither had it in their childhood nor are vaccinated. It is also more contagious because all adults can get it, who have a variety of social contacts outside the home. If they believe in falling droplets, which is only true for the large heavier droplets but not for the small ones, we add to the spread with such outdated statements. We are a scientific encyclopaedia and must reproduce the most up-to-date information from peer-reviewed publications. Sciencia58 (talk) 10:13, 4 May 2020 (UTC)
 * See also Bioaerosol. Sciencia58 (talk) 11:53, 4 May 2020 (UTC)
 * Please don't spread your misinformation here.
 * The WHO is perfectly capable of keeping track of research and summarising it for everyone's use.
 * Wikipedia is a tertiary source and nobody at WHO is likely to mistake it for anything else.
 * SARS-CoV-2 is less contagious than measles. In most countries SARS-CoV-2 has an R0 between 2 and 5, while the R0 for measles is 12–18 (Lancet).
 * Either you're very badly informed or deliberately trolling, because it's common knowledge that measles can affect people of any age (Medscape).
 * All droplets fall, including aerosols, and we have good sources already in the article saying so.
 * You are scaremongering based on poor sources and discredited gossip. This isn't the place for your soapboxing. --RexxS (talk) 20:47, 4 May 2020 (UTC)
 * Aerosol SARS-CoV-2 have an half-life of ~60 minutes in absence of sunlight According to the Homeland Security Department. So, several hours. Iluvalar (talk) 14:48, 7 May 2020 (UTC)
 * Aerosol SARS-CoV-2 have an half-life of ~60 minutes in absence of sunlight According to the Homeland Security Department. So, several hours. Iluvalar (talk) 14:48, 7 May 2020 (UTC)

Tobacco and nicotine
I'm surprised there aren't more references to correlations between tobacco consumption and onset and progress of the infection. The only one is from mid-March, and since then I believe there have been some unexpected benefits reported, backed up with data, with the hypthesis that nicotine is the effective agent. I guess there are no completed studies, much less peer review, so is that the reason? Shtove 19:45, 4 May 2020 (UTC)
 * Could you link one of them? Nithintalk 21:01, 4 May 2020 (UTC)
 * Here's one Science Direct editorial relating to China (I'm aware of some correlations from France too, although the only links I can find are to newspapers): "On that date, we presented for the first time a hypothesis about the potential beneficial effects of nicotine, which was subsequently expanded [37]. While there were limitations in the study analysis, mainly due to the inability to adjust for confounding factors, the findings of low smoking prevalence among hospitalized COVID-19 patients in China were consistent across all studies and in agreement with case series from USA [38,39]. The original hypothesis was based on the anti-inflammatory properties of nicotine through the cholinergic anti-inflammatory system, acknowledging that the disease appeared to involve a dysregulation of the immune response to viral invasion."


 * Please see WP:MEDRS Doc James  (talk · contribs · email) 06:29, 5 May 2020 (UTC)
 * This review may be useful. (COI: I know some of these authors.) Bondegezou (talk) 14:57, 5 May 2020 (UTC)
 * I'd have to find a link, but I just saw a story which most people here can't access. A study will use tobacco leaves to see if antibodies can be produced.— Vchimpanzee  •  talk  •  contributions  •  18:54, 7 May 2020 (UTC)
 * Forgot to do this. Here is my link. That's a month old so maybe there's been an update.— Vchimpanzee  •  talk  •  contributions  •  21:38, 7 May 2020 (UTC)

People lose their sense of taste
This is not the same as loss of sense of smell. I'm sorry I don't have the type of source you're looking for but I have seen or heard about people losing their ability to taste over and over and it's not even mentioned.— Vchimpanzee  •  talk  •  contributions  •  17:28, 1 May 2020 (UTC)
 * Find a good reference. Likely the issue is that smell is a major contributor to what the average person describes as taste, which is covered in the WP article. MartinezMD (talk) 17:52, 1 May 2020 (UTC)
 * I doubt anything I found is going to satisfy you. The amazing thing is that no one has apparently found anything yet.— Vchimpanzee  •  talk  •  contributions  •  18:18, 1 May 2020 (UTC)
 * I have updated the article adding loss of taste sourced to CNBC. Veritycheck✔️ (talk) 18:57, 1 May 2020 (UTC)
 * Thanks. All I really had were individuals describing their own experiences.— Vchimpanzee  •  talk  •  contributions  •  19:14, 1 May 2020 (UTC)
 * We should use sources per WP:MEDRS not the popular press.
 * We have this source https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html which is already present Doc James  (talk · contribs · email) 08:47, 2 May 2020 (UTC)
 * Not a printed study, but an interview with one of the established professors in Germany:
 * https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavirus/neue-corona-symptome-entdeckt-virologe-hendrik-streeck-zum-virus-16681450.html "... Almost all infected people we interviewed, and this applies to a good two thirds, described a loss of smell and taste lasting several days. It goes so far that a mother could not smell the full diaper of her child. Others could no longer smell their shampoo, and food began to taste bland ..." --Con-struct (talk) 07:27, 8 May 2020 (UTC)

Current consensus list?
What happened to this article's current consensus list? It's at Talk:Coronavirus disease 2019/Current consensus but no longer on this talk page — did we forget to pin it and let it get archived? Can we restore it? &#123;{u&#124; Sdkb  }&#125;  talk 06:24, 8 May 2020 (UTC)
 * Not sure. Please feel free to restore it. Doc James  (talk · contribs · email) 07:16, 9 May 2020 (UTC)

Removal of cited statement concerning materials used in retention study
A while ago, I added some information on this page, as well as another, from an NIH study about the stability of coronavirus on various surfaces. It seemed to have been completely removed in subsequent edits, and due to edit volume I was not able to figure out which specific diff took it out. Since there isn't any discussion about it on the talk pages, I'm adding it back to both articles. It seems to have been removed accidentally -- if there is a reason for this information to be removed, I'll take it back out. { $\mathbb{JPG}$ } 03:57, 8 May 2020 (UTC)
 * found it.
 * I've replied on the relevant discussion with the diff for the removal from the SARS-CoV-2 article. Cheers, Rotideypoc41352 (talk · contribs) 20:14, 8 May 2020 (UTC)
 * Yes while you can detect the virus for varied amount of time, that doesn't mean that its infectious. A parallel thing is if you can detect dinosaur DNA in a fossil, that doesn't mean that you have found a live dinosaur. So whilst interesting, it doesn't particularly belong in the transmission section. To follow MEDRS, WHO and ECDC make mention of this study, noting that it may not be infectious, and I paraphrase them. --Almaty (talk) 22:58, 8 May 2020 (UTC)
 * Right. I don't know that it belongs in the "Transmission" section (I have a vague memory of it having originally been somewhere else). If it fits better somewhere else, it should probably be moved there, and given clarification on this point. The current text says "may remain viable", perhaps it could be changed to "remains detectable (and may remain viable)"? { $\mathbb{JPG}$ } 00:07, 9 May 2020 (UTC)
 * I dont think we should cite the study directly just the WHO and ECDC and CDC's interpretation of it per WP:MEDRS --Almaty (talk) 01:45, 9 May 2020 (UTC)
 * Per User:Almaty agree we should try to move to secondary sources as they mention. Doc James  (talk · contribs · email) 07:17, 9 May 2020 (UTC)
 * Per User:Almaty agree we should try to move to secondary sources as they mention. Doc James  (talk · contribs · email) 07:17, 9 May 2020 (UTC)

