COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...

[DHajekRC84]

You sound like you really have some problems. I use to have Gout pretty consistently until I really changed my diet with salad for lunch and cutting my drinking. I use to have maybe 3-4 attacks a year and could last for 3-10 days, real difficulty walking. Now, maybe a small gout attack once a year but I could still walk.

Oh no Dave. Not anymore. I take Uloric and I haven't had but 1 major attack last 10 years. Alopuranol (sp) is cheap but was messing up the liver. Prior to that? My fingers, elbows, knees, and toes would take monthly turns tripling in size and it was serious pain meds to go to sleep for 2 days. Couldn't drink beer or wine for forever. Not only did the Uloric pull out the Uric Acid from my system. It had several other positive impacts to my lab work. PLus I now only eat about 5% of the red meat I once did.

Now if I could figure out why at 58 (now 61) I am no longer able to breath ... :)

 

[rutgersdave]

Oh no Dave. Not anymore. I take Uloric and I haven't had but 1 major attack last 10 years. Alopuranol (sp) is cheap but was messing up the liver. Prior to that? My fingers, elbows, knees, and toes would take monthly turns tripling in size and it was serious pain meds to go to sleep for 2 days. Couldn't drink beer or wine for forever. Not only did the Uloric pull out the Uric Acid from my system. It had several other positive impacts to my lab work. PLus I now only eat about 5% of the red meat I once did.

Now if I could figure out why at 58 (now 61) I am no longer able to breath ... :)

I took alopuranal for a couple of years but stopped taking it. Didn’t hear of Uloric, will look into it.

 

[DHajekRC84]

I took alopuranal for a couple of years but stopped taking it. Didn’t hear of Uloric, will look into it.

Alopuranal very cheap. Uloric very expensive. However I believe they finally came out with the generic version.
You can get coupons online to save some decent cash and if you go that route...do what I do. Get the 80m (same price) and take it every other day or split it.
Together...these plays cut the cost well over half.

 

[Wolv RU]

Disagree mostly. The media focus on this, to me, given the lack of data for an early evolution of virus, has been largely appropriate. We also can't know, for sure, yet, that Faust is correct - extrapolating from the cruise ship to the rest of the real world may not be perfect. I think he's largely right, which is why I started this thread based on the Fauci editorial, but until we know a lot more, there are still major concerns about this virus and people shouldn't ignore them.

Generally agree with this (except for the media hysteria part - the media need to be sharing the range of potential outcomes and the uncertainties involved). As I posted above, for influenza, the correlations of deaths to hospitalizations to infected with symptoms (but not tested/confirmed, which is the vast majority) are very well known from decades of data. The extrapolation from deaths to hospitalizations/confirmed cases (the same thing, almost, in China) to symptomatic but not serious cases for nCoV are not well known at all, however, as the data just don't exist - we just don't know if it's moderately underestimated or grossly underestimated and until we know that, we need to take the conservative approach and assume the worst credible case.

If the death rate vs. total symptomatic infected patients (most of whom aren't seriously ill) ends up being as low as ~0.5% or even lower, which would not be much greater than the 0.1-0.2% rate for influenza, then this will likely end up being kind of like a severe flu season (but better, since intervention levels will likely be much greater than for the flu). However if the real mortality rate vs. symptomatic infected patients is 1-2%, then without significant interventions, this would likely be much worse than a severe flu season.

I will say when you make solid posts like above, it's more helpful than when you make flippant posts dismissing the risks. I also assume you'd agree that it was great to hear that the testing restrictions have been lifted by the CDC and that working kits are now out there all over the US, which should finally be able to provide us a much more accurate denominator in the US, so we can much better understand the threat.

The problem, as I see it, with the media is it is reporting what are fairly useless numbers. The problem is that they are essentially reporting data similarly to data that would be reported in running a science experiment without a "control." That is, yes, people have died from this, and people have caught it. But there's no information that tells us whether this is a lot or not.

I think everyone should accept that this virus is going to be nearly everywhere in the U.S. and there are likely to be thousands of deaths and tens of millions exposed. While we all understand there were 50,000 deaths from the flu in the U.S. two years ago (and tens of thousands each year, without a ton of media coverage) I can also tell you that there will be about 30,000 road fatalities in the U.S. this year. Most would likely agree that they understand there will be fatalities, but getting in the car is an acceptable risk.

