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WARNING: ACTIVE PAGE-SPECIFIC DISCRETIONARY SANCTIONS The article COVID-19, is currently subject to the following active community-authorised discretionary sanctions. Please review them before making any further edits to this or related pages: Editors are prohibited from adding preprints as sources for content in this article. Further information After being notified of the sanctions, any editor who repeatedly or seriously fails to edit in accordance with the restrictions may be sanctioned by any uninvolved administrator. Reports of editors violating any of these restrictions should be made to the administrators' incidents noticeboard for general matters.

WikiProject COVID-19 consensus WikiProject COVID-19 aims to add to and build consensus for pages relating to COVID-19. They have so far discussed items listed below. Please discuss proposed improvements to them at the project talk page. General Superseded by TfD October 2020 and later practice - consult regular {{Current}} guidance. Refrain from using Worldometer (worldometers.info) as a source due to common errors being observed as noted on the Case Count Task Force common errors page. (April 2020, April 2020) For infoboxes on the main articles of countries, use Wuhan, Hubei, China for the origin parameter. (March 2020) "Social distancing" is generally preferred over "physical distancing". (April 2020, May 2020) Page title COVID-19 (full caps) is preferable in the body of all articles, and in the title of all articles/category pages/etc.(RM April 2020, including the main article itself, RM March 2021). SARS-CoV-2 (exact capitalisation and punctuation) is the common name of the virus and should be used for the main article's title, as well as in the body of all articles, and in the title of all other articles/category pages/etc. (June 2022, overturning April 2020) Map There is no consensus about which color schemes to use, but they should be consistent within articles as much as possible. There is agreement that there should be six levels of shading, plus gray   for areas with no instances or no data. (May 2020) There is no consensus about whether the legend, the date, and other elements should appear in the map image itself. (May 2020) For map legends, ranges should use fixed round numbers (as opposed to updating dynamically). There is no consensus on what base population to use for per capita maps. (May 2020) To ensure you are viewing the current list, you may wish to purge this page.

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This article has been mentioned by multiple media organizations: Omer Benjakob (February 9, 2020). "On Misplaced Pages, a fight is raging over coronavirus disinformation". Wired (magazine). Retrieved February 9, 2020. While a short and generic Misplaced Pages page on "coronavirus" had existed since 2013, the article about the "2019–20 Wuhan coronavirus outbreak" was created on January 5, 2020. Four days later, a new article was spun off from it, dedicated solely to the "Novel coronavirus" – officially known as 2019-nCoV. Yet another was created in February to detail the symptoms of the respiratory disease caused by the virus. Noam Cohen (15 February 2020). "How Misplaced Pages Prevents the Spread of Coronavirus Misinformation". Wired. Retrieved 15 February 2020. His point, and it's really indisputable, is that this mammoth online project has developed a personality, a purpose, a soul. Now, as the new coronavirus outbreak plays out across its many pages, we can see that Misplaced Pages has also developed a conscience. A news item involving COVID-19 was featured on Misplaced Pages's Main Page in the In the news section on 11 March 2020. Template:Copied multi This article has previously been nominated to be moved. Please review the prior discussions if you are considering re-nomination. Discussions: RM, Coronavirus disease 2019 → COVID-19, Keep, 24 April 2020, Talk:Coronavirus disease 2019#Requested move 24 April 2020 RM, 2019-nCoV acute respiratory disease → Coronavirus disease 2019, Move, 12 February 2020, Talk:Coronavirus disease 2019/Archive 1#Requested move 12 February 2020 Template:Vital article

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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)

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 Misplaced Pages, 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)

Iluvalar 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)

"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/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)

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)

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. { ${\displaystyle \mathbb {JPG} }$ } 03:57, 8 May 2020 (UTC)

@Jacob Gotts: found it.

we have lots of singular studies in the previous edit. The WHO, CDC and ECDC have the job of synthesizing them and giving each study its due weight, in a timely fashion. Misplaced Pages does not have that role.
— User:Almaty 14:06, 30 April 2020 (UTC)

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)"? { ${\displaystyle \mathbb {JPG} }$ } 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)

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? {{u|Sdkb}}  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)

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)

@Doc James: 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)

@Doc James: 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)

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 Misplaced Pages:Identifying reliable sources (medicine):

Primary sources should generally not be used for medical content – as such sources often include unreliable or preliminary information, for example early in vitro results which don't hold in later clinical trials.