"Disinfectants or bleach are not a treatment for COVID-19"
This is a confusing statement because these can kill the virus when applied to surfaces. I understand the purpose is to try to respond to Trump's statements but that could be under some "Trump's response to covid-19 if you all want to go there. I'd rather this be a 'what we do know about covid' and not a snopes article.  in fact, there is a whole page dedicated to misinformation https://en.wikipedia.org/wiki/Misinformation_related_to_the_COVID-19_pandemicJawz101 (talk) 20:40, 7 May 2020 (UTC)
 * It really isn't confusing. You don't treat a disease by disinfecting surfaces. You might indeed do that to prevent future infection, but nobody who has contracted COVID-19 is going to be treated with bleach (I hope). --RexxS (talk) 21:05, 7 May 2020 (UTC)
 * I think it's still a slightly ambiguous word. The place where chlorine is added to water to prevent disease is called a water treatment plant, after all. Think "treating the surface" not "treating the disease". Suffusion of Yellow (talk) 21:29, 7 May 2020 (UTC)
 * Sure, you're treating the water in a "water treatment plant" by adding chlorine to it. Adding chlorine to people, on the other hand, is usually called chemical warfare.
 * Think "bleach will treat the surface" because we can use bleach on the surface. But I don't believe you can think "bleach will treat the patient" because we don't use bleach on people (other than dyed blondes, or the Donald, of course). --RexxS (talk) 01:30, 8 May 2020 (UTC)
 * Sounds like a matter of ambiguity. Why not just say "disinfectants and bleach are not used as human treatments for COVID-19"? I hope people are smart enough not to try this on animals. — Tenryuu 🐲 ( 💬 • 📝 )  18:54, 8 May 2020 (UTC)
 * COVID-19 is a disease, not a virus. We treat diseases in people. Bleach and disinfectant are used on surfaces to kill the virus, not treat the disease. Where's the ambiguity? --RexxS (talk) 21:12, 8 May 2020 (UTC)
 * Indeed, there's no ambiguity at all. Using disinfectants and bleach to kill a virus on a surface is simply not a treatment for the disease. A preventative measure perhaps, or a treatment of the surface, but not a treatment for the disease. Boing! said Zebedee (talk) 21:20, 8 May 2020 (UTC)
 * Agree with User:RexxS Doc James  (talk · contribs · email) 07:20, 9 May 2020 (UTC)
 * Indeed, there's no ambiguity at all. Using disinfectants and bleach to kill a virus on a surface is simply not a treatment for the disease. A preventative measure perhaps, or a treatment of the surface, but not a treatment for the disease. Boing! said Zebedee (talk) 21:20, 8 May 2020 (UTC)
 * Agree with User:RexxS Doc James  (talk · contribs · email) 07:20, 9 May 2020 (UTC)

Another mutated virus which is even more contagious?
I'm suspicious of the source anyway. Perhaps someone knows some reliable information and if such information is already included in the various articles.

The web site has a list of headlines, mostly about celebrities, and fails to make clear who the article is about or what the big problem is, meaning we have to click to see details. I have repeatedly told my phone company that I either want to go directly to my email or to stay signed in. Unlike Wikipedia, my phone company's email doesn't let me check a box to stay signed in, and if I'm not signed in I have to click an extra time to get to the sign-in page for my email--AFTER I have been subjected to these dire headlines. And my phone company needs to be ashamed for having such a web site in the first place.— Vchimpanzee  •  talk  •  contributions  •  15:59, 7 May 2020 (UTC)
 * There are several lineages of the same strain. One of which is more frequent than expected. But it seems too early to take conclusions for now. Iluvalar (talk) 17:53, 7 May 2020 (UTC)
 * This was posted on Facebook and I think the headline is the same as the one on my phone company's web site.— Vchimpanzee  •  talk  •  contributions  •  18:49, 8 May 2020 (UTC)
 * Short story short, i'm suspicious too. They seem to have taken the inferred dates on GISAID as truth. And there is things that they can't explain. Mainly why another lineage got so prominent. I think my opinion on that one is already known, so i'm gonna stop here. Hmmm, not sure we can do much with this source. Any suggestion from anyone else ? Iluvalar (talk) 01:05, 9 May 2020 (UTC)
 * I wasn't expecting to use the source. I was asking what reliable information there was on this theory.— Vchimpanzee  •  talk  •  contributions  •  15:22, 9 May 2020 (UTC)

First second third and fourth sentences of second paragraph
Minor changes propopsed to keep up with the WHO ECDC and CDC FAQs. CDC particularly. The virus is primarily spread between people during close contact, most often via small droplets produced by coughing, sneezing, and talking. The droplets usually fall to the ground or onto surfaces rather than travelling through air over long distances. Less commonly, people may become infected by touching a contaminated surface and then touching their face. It is most contagious during the first three days after the onset of symptoms, although spread may be possible before symptoms appear, or from people who do not show symptoms. COVID-19 is a new disease, with many modes of spread under investigation. It spreads very efficiently and sustainably between people – easier than influenza, but not as efficiently as measles. It does this mainly when people are in during close contact, most often via small droplets produced by coughing, sneezing, and talking. During close contact, (1 to 2 metres, 3 to 6 feet), people catch the disease after breathing in contaminated droplets that were exhaled by infected people. Less commonly, people may become infected by touching a contaminated surface and then touching their face. It is likely to spread when people are symptomatic, including mild symptoms, although spread may occur 2 days before symptoms appear, or from people who do not show symptoms.
 * Old version
 * New Version
 * References

Thanks, --Almaty (talk) 13:33, 10 May 2020 (UTC)
 * The only major difference I see is the addition of details about relative spreading capability. Is that not covered elsewhere in this already long article? Otherwise I prefer the older wording for the reminder; although that one too could be improved slightly (albeit not as dramatically as you suggest). The efn about close contact, on it's own, should be added in the article if nobody objects (if it's not covered elsewhere).RandomCanadian (talk | contribs) 18:20, 10 May 2020 (UTC)
 * That paragraph is excerpted from coronavirus disease 2019, so I'm going to move this conversation there. It seems like most of the changes here are adding detail that makes the paragraph less concise, so I have to generally oppose, with the caveat that I do think some tweaks to that paragraph could improve it if we can find the right ones. I'd suggest proposing changes more individually rather than all together, so that we can discuss each on its own merits. &#123;{u&#124; Sdkb  }&#125;  talk 19:16, 10 May 2020 (UTC)
 * OK i propose adding It spreads very efficiently and sustainably between people – easier than influenza, but not as efficiently as measles.. This is very pertinent, because traditionally, influenza viruses are considered to spread from person to person primarily through large respiratory droplets. This disease spreads easier than influenza, per the data and the CDC. This sentence is therefore important. --Almaty (talk) 11:34, 11 May 2020 (UTC)
 * Prefer the original version as User:Sdkb says it is more concise. I do not think "COVID-19 is a new disease, with many modes of spread under investigation." is needed in the lead. Comparing it to other diseases IMO also belongs in the body rather than the lead "It spreads very efficiently and sustainably between people – easier than influenza, but not as efficiently as measles". Well accurate this is fairly details information. Doc James  (talk · contribs · email) 14:28, 11 May 2020 (UTC)
 * Would support changing "It is most contagious during the first three days after the onset of symptoms..." to "It is most likely to spread during the first three days after the onset of symptoms..." Happy with User:RandomCanadian's suggestion.
 * It is also not simple "likely to spread when people are symptomatic", it is just relatively more likely than at other times. It maybe unlikely to spread as long as everyone is taking appropriate measures. Doc James  (talk · contribs · email) 14:31, 11 May 2020 (UTC)

Cough (dry versus vet)
Per here about 31% have a wet cough with 71% having a cough. So 44% of those with a cough have a wet one. I do not think it useful to clarify in the infobox that the cough is usually dry as it is nearly 50/50. Doc James (talk · contribs · email) 14:45, 11 May 2020 (UTC)