I think the fact that there has been a run on certain supplies shows that there has been irresponsible reporting and/or management of the disease. Everyone in a leadership position is afraid to underestimate it for any group because they will be made to pay for it by the logic that one death is too many -- that is the PR world we live in so I get it. I truly hope that medical professionals can put out clear statistics and information so that resources can be efficiently used on those that actually need them and unnecessary panic will be avoided.

 

[anon_ivydyf0amkzay]

Funny that this is now a sticky thread...[roll]

 

[DJ Spanky]

Funny that this is now a sticky thread...[roll]

Someone must have gotten excited!

 

[anon_ivydyf0amkzay]

Always good to highlight those threads that will have exaggeration, accusations, right-wing and left-wing points of views, links from dubious sources and more! Don’t political threads get tossed over to that “other” board? (Make no mistake, this IS a political thread)

fascinating!

 

[RU848789]

Great find, thanks! The article confirms what I was thinking when I started this thread - that COVID-19 is a serious disease with serious impacts for the elderly, but is not as serious as originally thought, with regard to mortality rates, especially for people under 65 and that the focus should be on preventing transmission to the elderly, as per his closing paragraph, below - he makes a compelling case and let's hope he is correct.

This still largely comes down to hygiene and isolation. But in particular, we need to focus on the right people and the right places. Nursing homes, not schools. Hospitals, not planes. We need to up the hygienic and isolation ante primarily around the subset of people who can’t simply contract SARS-CoV-2 and ride it out the way healthy people should be able to.

He makes a great case, based on the fantastic "experimental data" we now have from the Diamond Princess cruise ship, for the overall mortality rate being well less than 1% and it being probably on the order of 0.2-0.4% in healthy non-geriatric adults (or even lower).

All 6 deaths on that cruise ship were in people over 70, out of 705 that tested positive for the virus (out of 3711 passengers), for an overall mortality rate of 0.8%, but a rate of 1.1% for those over 70 and 4.9% for those over 80 vs. 0% for those under 70 (which should not be expected to hold for the general population since there are deaths under 70 in China and elsewhere, but at low rates).

This is not that far above the overall mortality rate for most seasonal influenza outbreaks, which is 0.1-0.2% - but it's also important to note that seasonal flu has a mortality rate of 0.02% for those under 50 and about 1% for those over 65 - which may end up being close to the actual mortality rates from COVID-19 when all is said and done if Dr. Faust is correct.

This is where the Diamond Princess data provides important insight. Of the 3,711 people on board, at least 705 have tested positive for the virus (which, considering the confines, conditions, and how contagious this virus appears to be, is surprisingly low). Of those, more than half are asymptomatic, while very few asymptomatic people were detected in China. This alone suggests a halving of the virus’s true fatality rate.

On the Diamond Princess, six deaths have occurred among the passengers, constituting a case fatality rate of 0.85 percent. Unlike the data from China and elsewhere, where sorting out why a patient died is extremely difficult, we can assume that these are excess fatalities—they wouldn’t have occurred but for SARS-CoV-2. The most important insight is that all six fatalities occurred in patients who are more than 70 years old. Not a single Diamond Princess patient under age 70 has died. If the numbers from reports out of China had held, the expected number of deaths in those under 70 should have been around four.

This all suggests that COVID-19 is a relatively benign disease for most young people, and a potentially devastating one for the old and chronically ill, albeit not nearly as risky as reported. Given the low mortality rate among younger patients with coronavirus—zero in children 10 or younger among hundreds of cases in China, and 0.2-0.4 percent in most healthy nongeriatric adults (and this is still before accounting for what is likely to be a high number of undetected asymptomatic cases)—we need to divert our focus away from worrying about preventing systemic spread among healthy people—which is likely either inevitable, or out of our control—and commit most if not all of our resources toward protecting those truly at risk of developing critical illness and even death: everyone over 70, and people who are already at higher risk from this kind of virus.

Great Times interview on the math behind mortality rate and transmission rate calculations in outbreaks like this, by the guy who literally wrote the book (called “The Rules of Contagion,” before the current outbreak, which has been made into a BBC series debuting soon). His thinking is generally aligned with what I've been posting from Fauci/Faust, i.e., that the eventual overall mortality rate is likely to be 0.5-2.0%, but that this will likely reflect much greater rates in the elderly (2-5% or more) and probably <0.5% in healthy younger people - that would be like a pretty severe flu season, but probably not 1918 pandemic-like. His numbers a bit higher than what Faust is projecting based on the Diamond Princess - and we're likely to see other numbers over the coming days/weeks.