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:

Primary sources should not be cited with intent of "debunking", contradicting, or countering any conclusions made by secondary sources. Synthesis of published material advancing a position is original research, and Misplaced Pages is not a venue for open research. Controversies or uncertainties in medicine should be supported by reliable secondary sources describing the varying viewpoints. Primary sources should not be aggregated or presented without context in order to undermine proportionate representation of opinion in a field. If material can be supported by either primary or secondary sources – the secondary sources should be used. Primary sources may be presented together with secondary sources.

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 Misplaced Pages 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)

First second third and fourth sentences of second paragraph

Minor changes propopsed to keep up with the WHO ECDC and CDC FAQs. CDC particularly.

Old version

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.

New Version

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.

References

1. ^ "How COVID-19 Spreads". Centers for Disease Control and Prevention (CDC). 2 April 2020. Archived from the original on April 3, 2020. Retrieved April 3, 2020.
2. ^ "Q&A on coronaviruses". World Health Organization. 8 April 2020. Archived from the original on 20 January 2020. Retrieved 30 April 2020.
3. Bourouiba L (March 2020). "Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19". Jama. doi:10.1001/jama.2020.4756. PMID 32215590.
4. ^ "Q & A on COVID-19". European Centre for Disease Prevention and Control. Retrieved 30 April 2020.

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. {{u|Sdkb}}  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)

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, Misplaced Pages 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 Misplaced Pages's goals. The reason so many people now respect Misplaced Pages 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 Misplaced Pages 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 Misplaced Pages: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 Misplaced Pages, 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}}  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}}  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: Misplaced Pages'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)

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

https://en.wikipedia.org/search/?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/search/?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)

Semi-protected edit request on 12 May 2020

This edit request to Coronavirus disease 2019 has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

pandemic statistics Abdullahiabdul7 (talk) 12:55, 12 May 2020 (UTC)

 Not done. 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)

@Abdullahiabdul7: I think you may be looking for the article COVID-19 pandemic. --RexxS (talk) 18:31, 12 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, Andrew. 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:

1. Does Vitamin D Protect Against COVID-19?
2. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality
3. Is vitamin D an important biomarker for symptom severity in COVID-19?
4. Vitamin D for prevention of respiratory tract infections
5. The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients
6. COVID-19 ’ICU’ risk – 20-fold greater in the Vitamin D Deficient.
7. Vitamin D advice for everyone: coronavirus
8. Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study
9. Coronavirus: Should I start taking vitamin D?
10. Perspective: improving vitamin D status in the management of COVID-19
11. Vitamin D and Inflammation: Potential Implications for Severity of Covid-19
12. 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)

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 Misplaced Pages'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)

@Andrew: 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)

Semi-protected edit request on 14 May 2020

This edit request to Coronavirus disease 2019 has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

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)

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:

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)

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%) ...
• "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"

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)

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)

1. https://www.discovermagazine.com/health/is-herd-immunity-our-best-weapon-against-covid-19
2. https://www.webmd.com/lung/coronavirus-immunity-reinfection#1
3. https://www.foreignaffairs.com/articles/sweden/2020-05-12/swedens-coronavirus-strategy-will-soon-be-worlds

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 the CFR instead? (population in denominator, as opposed to infected).

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 Jmv2009 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 confirmed cases (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)

@Feelthhis: 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)

@RexxS: 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)

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)

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)

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

—> Misplaced Pages:Identifying reliable sources (medicine):

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)

@FriendlyRiverOtter: 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)

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)
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