Gangelt study
It appears I was warned related to me for adding a pdf preprint. However, it was a primary source listed together with a secondary source, which was allowed. Acknowledgement that the preprint only became available after the secondary sources used the result of a press conference and an exerpt/press release of the study. The primary source is useful as it partially clears up confusion about the reliability of the used test (false positives supposedly only in earlier versions of the test, according to more extensive test by manufacturer, with confirmation of authors of study with much weaker statistics), and it makes it clear the shot noise / uncertainty associated of only 7 deaths was indeed not properly taken into account. The pdf is now replaced by a more recent medx archive version. Jmv2009 (talk) 03:40, 10 May 2020 (UTC)
 * First, preprint materials have not been subject to the same scrutiny as published journal articles. Their reliability is therefore not established.
 * Secondly, the use of primary sources in medical content is discouraged by Identifying reliable sources (medicine): The sentence in question "According to CEBM, random antibody testing in Germany suggested an IFR of 0.37% (0.12% to 0.87%) there, but there have been concerns about false positives." is already supported by four sources and another one is completely unnecessary. You may not clump together a bunch of primary sources to attempt to make a point that secondary sources do not make. That applies to all content, and even more so to medical content, which demands stringent adherence to our sourcing requirements. The Gangelt study preprint is a primary source, is not useful at all, and should not be in the article. --RexxS (talk) 19:06, 10 May 2020 (UTC)
 * I agree with RexxS, this source is redundant. But as long as we use the old source from WHO as our flag source with an IFR up to 2.9, I think it's just fair and NPOV to keep stacking the sources that contradict it. BTW, I quote again the source used by WHO "All estimates and assessments are preliminary. We are providing them to guide decision making in the absence of better information, and they will continue to be revised or be superceded by the work of others as evidence warrants." (bold from the source). Iluvalar (talk) 20:02, 10 May 2020 (UTC)
 * I absolutely disagree that it's NPOV to use primary studies to contradict secondary sources. WP:MEDPRI states: Please don't think that the last sentence can be read without taking account of the prior five sentences. --RexxS (talk) 20:18, 10 May 2020 (UTC)
 * Okay, I fixed it. Btw I do have the source (see above) but no WP:MEDPRI sources to prove it. So I decided to err on the side of caution and not add any primary source which is not quoted properly by a WP:MEDPRI secondary source. So we gonna have to stick, as the source black white write it : "one research group". Or is it WP:COPYRIGHT ? Maybe i should change a word ? Iluvalar (talk) 21:49, 10 May 2020 (UTC)
 * I don't know what kind of WP:POINT you're trying to make by changing "the World Health Organization" to "one research group". How on Earth is that improving the article? You should not be using primary sources, especially when secondary sources exist. Period. Use the secondary sources to write accurate and neutral content; that's all any editor should be doing for our medical content. --RexxS (talk) 21:59, 10 May 2020 (UTC)
 * That's what the source say, did you read it ? I just corrected the quote. Maybe you feel like it's less relevant now, which I also agree, but never the less, that's what the source say ("one research group"). Iluvalar (talk) 22:23, 10 May 2020 (UTC)
 * The text in our article is not a quote. Read WP:QUOTE. Even if it were, you don't quote the primary source, you quote the secondary source that discusses it. Once the WHO makes use of a source to make a statement or reach a conclusion, it's the WHO's statement or conclusion, not the primary sources's, and it carries the authority of the WHO, not just the primary source's. We summarise what the WHO says, and if you insist on attributing it, you must attribute the WHO, the secondary source. Stick with the secondary sources and keep off the primary ones: they're not suitable. Do you understand now? --RexxS (talk) 22:59, 10 May 2020 (UTC)
 * I must repeat I'm afraid, did you read the source ? Can we stick to what the source say ? Iluvalar (talk) 00:16, 11 May 2020 (UTC)
 * Do be so rude. I know what the WHO source says, and it's the WHO that's saying it. Why are you trying to weaken the authority of the statement by the WHO by attributing it to some unnamed "research group"? Are you playing silly "dis the WHO" games? --RexxS (talk) 01:50, 11 May 2020 (UTC)
 * The WHO source say that "one research group" estimated. I have no issues telling you that it's the Institute for Disease Modeling and here is the primary source : . It's a GREAT source, which aged pretty well. However they only had 761 confirmed cases to work with. There is now 4 millions cases. And I rarely see any source talking of an IFR above 1% let alone 2%. I don't see why we are so attached to this source which is outdated. Iluvalar (talk) 06:05, 11 May 2020 (UTC)
 * Agree with User:RexxS we should be sticking with secondary sources. We do not need to be using preprints. Doc James  (talk · contribs · email) 14:39, 11 May 2020 (UTC)
 * Can we please stop with the wikipedia buzz-words used out of context ? It was a secondary source. The preprint was posted on may 8, the sentence Jmv2009 sourced with it was in the article in may 6. It's obvious it's not a primary source. We all agree for now, let stick strictly to the sources. But in short term we'll have to talk again about early IFR estimations which are outdated now. Iluvalar (talk) 17:51, 11 May 2020 (UTC)
 * of course we can stop using buzz-words. Stop using preprints for any medical content at all; stop using primary sources for biomedical content. Is that clear enough for you now? --RexxS (talk) 20:51, 11 May 2020 (UTC)
 * This is quite a bizarre disagreement here, considering that WP:RS and WP:MEDRS are so clear. RexxS is 100% correct here. Boing! said Zebedee (talk) 21:10, 11 May 2020 (UTC)
 * No he's not, he's still saying it's a primary source when it was not even published when the text in the article was written. This being said, I removed the link myself. This problem is over for now. Iluvalar (talk) 21:21, 11 May 2020 (UTC)

In my experience (stretching back more than a few years now) when it comes to Wikipedia sourcing, if you go on the assumption that RexxS's understanding is correct, you'll rarely be wrong. Boing! said Zebedee (talk) 21:27, 11 May 2020 (UTC)

Semi-protected edit request on 12 May 2020
pandemic statistics Abdullahiabdul7 (talk) 12:55, 12 May 2020 (UTC)
 * ❌. You haven't included the details of the change you actually wish to make, or provided a source for any statistics. Boing! said Zebedee (talk) 13:21, 12 May 2020 (UTC)
 * I think you may be looking for the article COVID-19 pandemic. --RexxS (talk) 18:31, 12 May 2020 (UTC)

Semi-protected edit request on 14 May 2020
List of companies that are in the race to find a treatment or vaccine for the novel coronavirus (COVID-19: Drugs in Development). Steve00257 (talk) 06:03, 14 May 2020 (UTC)
 * I don't think a small selection of companies made by an investment site is a good source for us to use, especially as it's really just clickbait for its "latest records of COVID-19 Drugs in Development Calendar". There are many more companies engaged in research than that small selection, and an exhaustive list would essentially just be a list of all the world's major pharamaceuticals plus dozens of smaller ones. I don't see encyclopedic value in that. Boing! said Zebedee (talk) 06:15, 14 May 2020 (UTC)
 * If anything, that might belong in COVID-19 drug development or COVID-19 vaccine, but not here. MartinezMD (talk) 06:17, 14 May 2020 (UTC)
 * And even there, my objection to this source would stand. Boing! said Zebedee (talk) 06:23, 14 May 2020 (UTC)

vitamin D
I suppose something could be written in the article about the role of vitamin D. see here and here. I keep finding this information looking for non medical ones, so there might be some worth in it. Regards.--Alexmar983 (talk) 22:35, 12 May 2020 (UTC)


 * I agree and so have added a paragraph about Vitamin D: . Andrew🐉(talk) 23:50, 13 May 2020 (UTC)
 * I really wish you wouldn't, . That's a biomedical claim and those are primary sources. A search on Trip database offers a good review from the Centre for Evidence-Based Medicine which concludes there is no clinical evidence. Until we get another secondary source that gives a different conclusion, that's what we should stick with. --RexxS (talk) 01:08, 14 May 2020 (UTC)


 * They're crap studies too. First one says low vitamin D is associated with increased mortality, but also that happens in old people who happen to the ones at most risk for dying from Covid. The second one is pre-print (not peer reviewed) and that has been the focus of intense discussion -see section above, and the best they can conclude is "could possibly improve clinical outcomes... Further research should conduct randomized controlled trials and large population studies to evaluate this recommendation." - in other words "We don't know, maybe someone can do a better job than us" is my interpretation of that. MartinezMD (talk) 02:13, 14 May 2020 (UTC)
 * Furthermore, I removed a single reference to Vitamin D in the article that was out of place and also the source said "Disclaimer: This article has not been peer-reviewed". MartinezMD (talk) 05:46, 14 May 2020 (UTC)


 * Agree with RexxS and MartinezMD. Yes COVID "could" be associated with anything and everything. That does not mean that any of these associations are causal / meaningful. This is one more reason why we so strongly support the use of high quality secondary sources, to winnow out all these poorly supported associations. Yes unhealthy people have low vit D, yes unhealthy people die from COVID. Just as towns with alot of pubs also have a lot of churches. Doc James  (talk · contribs · email) 02:23, 14 May 2020 (UTC)
 * And I agree with RexxS, MartinezMD and Doc James. Any content added based on those sources should be removed. Boing! said Zebedee (talk) 06:19, 14 May 2020 (UTC)


 * So, a distinguished professor of epidemiology at Harvard says that "the evidence is becoming quite compelling" but we require more. Ok, let's start collecting relevant sources:


 * Does Vitamin D Protect Against COVID-19?
 * The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality
 * Is vitamin D an important biomarker for symptom severity in COVID-19?
 * Vitamin D for prevention of respiratory tract infections
 * The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients
 * COVID-19 ’ICU’ risk – 20-fold greater in the Vitamin D Deficient.
 * Vitamin D advice for everyone: coronavirus
 * Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study
 * Coronavirus: Should I start taking vitamin D?
 * Perspective: improving vitamin D status in the management of COVID-19
 * Vitamin D and Inflammation: Potential Implications for Severity of Covid-19
 * A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (has a section on Vitamin D, showing the weight given in context with other factors)
 * Vitamin D and SARS-CoV-2 virus/COVID-19 disease
 * Vitamin D concentrations and COVID-19 infection in UK Biobank