One of the big issues we're going to see almost no matter what is a major strain on the health care system, as there might not be enough controlled-environment (and with oxygen, which will likely be needed for many) beds/units available for the numbers of people likely to eventually require hospitalization. So even if death rates end up being more severe-flu like (optimistic scenario), the strains on the health care system will be major - and of course on commerce, travel, etc. All the more reason to make sure we have working test kits everywhere and continue to educate people on frequent hand-washing and social distancing, as well as implementing self-quarantines and enforced quarantines/closures (and tracking of infections) as needed. The next month or two, at least are likely going to be pretty difficult.

https://www.nytimes.com/2020/03/05/health/coronavirus-deaths-rates.html

 

[RU4Real]

The problem, as I see it, with the media is it is reporting what are fairly useless numbers. The problem is that they are essentially reporting data similarly to data that would be reported in running a science experiment without a "control." That is, yes, people have died from this, and people have caught it. But there's no information that tells us whether this is a lot or not.

I think everyone should accept that this virus is going to be nearly everywhere in the U.S. and there are likely to be thousands of deaths and tens of millions exposed. While we all understand there were 50,000 deaths from the flu in the U.S. two years ago (and tens of thousands each year, without a ton of media coverage) I can also tell you that there will be about 30,000 road fatalities in the U.S. this year. Most would likely agree that they understand there will be fatalities, but getting in the car is an acceptable risk.

I think the fact that there has been a run on certain supplies shows that there has been irresponsible reporting and/or management of the disease. Everyone in a leadership position is afraid to underestimate it for any group because they will be made to pay for it by the logic that one death is too many -- that is the PR world we live in so I get it. I truly hope that medical professionals can put out clear statistics and information so that resources can be efficiently used on those that actually need them and unnecessary panic will be avoided.

I think this is a solid assessment of the situation.

 

[rutgersguy1]

Just saw on CNN 148 deaths and 3858 cases thus far in Italy. I read Italy has the second oldest population in the world behind Japan so that might be skewing the numbers too because of the demographic being affected.

 

[RU848789]

Just saw on CNN 148 deaths and 3858 cases thus far in Italy. I read Italy has the second oldest population in the world behind Japan so that might be skewing the numbers too because of the demographic being affected.

That's correct - think I posted on that above, but hard to keep track, lol; SK is the exact opposite with very young population: 3.8% mortality rate in Itally vs. 0.7% from SK (42 in 6000) - makes sense from the Diamond Princess analysis, which showed no deaths of people <70 years old and 1.7% deaths for those over 70 and 4/9% for those over 80. Of course, the 0 deaths in people 70 probably is a bit low, given China's 0.2-0.4% mortality rate in those under 50, iirc.

One more caveat though: the smoking rate in Hubei/Wuhan is extremely high (over 50%) and the air pollution has been horrible for years - certainly makes it much more likely people will die from a respiratory infection/pneumonia than healthy mostly non-smokers in a low pollution area (like a wealthy clientele cruise ship). If that example is extrapolatable and it should be, at least qualitatively, that bodes well for the US/Europe.

 

[RU848789]

Pretty cool results from evaluations of people with coronavirus pneumonia via CT-scans, showing telltale signs, where coronavirus patients have very different patterns from non-coronavirus pneumonai patients? It's not 100%, but it's pretty high and every hospital has these, usually, and it could at least be used as a screening tool, especially as I think "positives" are real, while "negatives" could be false negatives (not far enough along in the infection for example) - if one has a positive CT-scan, they should be presumed positive (instead of "wasting" a test, when test kits aren't fully deployed yet and especially since it's much faster than the test) and be quarantined. If negative, then they probably should get the PCR test.

https://www.medicaldevice-network.com/news/coronavirus-ct-scans/

 

[RU848789]

Watching the CNN Coronavirus Town Hall with Anderson Cooper and Sanjay Gupta and many excellent guests in the town hall and remote from key locations abroad and in the US - tons of great info from world experts and very, very little politics (apart from the testing kits, which is fair). One really cool tidbit they just showed was the new "drive-thru" testing stations in South Korea, which greatly reduces exposure to the testers and the patients (it's outside and the patient doesn't even have to leave the car, which is way better than having to sit in a waiting room and walk through an office or hospital (far more contact points). Incredibly innovative. If we don't get these soon in areas with outbreaks, it'll be another failure.

https://www.cnn.com/2020/03/02/asia/coronavirus-drive-through-south-korea-hnk-intl/index.html

 

[RU848789]

The WHO Director-General has finally said it's time to "pull out all of the stops," in his address yesterday. He also said there are encouraging signs in China and South Korea, but that other countries that are seeing first and new cases will need to execute on the epidemic intervention/containment plans they've all had in place in order to successfully prevent a major epidemic in these countries (obviously includes the US). Here is an excerpt from his speech, which was spot on.