 * There's a variety of sources there. As lots of respectable people are talking about this, our article should say something too.  Currently, the article now says nothing at all about Vitamin D whereas it finds space to say something about bleach.  But if the article says nothing about the matter, then readers will naturally go elsewhere to get their information.  My view is that it is common sense.  Vitamin D deficiency is common and it is already public health advice that "those who don’t get out in the sun or always cover their skin when they do, should take a vitamin D supplement throughout the year".  Me, I'm taking a couple of teaspoons of cod liver oil daily and making sure to get some sun.  What are the rest of you doing? Andrew🐉(talk) 08:22, 14 May 2020 (UTC)
 * Well, I'm not saying we shouldn't say anything about Vitamin D, just that we shouldn't make any efficacy claims based on primary sources. So no, I don't care what a "distinguished professor of epidemiology at Harvard" says - if it's not in a WP:MEDRS source, it should not be repeated in Wikipedia's voice. I have not yet examined those other sources. Boing! said Zebedee (talk) 10:07, 14 May 2020 (UTC)
 * Oh, and whether it's wise to take a vit-D supplement as a compensation for not getting enough sun is not relevant to whether it's effective against Covid-19. Boing! said Zebedee (talk) 10:11, 14 May 2020 (UTC)
 * the last source, the Comprehensive Literature Review, is just the sort of source we should be using for medical content. Unfortunately for this thread, it says nothing about the effect of vitamin D on treating COVID-19. It's tempting to say that (1) vitamin D has a prophylactic effect on ARDS and other respiratory conditions (not in doubt); and (2) COVID-19 may cause an effect very similar to ARDS (not in doubt). But to put the two together and try to state that therefore vitamin D has a prophylactic effect on COVID-19 is pure WP:SYNTH, and we have no accepted evidence base for any such assertion. --RexxS (talk) 15:11, 14 May 2020 (UTC)


 * No, this article should NOT say something about Vitamin D unless there is something to say. This is an encyclopedia article, not a guide for investigative treatment. The information here needs to be reliable, not speculative. MartinezMD (talk) 16:42, 14 May 2020 (UTC)

Coronavirus 2019?
I think 2020 must be added, this is what all us are living today, the big epidemic. 2021 and onwards perhaps going to be added, we see. --BoldLuis (talk) 11:43, 14 May 2020 (UTC)
 * What are you suggesting? MartinezMD (talk) 16:40, 14 May 2020 (UTC)
 * Coronavirus disease 2019 is the name of the disease. And this isn't the article on the pandemic. The article on the pandemic is COVID-19 pandemic. Nil Einne (talk) 17:11, 14 May 2020 (UTC)

Sheltering in place is actually worse?
Here's an interesting theory that appeared on an editorial page, written by an ordinary person:

"According to many immunology and virology specialist and scientists, we build immunity when our immune system mounts a response after exposure to antigens such as bacteria and viruses to produce protective antibodies. It's possible that sheltering in place might decrease our immunity."

Anyone find any source to support such an idea?— Vchimpanzee  •  talk  •  contributions  •  20:40, 14 May 2020 (UTC)


 * Where did you get that quote? And yes, that is standard immunology and it's reflective of the concept of herd immunity. That's why immunizations exist and sheltered populations are susceptible to new infections - like almost all of us with COVID, historically the native American with smallpox, etc. MartinezMD (talk) 20:54, 14 May 2020 (UTC)


 * Ordinary people are blocked from seeing it. I happen to have a library card that lets me see these articles. I tried going to the newspaper's web site and got "No result found". I could give you the link but not everyone has access.— Vchimpanzee  •  talk  •  contributions  •  21:12, 14 May 2020 (UTC)
 * It's alright. The idea has been discussed already in other sources.  The main issue is that for it to work, you need to infect the majority of the population, maybe the vast majority of people as with measles, or it doesn't work. So you really aren't treating people, you are simply letting nature take it's course. The purpose of social distancing, etc, is to delay the infection rate so the health care system can accommodate the people who get seriously sick and buy time to find effective treatments and maybe a vaccine. MartinezMD (talk) 21:28, 14 May 2020 (UTC)


 * The claim, though, is that those who aren't going out aren't getting a benefit and may be worse off. I get why herd immunity isn't possible given what happened in Italy and New York City. They were afraid it would happen where I live too.— Vchimpanzee  •  talk  •  contributions  •  21:56, 14 May 2020 (UTC)
 * That would suggest the person is being immunized from the virus without getting ill. Even if a low-level exposure could do that, by not sheltering/social distancing you risk a high-level exposure. So that that person's theory doesn't hold water. I'd simply hold off for secondary sources as we've been discussing in much of the talk page. MartinezMD (talk) 22:19, 14 May 2020 (UTC)

CFR vs IFR
I was editing the Infection fatality rate section, more specifically this sentence: As of May 7, in New York City, with a population of 8.4 million, 14,162 have died from COVID-19 (0.17% of the population).

Per IFR, isn't that [0.17%] the CFR instead? ( in denominator, as opposed to ).

Feelthhis (talk) 22:05, 14 May 2020 (UTC)
 * No. The case fatality rate (CFR) is the number of deaths divided by the number of confirmed cases. The infection fatality rate (IFR) is the number of deaths divided by the number of people infected. The population fatality rate (PFR) is the number of deaths divided by the number of people in the population. CFR ≥ IFR ≥ PFR. I tried to convince that putting that percentage into that section was confusing, but they decided they knew better. --RexxS (talk) 22:45, 14 May 2020 (UTC)
 * Personally I prefer your revision as it removes confusion and I did not understand at all the revert summary "confusion is on purpose". And I will take this opportunity to ask: when it's said (for CFR), it really is actual real-world numbers for confirmed cases (even if we know the testing capacity is very low resulting in high subnotification)? Feelthhis (talk) 00:27, 15 May 2020 (UTC)
 * It's worth remembering that CFR, IFR and PFR don't just apply to COVID-19. Both the CFR and PFR are obviously simple metrics, because the numerator and denominator are matters of fact in reporting (the number of confirmed cases and confirmed deaths may not be accurate, but they are trivially countable). The IFR, which is actually the most useful metric, is always dependent on estimation. After a disease has run its course, it's often possible to get much closer estimates for IFR, so you'll find retrospective analyses for MERS, for example. It's interesting to note that Estimating the Severity and Subclinical Burden of Middle East Respiratory Syndrome Coronavirus Infection in the Kingdom of Saudi Arabia estimated an IFR of MERS at 22% (95% CI: 18, 25), which indicates it was far more lethal than COVID-19 seems to be. For comparison, smallpox's IFR was about 30%. The confounding factor, of course, is that whenever the volume of severe infections exceeds the capacity of a health service to treat them, the number of fatalities increases dramatically as people die who would have lived had they been treated. Hope that helps. --RexxS (talk) 20:30, 15 May 2020 (UTC)
 * So the lower the testing capacity the less accurate is the CFR. So COVID-19 is not as lethal but it ends up killing a high absolute number because it is much more contagious. Thanks for the reply, I appreciate. Feelthhis (talk) 22:23, 15 May 2020 (UTC)
 * So the lower the testing capacity the less accurate is the CFR. So COVID-19 is not as lethal but it ends up killing a high absolute number because it is much more contagious. Thanks for the reply, I appreciate. Feelthhis (talk) 22:23, 15 May 2020 (UTC)

Transmission - Is it sexually transmitted?
Can a confirmed user take a look at https://www.theguardian.com/world/2020/may/07/covid-19-found-in-semen-of-infected-men-say-chinese-doctors Thanks 86.142.36.66 (talk) 21:51, 7 May 2020 (UTC)


 * No different than flu or many other viruses. It can be transmitted by many bodily fluids. To say something is sexually transmitted implies that that is the only or most typical way for it to spread. MartinezMD (talk) 22:22, 7 May 2020 (UTC)
 * Unless you know how to do sex while keeping 2m distance, does it really matter ? Iluvalar (talk) 02:44, 8 May 2020 (UTC)
 * With ebola, for example, after there was clinical recovery, the virus was still found in semen several weeks later. So it may have some bearing here if it persists afterwards, but it's too soon to tell. MartinezMD (talk) 04:31, 8 May 2020 (UTC)
 * We say close contact is one of the primary ways, no need to say sexually transmitted... Doc James  (talk · contribs · email) 07:18, 9 May 2020 (UTC)