This epidemic can be pushed back, but only with a collective, coordinated and comprehensive approach that engages the entire machinery of government.

We are calling on every country to act with speed, scale and clear-minded determination.

Although we continue to see the majority of cases in a handful of countries, we are deeply concerned about the increasing number of countries reporting cases, especially those with weaker health systems.

However, this epidemic is a threat for every country, rich and poor. As we have said before, even high-income countries should expect surprises. The solution is aggressive preparedness.

We’re concerned that some countries have either not taken this seriously enough, or have decided there’s nothing they can do.

We are concerned that in some countries the level of political commitment and the actions that demonstrate that commitment do not match the level of the threat we all face.

This is not a drill.

This is not the time to give up.

This is not a time for excuses.

This is a time for pulling out all the stops.

Countries have been planning for scenarios like this for decades. Now is the time to act on those plans.

These are plans that start with leadership from the top, coordinating every part of government, not just the health ministry – security, diplomacy, finance, commerce, transport, trade, information and more – the whole government should be involved.

Activate your emergency plans through that whole-government approach.

Educate your public, so that people know what the symptoms are and know how to protect themselves and others.

Increase your testing capacity.

Get your hospitals ready.

Ensure essential supplies are available.

Train your health workers to identify cases, provide careful and compassionate treatment, and protect themselves from infection.

If countries act aggressively to find, isolate and treat cases, and to trace every contact, they can change the trajectory of this epidemic.

If we take the approach that there’s nothing we can do, that will quickly become a self-fulfilling prophecy.

It’s in our hands.

https://www.who.int/dg/speeches/det...the-media-briefing-on-covid-19---5-march-2020

And here is today's NY Times story on the same, which has some insightful commentary on how several countries, including the US are doing with respect to what might be expected...

https://www.nytimes.com/2020/03/06/...P_BANNER&context=storyline_menu#link-5f7cc0ce

 

[RU848789]

Major milestone reached in China: no new cases yesterday in Hubei province, outside of the capital city of Wuhan (where there were 126 new infections, a low number for them). Extremely aggressive actions were required to achieve this. At one point in early February, Hubei reported more than 1,400 new cases outside Wuhan in one day.

https://www.nytimes.com/2020/03/06/...P_BANNER&context=storyline_menu#link-7c004d81

 

[srru86]

Washington Post
The NCAA is preparing for the coronavirus, and it’s complicated

 

[rutgersguy1]

Just saw on CNN 148 deaths and 3858 cases thus far in Italy. I read Italy has the second oldest population in the world behind Japan so that might be skewing the numbers too because of the demographic being affected.

From CNN:

The death toll from novel coronavirus in Italy surged today, marking the highest daily increase since the start of the virus outbreak in the country.

Angelo Borrelli, head of the Italian Civil Protection Agency, said today that 49 people had died in the last day, bringing the country wide death toll to 197.

The total number of confirmed cases in Italy rose by 778 on Friday, bringing the total number in the country to 4,636.

Borrelli said the median age of the people who have died from the virus in Italy is 81 years of age.

 

[RUfubar]

Pretty cool results from evaluations of people with coronavirus pneumonia via CT-scans, showing telltale signs, where coronavirus patients have very different patterns from non-coronavirus pneumonai patients? It's not 100%, but it's pretty high and every hospital has these, usually, and it could at least be used as a screening tool, especially as I think "positives" are real, while "negatives" could be false negatives (not far enough along in the infection for example) - if one has a positive CT-scan, they should be presumed positive (instead of "wasting" a test, when test kits aren't fully deployed yet and especially since it's much faster than the test) and be quarantined. If negative, then they probably should get the PCR test.

https://www.medicaldevice-network.com/news/coronavirus-ct-scans/

So here we are with the real reality. Evaluated a restaurant worker last night who is immunosuppressed on a biological agent colitis.
He's been ill for about a week and hematologist nonchalantly started him on a zithromycin.
He's developed a new leukopenia and lymphopenia and bumped his liver function a little bit. He is a grossly abnormal lung exam and a stat chest x-ray shows no infiltrates. He is luckily been out of work and I sent him for a stat CAT scan because as you say there's a peripheral pattern on the CT that'll help determine whether I'm going to test him further. Meanwhile I'll probably begin antivirals though rapid flu Test's negativeRight now he is refusing to pay for the CAT scan that needs to be done and I'm not spending my time on the phone doing a stat pre-authorization with his insurance company. I really don't want to have to send him to the emergency room unless he deteriorates. These are the real realities that we deal with. Overwhelmed ERs and insurance companies who don't give a damn and patients who got caught in between.