No we need to say that it can be transmitted via saliva and intimate contact that isn’t obvious from close contact. Many sexual health authorities have made statements on the issue. Holland interestingly said no, sex is a human right today. Which it is but people need to be informed about sex as a transmission mode. It is not a STI though Almaty (talk) 05:09, 16 May 2020 (UTC)

Cleaning Up Complications
The 'Complications' section needed to be more concise, so I worked on it but would like to hear others' thoughts. I think the struggle will be to avoid getting into minutiae while highlighting the major complications, namely the cardiopulmonary ones. While the neurological complications are sourced, the paper is in Spanish, and I cannot verify it. I also reduced the length of details on pediatric multisystem inflammatory syndrome. Moksha88 (talk) 02:56, 9 May 2020 (UTC)
 * I have replaced a mass of primary sources / popular press with a high quality secondary source. Doc James  (talk · contribs · email) 07:00, 9 May 2020 (UTC)
 * Sorry, I didn't see your reply here until just now but also didn't see where you removed those sources. I did want to bring to your attention this sentence in the lead paragraph I've tried editing, "While the majority of cases result in mild symptoms, some progress to acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and blood clots." I think the last complication should be death because it logically follows as the most severe complication. Previously, it was cytokine storm and now someone has changed it to blood clots. What do you think? Moksha88 (talk) 02:51, 12 May 2020 (UTC)
 * We already mention the exact number of deaths just above that. I do not think we need to mention it again User:Moksha88 as it is duplication. There are lots of potential complications, IMO we should keep it to four with the rest going in the body. Doc James  (talk · contribs · email) 06:54, 12 May 2020 (UTC)
 * Good point, then let's leave the sentence as is. Moksha88 (talk) 18:52, 12 May 2020 (UTC)
 * Thanks. Doc James  (talk · contribs · email) 04:20, 13 May 2020 (UTC)

Why was cytokine storm removed that lancet paper has been cited thousands of times already Almaty (talk) 05:11, 16 May 2020 (UTC)

Header for WP:MEDRS says “. . best treated with common sense, and occasional exceptions may apply. . ”

 * —> Identifying reliable sources (medicine):
 * First header:
 * “It is a generally accepted standard that editors should attempt to follow, though it is best treated with common sense, and occasional exceptions may apply. . . “

Now, that doesn’t mean run hog wild (and it doesn’t mean consensus first for our Coronavirus article).

With the rules, each of us can probably go faster. On the other hand, going the route of exception and common sense will probably benefit from slowing down, or at least making a point to come back later and take a second look.

An example might be primary sources.

With a new disease, we might occasionally need — or highly benefit from — using a primary source. Now, we’ve got to make sure we’re doing a solid, first-rate job of summarizing it, as well as putting it in context, for example, “One study of COVID-19 patients at three hospitals showed. ., ” this type of thing.

All the same, this a breath of fresh air. We’re not going to make a religion out of our policies. . . Thank Goodness!

Your ideas please. :-) FriendlyRiverOtter (talk) 22:19, 15 May 2020 (UTC)
 * As you don't seem able to drop the stick, here's my idea:
 * I intend to impose a general sanction on this article prohibiting the use of primary sources to support biomedical claims. Any occasional common sense exception must receive clear consensus on the talk page prior to the edit being made.
 * As for "One study of COVID-19 patients at three hospitals showed ...", if you finish that sentence with a biomedical claim, I'll block you until you're prepared to abide by our sourcing policies and guidelines. It's as simple as that. --RexxS (talk) 01:04, 16 May 2020 (UTC)
 * you’re one of us. You have jumped in and joined your fellow Wiki citizens, and we’re happy you have you! Now, I understand the policy is that any blocking has to come from an uninvolved admin, though I’m sure we both hope it doesn’t come to that.
 * It’s fine if you don’t like me. I will point out that I was the first one who found an alternate source and deleted one of the MedRxiv references in the following edit: https://en.wikipedia.org/w/index.php?title=Coronavirus_disease_2019&diff=956758600&oldid=956758149
 * And I deleted it because, exactly as you point out, it’s a pre-print. And plus, it doesn’t meet my personal standard of being worthy for a rare exception.  We might disagree on this last point, but I actually did the work, and other people did not.  And unless someone or a couple of someones has since fixed it, I think there are two other MedRxiv refs still in our article. FriendlyRiverOtter (talk) 20:07, 16 May 2020 (UTC)
 * Don't patronise me. I've been editing medical articles for over 12 years, so I don't appreciate your sarcastic "welcome". You obviously don't understand the meaning of WP:INVOLVED, because I'm only involved here in an administrative capacity. Take careful note of "Warnings, calm and reasonable discussion and explanation of those warnings, advice about community norms, and suggestions on possible wordings and approaches do not make an administrator 'involved'. because I've been very patient with your repetitive provocations, as well as tolerant of your breaches of our sourcing policies and guidelines. I'd like to think that it won't come to the point where sanctions are the only step left to prevent your disruption, but that's entirely up to you.
 * I neither like you nor dislike you. I don't know you. My warnings and admonitions to you are not personal; they are simply necessary as part of the process of cleaning up the sourcing in this article, which is in a dire state. I'm am going to continue to uphold WP:RS and WP:MEDRS rigorously, and I'd appreciate it if you wouldn't be obstructive, but I not prepared to allow you the choice.
 * I really did appreciate your removal of the preprint. I was less impressed with your announcement that you would restore it after it was published, but that will depend on what content you intend to use it to support. There are indeed two other MedRxiv refs still in our article, but I'm refraining from editing where I've applied a sanction, as I feel that would blur the boundaries of being involved on that issue. No doubt someone will eventually remove them. In the meantime, I'll try to find the time to identify the breaches of MEDRS as the next step. --RexxS (talk) 21:39, 16 May 2020 (UTC)
 * I really did appreciate your removal of the preprint. I was less impressed with your announcement that you would restore it after it was published, but that will depend on what content you intend to use it to support. There are indeed two other MedRxiv refs still in our article, but I'm refraining from editing where I've applied a sanction, as I feel that would blur the boundaries of being involved on that issue. No doubt someone will eventually remove them. In the meantime, I'll try to find the time to identify the breaches of MEDRS as the next step. --RexxS (talk) 21:39, 16 May 2020 (UTC)

Long-term complications of Covid-19
Perhaps include more about it? Here is good source. Even if it does not satisfy WP:MEDRS, many sources scited there do satisfy MEDRS. My very best wishes (talk) 04:01, 15 May 2020 (UTC)
 * It's just speculation at present. Do you really think it's the job of an encyclopedia to speculate about what might happen? Doesn't WP:CRYSTAL apply to COVID-19?
 * I looked hard for the MEDRS sources you mentioned, but couldn't find them. Perhaps you can help by listing them here for us? --RexxS (talk) 20:38, 15 May 2020 (UTC)
 * I looked hard for the MEDRS sources you mentioned, but couldn't find them. Perhaps you can help by listing them here for us? --RexxS (talk) 20:38, 15 May 2020 (UTC)

Can we remove all the primary studies in the transmission section then?

Also if the WHO does one study in February; it is a primary study even if they put it in a report. Anyway changed to Australian DoH. Almaty (talk) 05:07, 16 May 2020 (UTC)
 * Yes, please remove any primary sources anywhere that are being used to support a biomedical claim.
 * If the WHO creates a report about a study, regardless of who did the study, you have to assume that the report is done by people well acquainted with the literature and that their analysis is informed by more than just one study. It's that process which gives bodies like WHO or national health organisations the authority we ascribe to them when placing their pronouncements in the category of "highest quality evidence" per MEDRS. There may be occasions where the assumption is unjustified, so I agree it's better at times to substitute another MEDRS source. --RexxS (talk) 01:57, 17 May 2020 (UTC)
 * If the WHO creates a report about a study, regardless of who did the study, you have to assume that the report is done by people well acquainted with the literature and that their analysis is informed by more than just one study. It's that process which gives bodies like WHO or national health organisations the authority we ascribe to them when placing their pronouncements in the category of "highest quality evidence" per MEDRS. There may be occasions where the assumption is unjustified, so I agree it's better at times to substitute another MEDRS source. --RexxS (talk) 01:57, 17 May 2020 (UTC)

I think you could have run this argument quite well in January. Now we have plenty of medrs sourcing out there were not even using the half of it yet Almaty (talk) 05:32, 16 May 2020 (UTC)

Can you please do warnings and personal discussions away from the talk page Almaty (talk) 00:33, 17 May 2020 (UTC)
 * Please feel free to archive discussions that are not related to the improvement of this article. You might also want to simply remove posts that start unproductive threads. --RexxS (talk) 01:57, 17 May 2020 (UTC)
 * Please feel free to archive discussions that are not related to the improvement of this article. You might also want to simply remove posts that start unproductive threads. --RexxS (talk) 01:57, 17 May 2020 (UTC)

Incubation period
The Lauer article in Annals is tagged as unreliable. The source, Annals, is typically reliable, but their use of news reports makes me agree that the data itself could be unreliable. I see this recent article in J Inf Dis. that looks promising as a alternate source; the authors used 7000 cases from health department data which I think is as good as we'll be able to get. https://www.ncbi.nlm.nih.gov/pubmed/32339231 Anyone see an issue with the article? it looks like it's official from 3 weeks ago MartinezMD (talk) 04:31, 16 May 2020 (UTC)
 * We have secondary sources that same more or less similar things "The median incubation period was 5 days and extended from 2 days ... to 15 days." Doc James  (talk · contribs · email) 10:05, 18 May 2020 (UTC)
 * The problem with 32339231 is that it's a still a single study and hence a primary source. If that's as good as we're going to get, then we ought to be saying nothing until the secondary sources analysing the literature become available. --RexxS (talk) 17:39, 18 May 2020 (UTC)
 * I prefer secondary sources as well, but so far I see two problems. If you're talking the WHO summary page, it is extremely weak, consisting of literally a single sentence for incubation information and offering little data. Also, I'm not super convinced that the number of days is requiring a MEDRS standard (whereas an RS standard is sufficient). The statement makes no treatment or diagnostic assertions, simply an epidemiological time frame observation. That being said, if you have a good secondary source, I welcome it. MartinezMD (talk) 22:01, 18 May 2020 (UTC)
 * I'm sympathetic in general to making exceptions for cases where the information is arguably not a biomedical claim. But quoting raw figures from a primary source is always problematical as well, and we do have some secondary sources :
 * British Columbia Centre for Disease Control: "believed to be 2-14 days with a median of 5 days"
 * National Academies of Sciences, Engineering, and Medicine commenting on the Chinese data " In this study, the mean and median incubation periods were estimated to be 5.84 and 5.0 days, respectively. Patients 40 years or older had a longer incubation period and larger variance than did patients younger than 40 years. There was no statistically significant difference in incubation period based on gender. These findings suggest that different periods of quarantine may be advisable based on age. However, these results need to be confirmed through additional studies and with further stratification of incubation period results by age group."
 * NHS Scotland "Many of the studies published to date are limited by small sample sizes and overrepresentation of severe cases, the incubation period for which may differ from that of mild cases. Evidence suggests an incubation period of 5-6 days with a range of 1-14 days from infection to symptoms surfacing. Lauer et al estimate that most (97%) of those who develop symptoms do so within 11.5 days of infection (95% CI, 8.2-15.6), consequently only a limited number of cases will potentially develop symptoms out-with the 14 days of self-isolation that is required following contact with a confirmed case."
 * My inclination would be to summarise what the secondary sources say and only add content that can be sourced from those. Cheers --RexxS (talk) 22:32, 18 May 2020 (UTC)
 * That works for me. I'll put them in and make changes. MartinezMD (talk) 22:50, 18 May 2020 (UTC)

Semi-protected edit request on 21 May 2020
Change "White" to "white" in the following near the end:

Ethnic differences

In the U.S., a greater proportion of deaths due to COVID-19 have occurred among African Americans.[313] Structural factors that prevent African Americans from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as public transit and health care. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death.[314] Similar issues affect Native American and Latino communities.[313] According to a U.S health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of White non-elderly adults.[315] The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water.[316] Leaders have called for efforts to research and address the disparities.[317] GoobyGoobyGoob (talk) 19:22, 21 May 2020 (UTC)


 * Why? I'll admit to not totally understanding American racial labels, but isn't White there just another one like all the other capitalised "races" in that paragraph? HiLo48 (talk) 22:35, 21 May 2020 (UTC)


 * It should be changed. We still follow English grammar rules. It should be white, black, native American, etc. Go ahead and change it. MartinezMD (talk) 23:32, 21 May 2020 (UTC)
 * So to clarify, you want ALL those changes made? HiLo48 (talk) 00:47, 22 May 2020 (UTC)
 * I made the change. There was only White->white to make. I looked at the WP articles and the others are capitalized. MartinezMD (talk) 00:57, 22 May 2020 (UTC)
 * I still don't get it. Why should "white" not have a capital letter? The words "native" and "latino" have caps. HiLo48 (talk) 02:46, 22 May 2020 (UTC)
 * I don't make the rules. I just follow them. It appears the color is considered a descriptor of a common noun while the geographic descriptor makes it a proper noun. See Latin America, Native Americans in the United States, etc vs the article on White people and Black people. MartinezMD (talk) 02:55, 22 May 2020 (UTC)

Disease cycle
The article lacks a description of the cycle, from contagion to recovery. How long it lasts, how long it takes to get symptoms, how long it takes to be detected, how long the person is a carrier, how long he is contagious. — Preceding unsigned comment added by 181.118.72.50 (talk) 09:18, 22 May 2020 (UTC)
 * give it some time, the first viable source from CDC about all of it came today . 6 days, 6 days and 6 days. The numbers of the devil. Iluvalar (talk) 22:59, 22 May 2020 (UTC)

Semi-protected edit request on 23 May 2020
I am to edit some of the pages by replacing dead or broken links to quality content links. Can I get the access for it Sameersamir (talk) 10:52, 23 May 2020 (UTC)
 * Hi. You'll need to make a specific request here, for example "Please change dead link X to Y", and someone will make the change for you. Boing! said Zebedee (talk) 11:39, 23 May 2020 (UTC)

Semi-protected edit request on 24 May 2020
Add a section about the possibility that vaccines cause covid-19 disorder. Otherwise you're being dishonest, misleading, and biased. 2600:8805:C880:111:85C2:58A:1AAF:55A1 (talk) 13:56, 24 May 2020 (UTC)
 * No reliable sources support such a statement, and that is honest, direct, and factual. BiologicalMe (talk) 14:11, 24 May 2020 (UTC)
 * Read WP:NOTNEWS -- Tytrox (talk) 15:50, 24 May 2020 (UTC)

RfC on whether we should include a primary study on cough distance
Should we include a primary study on cough distance? 20:06, 20 May 2020 (UTC)

MEDRS clearly says secondary sources. All the same, the first header also says, “It is a generally accepted standard that editors should attempt to follow, though it is best treated with common sense, and occasional exceptions may apply. . . “

In addition, this is a very straightforward study: “. . All gargled 10 mL of diluted red then blue food dye. They were then seated with their mouths approximately 1.30 m from the floor, inhaled to vital capacity, and coughed with an open mouth. . ”

I’m not sure what a review article would add to this. More sophisticated studies may show longer droplet distances, but I doubt they would show shorter. And of course, if included, we should identify it as a preliminary study.


 * —>In our Transmission section, shall we include:


 * —>“A preliminary study showed that open-mouthed coughing can send visible droplets an average of 2.5 meters (8 feet) and up to 3.9 meters (13 feet).”


 * —>Using the above primary reference?

————

Requesting the participation of:

,, , , , , , , , , , , , , , ,

Basically, persons who have participated in Transmission during May, plus two admins.

And of course, other interested persons are very welcome, too.

Shall we include a brief summary of the Singaporean cough study and identify it as preliminary? 20:06, 20 May 2020 (UTC)
 * Is this anything genuinely new? Has nobody really ever tested how far a cough will go before, and had it covered by a secondary RS? Boing! said Zebedee (talk) 20:50, 20 May 2020 (UTC)
 * Yes, when WHO has talked about a social distance of 3 feet [maybe updated] and the U.S. CDC of 6 feet, this is talking about a main, centralled-discussed aspect of the disease. And this is a clean, crisp, and really an ingenious study.  FriendlyRiverOtter (talk) 21:33, 20 May 2020 (UTC)
 * Detailed information on cough distance should be in the Cough article. This article should then mention summary information, and link there. HiLo48 (talk) 00:09, 21 May 2020 (UTC)
 * I agree our Cough article should have it. But currently, it doesn’t mention “droplet,” not a single time, nor “meter,” nor “feet.”  In addition, the above primary source by Loh, Tan, et al., has the advantage of talking about cough distance in the context of COVID-19. FriendlyRiverOtter (talk) 03:18, 21 May 2020 (UTC)
 * Droplets are mainly what a cough or a sneeze spreads. Erkin Alp Güney 09:05, 25 May 2020 (UTC)
 * I’d say droplets, and the fluid dynamics of the localized warm, moist atmosphere which briefly carries them along. And this makes it both surprising and disappointing that our Cough article does not mention droplet a single time.  And it only mentions the word “spread” once in the lead, in generalities.  A fair number of our Wiki articles need some sustained attention.  Please jump in wherever you wish. FriendlyRiverOtter (talk) 22:30, 25 May 2020 (UTC)

Yes. We also have  The 5th Pillar of Wikipedia —> Wikipedia has no firm rules which states, “Wikipedia has policies and guidelines, but they are not carved in stone;”
 * Regarding a primary source I’d ask:
 * Is it a good source?
 * Is it pertinent?
 * Have we done a solid job summarizing it?
 * Have we added a qualifier such as “preliminary” or “single study”?
 * If we’ve hit all four, I think it’s a good candidate for inclusion. I want to take it step-by-step and be very systematic about it. FriendlyRiverOtter (talk) 02:42, 21 May 2020 (UTC)
 * Questions to myself on this: is there an urgency to include it? No, we aren't a treatment guide. What's the power of the study? Extremely weak, N=5. What's the impact? None - someone on HFNC is in a hospital, in a small room, where an extra 0.4 meters of particle dispersion makes no difference. A cough study I would support would be a much larger sample size of regular coughing measuring microscopic particles that would be reflective of people in a community or not in isolation. MartinezMD (talk) 03:11, 21 May 2020 (UTC)
 * Even though not a treatment guide . . . “social distance” is a new phrase which has entered the English language, and plus we even have the gerund form of “social distancing.” The extra .4 meters is the delta.  The baseline is average droplet distance of 2.48 and a maximum of 3.9 meters.
 * Thus, adding a HFNC (High-Flow Nasal Cannula) gives a new average droplet distance of 2.91 meters (9.58 feet). I’d also point out that medical workers haven’t really gotten a handle on transmission within a medical setting.  Or at least it doesn’t seem that way to a layperson like myself.  Maybe it’s not that different from strep or pneumonia transmission in a medical setting, for example.  But I’d still say, holy cow, for something which is so much on the forefront of our minds and on which we’re putting so much effort and attention, we ought to be getting better results.
 * As this study points out, four of the five volunteers coughed further than the WHO safe exclusion zone in their interim guidance. This study has a lot to recommend about itself, small as it may be.  And instead of merely preaching “many of the details of its spread are still under investigation,” as we do at the beginning of our Transmission section, we should give some examples of areas of active exploration.  This will make for a far richer article.
 * And Wikipedia has serious competition — from personal accounts on social media and from kooksville-crazy conspiracy theories. And we can’t directly compete with either.  But what we can do is give meaty, factually-oriented articles with abundant references.  Our article is fine, but we can and should be open to making it better. FriendlyRiverOtter (talk) 22:01, 21 May 2020 (UTC)


 * Here's a more general source which discusses a variety of studies and their findings: Natural Ventilation for Infection Control in Health-Care Settings. Annex C Respiratory droplets. This indicates that, "the size of droplet nuclei due to sneezing, coughing and talking is likely to be a function of the generation process and the environmental conditions. ... There is also a great individual variability".  It goes on to discuss the way that small floating droplets are carried about by air currents.  So, this does not seem to be a simplistic matter of droplet ballistics.  In the real world, you'll get different results depending on the conditions and so there will be a statistical distribution.  Public health advisories such as 3–6 feet are obviously pragmatic compromises.  Our coverage should be consistent with this rather fuzzy situation rather than making too much of exact distances from a single study. Andrew🐉(talk) 10:37, 21 May 2020 (UTC)
 * in fact I like these kind of discussions about whether something is obvious or not. Maybe WHO recommending 3 feet is intended as a pragmatic compromise, but many people take it as gospel truth.  Same for CDC recommending 6 feet.
 * Thank you for sharing the above Annex C. It states, “Currently, the term droplet is often taken to refer to droplets >5 μm in diameter that fall rapidly to the ground under gravity, and therefore are transmitted only over a limited distance (e.g. ≤1 m). In contrast, the term droplet nuclei refers to droplets ≤5 μm in diameter that can remain suspended in air for significant periods of time, allowing them to be transmitted over distances >1 m.”
 * 1 μm = 1 micron (millionth of a meter)
 * Maybe this is where WHO gets its recommendation of 1 meter. And I understand COVID-19 is generally thought not to generate droplet nuclei. Thank Goodness!
 * Now, if this proposed RfC is a case of it simply being one study, well, actually we have a couple more:
 * Aerosol emission and superemission during human speech increase with voice loudness, Nature, Asadi, Wexler, et al., Feb. 20, 2019. “ . . . simply talking in a loud voice would increase the rate at which an infected individual releases pathogen-laden particles . . . . . For example, an airborne infectious disease might spread more efficiently in a school cafeteria than a library, . . . ”
 * My Summary —> Loud talking releases more droplets than normal talking.
 * Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19, JAMA Insights, Lydia Bourouiba, March 2020.
 * Our Summary —> An article published in March 2020 argued that advice on droplet distance might be based on 1930s research which ignored the effects of warm moist exhaled air surrounding the droplets and that an uncovered cough or sneeze can travel up to 8.2 m. [I’m remembering building on someone else’s work, and when this collaborative approach happens, we should welcome the magic!]
 * Another example, you’ve probably heard how U.S. Pres Donald Trump has really promoted the anti-malarial drug hydroxychloroquine. If we had already summarized the first study which showed some promise, making sure to say that it’s “preliminary,” or “initial,” or however we wish to phrase that, and then summarized the later studies which showed it not panning out — we would be helping to inform people in this one particular area.  At this stage, however, it’s not as valuable to play catch up.
 * And no, we can’t be everything under the Sun to all people, but we can be, of course, some things under the Sun. And that’s a good artful compromise, right? :-)  FriendlyRiverOtter (talk) 20:00, 22 May 2020 (UTC)
 * The jury is still out on distance and incorporating anything other than the recommendations by official health services (WHO, CDC, etc) without secondary sources is premature. As it is now, primary studies say it can be 27 feet (8+ meters), so the numbers are all over the place. https://www.usatoday.com/story/news/health/2020/03/30/coronavirus-social-distancing-mit-researcher-lydia-bourouiba-27-feet/5091526002/ This is a WP:deadhorse at this point. MartinezMD (talk) 23:38, 21 May 2020 (UTC)
 * Ah yes, the stated humorous essay deadhorse. And this topic is certainly not getting an outpouring of participation, that’s for sure. But  I’d like to potentially win you over.  Yes, the Singapore study shows a max. of 13 feet (15 with HFNC), but it’s only looking at visible droplets.  Bourouiba’s “JAMA Insight” article (referencing one study in 2014 and two in 2016 in which she was co-author) found a max. of 27 feet using at least slo-mo photography and maybe more high-tech.  So, I don’t see a big contradiction.  The jury might be out, but it’s leaning in one direction.
 * If a state legislative committee asked your advice, for example, on whether to re-open high school sports this Fall, how married are you to 6 feet?
 * And second question, is there a respectful way to show some of the process of science? FriendlyRiverOtter (talk) 19:11, 23 May 2020 (UTC)
 * The science is my point. The individual studies have limited science because techniques are different, the investigative numbers are small (do some people spew more particles or further?), and they haven't established infectivity or lack thereof. I think in proper context, a primary study, properly presented as one, can have value in an article. I just don't understand why simply saying "organization "X" advises keeping a distance of "Y" feet" isn't sufficient at this time until more reviews of the subject are available. MartinezMD (talk) 23:46, 23 May 2020 (UTC)
 * I think the early 1900s physician William Osler was of the opinion that one can learn a lot from a single case study. And we have ..
 * —>The impact of high-flow nasal cannula (HFNC) on coughing distance . . ., Loh, et al., March 2020:
 * —>” . . In our study, four of the five volunteers’ cough droplets travelled further than the WHO-recommended 2 m safe exclusion zone [for health care workers]. . ”
 * And since they’re visible droplets, I’d say it’s likely they are infectious. The live question might be whether droplet nuclei are a significant issue for COVID-19 (And I hope not!)
 * By the way, the person who was touting “A cure for Covid-19” before that separate section was deleted, that is an example of what we’re up against.
 * I’m very much the moderate wanting to roll with good, well-reference, although perhaps neither complete nor perfect information. And we can say that.  For example, “A small study showed that four out of five persons coughed further than . . ”  The saving grace may be that this was uncovered coughing, and most people, most of the time, make some effort to cover up.
 * I mean, when WHO recommends 1 meter (3 feet) for civilians, for crying out loud, some people project further than this just when talking. You may have heard the expression, “Say it, Don’t spray it,” or something similar.
 * So, in response to the question of why it’s not sufficient just to say “Organization X” recommends “Y feet”? Because we have additional information which is too good to leave on the cutting room floor.  That’s my answer. FriendlyRiverOtter (talk) 19:29, 24 May 2020 (UTC)
 * Agree with MatinezMD. We should just say organization X advises keeping Y feet. Doc James  (talk · contribs · email) 08:37, 24 May 2020 (UTC)
 * I hope this isn’t because you think the rest of us aren’t smart enough, or serious enough, to summarize a range of good sources.
 * And I’ll give you another example. I understand that if I wear a mask, it’s only so-so in protecting me, but it’s great at source control.  Meaning, if I’m asymptomatic or pre-symptomatic, it helps to protect other people.  Well, I don’t see anywhere in our article that we clearly point this out.  It’s another weird little omission. FriendlyRiverOtter (talk) 23:22, 24 May 2020 (UTC)
 * FriendlyRiverOtter this was just my thoughts in this case. I am generally against the use of primary sources as I expect secondary sources to take them into account together with other evidence. This was not a comment on anyone's intelligence. Doc James  (talk · contribs · email) 08:24, 29 May 2020 (UTC)
 * I don't understand why we are sitting here analyzing the merits of a primary source. That's what secondary sources are for and the whole reason for MEDRS. This is a prime example of when to apply it. We don't want to mislead anyone with uninterpreted, unreviewed information. Regarding the immediately above by FriendlyRiverOtter, if you want to say a mask is good primarily at protecting against the spread of the disease to other people, from my understanding you need to cite a reliable secondary source or the advice of a health organization. This is an evolving topic and we are an encyclopedia, we are WP:NOTNEWS. We state things that are fairly firmly entrenched in mainstream (scientific) thinking. Why look for exceptions to MEDRS on this topic? I don't understand. —DIYeditor (talk) 00:46, 25 May 2020 (UTC)
 * I am not looking for exceptions. I can only state that this one jumped out at me, as I hoped it would with you.  And what interpreting?  Five people gargled with red food dye, sat in a chair, and coughed with open mouth.  Heck, I’m not even sure this would be interesting enough for a high school science fair.  What’s alarming is the results: that 4 out of 5 persons coughed further than two meters (six feet).  Now, maybe we got some outliers first time out the gate, and bigger studies might show only two out of five.  One, I wouldn’t count on that, and two, even that would be concerning.
 * I think for most purposes WHO is still staying with 1 meter (3 feet) for social distance. If we have information to the contrary, we should go with it.  If we don’t, we’re kind of doing less than our best for our readers.
 * Look, I think the world of WHO, CDC, and our own evolved policies and practices here at Wiki. However, we should not treat them as the Gospel of St. Luke, or the Book of Mormon 3 Nephi or [please insert your own favorite book of faith here].
 * Please work with me and meet me part way to the extent you can. The whole idea and phrase “social distance” is something hugely central to the societal response to COVID-19.  Furthermore, I’d argue the occasional exception is not something separate from MEDRS, but something built in from the very beginning.  In fact, the very first header.
 * I have added an edit, using a CDC source, that masks are great at source control and helping to prevent me from passing on the infection if I happen to be asymptomatic or pre-symptomatic.
 * —> https://en.wikipedia.org/w/index.php?title=Coronavirus_disease_2019&diff=958765898&oldid=958744934
 * Please change or improve as you wish. FriendlyRiverOtter (talk) 17:44, 25 May 2020 (UTC)
 * No. There's no cogent reason why a topic already covered in secondary sources should need to be cited to a primary source, especially when it used to contradict the secondary sources. See WP:MEDPRI. --RexxS (talk) 00:05, 3 June 2020 (UTC)
 * FriendlyRiverOtter, maybe I could be more supportive of this if I understood what you want to do with this source. "Should we include this source?" ought to come with a clear explanation of how you want to use it.  I think User:MartinezMD is correct on the real-world facts:  the numbers are all over the place.  I'm personally skeptical of any one-size-fits-most number.  For example, the optimal distance outdoors is probably smaller than the optimal distance indoors.  But for Wikipedia's purposes, I also think that Doc James and RexxS and others are right:  we don't need to use a primary source to say that various things that get coughed out can travel more than 2 meters, and we should continue to focus on the recommended behaviors.  This reminds me of the AIDS crisis around 1990 or so:  "You could get HIV from sharing a toothbrush!  What if there's a viral particle on the toothbrush, and you have a tiny abrasion in your mouth, and the viral particle happens to fall exactly in the right spot, and then you die!"  Yeah, well, it's theoretically possible.  But as far as anyone can tell, it never actually happened.  WhatamIdoing (talk) 00:04, 4 June 2020 (UTC)
 * , okay, so you’re asking, what about the outlandish theories of how HIV might be spread back in the day? Most of those were just regular non-doctors, non-scientists who were speculating.  I remember there was one neurologist guy who was spouting off.  A little outside his field, for he was not an infectious disease person.  And I don’t think he was published in a peer-reviewed journal.
 * In this case, we do have peer-reviewed articles talking about Coronavirus in the context of cough distance (and more broadly transport distance). We have the Singapore study (admittedly, only five subjects, but four of the five coughed further than 6 feet).  And we have Lydia Bourouiba’s above JAMA Insights article with her referencing three earlier studies in which she was either author or co-author.
 * In addition, we have:
 * They Say Coronavirus Isn't Airborne—but It's Definitely Borne By Air, Wired, Roxanne Khamsi, 14 March 2020.
 * I don’t think this is peer-reviewed, but I think it makes a good point. And sometimes you need a technical person outside your technical field to see something.
 * If we assume other people are just as intelligent as you and I, which is not always strictly true, but is often the case . . . . . if we assume that people interested in a topic can dive in and understand the nuance, which is perhaps even more often the case . . . . . I’d ask for your support in including some of these messy, real-world (and perhaps tentative) facts, and work with me together to find out the how. FriendlyRiverOtter (talk) 04:51, 4 June 2020 (UTC)
 * We can't use this cough study (the Singapore study) for general cough information even if we accepted primary studies. Again, this study used HIGH FLOW NASAL CANNULA in the participants which artificially adds pressurized gas into a person's airway. It is not valid to use with someone coughing outside of that setting. MartinezMD (talk)
 * each of the five patients coughed twice: once before HFNC and once with HFNC (High Flow Nasal Cannula). FriendlyRiverOtter (talk) 14:20, 4 June 2020 (UTC)
 * You're now analysing a primary study, which is precisely what Wikipedia editors are forbidden to do. The reason why we don't use primary studies is it requires analysis to make a possible link between "in these circumstances, some people coughed further than six feet" and "people are recommended to stay more than six feet apart because of the danger of COVID-19 infection". Those who write reviews, especially the national and international bodies, have experts who know the literature and can analyse a primary study in the light of others and distil it into something that we then take at face value until such time as an equally authoritative source comes up with a new conclusion. I'm not sure how many times this point needs to made to you before you accept that you have to respect secondary sources. --RexxS (talk) 14:48, 4 June 2020 (UTC)
 * I saw. Only if we're looking at maximum distance it's not a valid comparison, unless you were looking to use baseline distance only. Addendum - I also don't know why we're still discussing this. Can we drop the issue already and move on to some other part of the article? MartinezMD (talk) 14:42, 4 June 2020 (UTC)
 * I can't believe that anyone is entertaining the possibility of using this as a source. A study of 5 (yes five) people? And those people are authors of the paper themselves: "The authors (n = 5), with no history of lung disease, participated"? You couldn't get much further from a reliable source if you were making it up. Phil Bridger (talk) 18:24, 4 June 2020 (UTC)