 

[RUJohnny]

So here we are with the real reality. Evaluated a restaurant worker last night who is immunosuppressed on a biological agent colitis.
He's been ill for about a week and hematologist nonchalantly started him on a zithromycin.
He's developed a new leukopenia and lymphopenia and bumped his liver function a little bit. He is a grossly abnormal lung exam and a stat chest x-ray shows no infiltrates. He is luckily been out of work and I sent him for a stat CAT scan because as you say there's a peripheral pattern on the CT that'll help determine whether I'm going to test him further. Meanwhile I'll probably begin antivirals though rapid flu Test's negativeRight now he is refusing to pay for the CAT scan that needs to be done and I'm not spending my time on the phone doing a stat pre-authorization with his insurance company. I really don't want to have to send him to the emergency room unless he deteriorates. These are the real realities that we deal with. Overwhelmed ERs and insurance companies who don't give a damn and patients who got caught in between.

One more time for the slow kid in the back please?

 

[RUhasarrived]

Hal Turner is reporting that 75,000 of our troops have been infected.

Turner scooped the NY Post by 2 days about the prescription drug shortage,so who knows?

 

[bob-loblaw]

And in typical RU screw fashion, we wind up making the tourney this year, but no one will be able to attend...

 

[RUfubar]

One more time for the slow kid in the back please?

I'm trying to detail how it's working in the United States on the home front in real life.
There were comments about the early diagnostic use of a CAT scan as opposed to obtaining the diagnosis by virus antigen testing.
So as it is true that CAT scan is better than plain X-ray and can be of utility but it's also true that we are encountering roadblocks getting these scans done.
Beginning last night our big labs like LabCorp are making their test available as well as the test done by the CDC. However, the test has drawbacks and a few day turnover time, so many patients who are moderately or severely ill have predominant lower respiratory tract symptoms - obtaining naso pharyngeal or oropharyngeal swabs can be misleading and of poor quality. In other words testing snot is not great when there's no snot around .the virus has a preference for invading the cells deep in your lung substance.You're not going to get great diagnostic yields unless you go into the intubated patient and grab some samples so a lot of moderately ill but stable patients that we keep at home are going to be very difficult to diagnose and add as "definite case" stats as we begin to talk about community spread.

 

[anon_ivydyf0amkzay]

And in typical RU screw fashion, we wind up making the tourney this year, but no one will be able to attend...

If that’s the case I will declare us the National Champions (screw those one seeds)

 

[GoodOl'Rutgers]

Always good to highlight those threads that will have exaggeration, accusations, right-wing and left-wing points of views, links from dubious sources and more! Don’t political threads get tossed over to that “other” board? (Make no mistake, this IS a political thread)

fascinating!

It's only political if people make it so. My potential response to RUfubar's post would have been political.. so I shall refrain (hint: my "solution" is to get rid of health insurance companies.. yeah, a political hot potato that is better discussed on the CE board). But for news on a (potential) pandemic? It should be everywhere.

RU#s clearly has a big brain and if he wants to use his retirement time to think about this issue and share his thoughts and what he learns.. that's great. The thing about South Korea's drive-thru testing centers.. fantastic. He found out.. he shared it. Love it.

 

[anon_ivydyf0amkzay]

As the SXSW liberal utopia cluster in the SF-wannabe to my north is canceled, their dumb ass mayor called the situation a “disaster”

mind you...it is la beyond absurd statement. There hasn't been one confirmed case of Covid19 in the Austin area, let alone any deaths. How the *#%¥ can your declare the situation a "disaster!" just moronic. Way to cost your city around 1/2 a BILLION (typical SXSW revenue)

 

[RU848789]

Washington Post
The NCAA is preparing for the coronavirus, and it’s complicated

Here's what I just said on the hoops board on this:

As I said earlier in the week, I'll be surprised if the tourney is held with fans in attendance. After 29 years, we should be in and it's looking likely that we won't be allowed to attend (unless they postpone, hoping spring will lead to decreased infection rates, which may occur, but that occurs after a normal infection peak and we're just on the very beginning of the upswing of our peak here in the US. Up to 300+ cases now and I'd guess it'll be 1000 this week and close to 10,000 by next weekend or so (assuming the great increase in test kits occurs, as the biggest reason we're not seeing more cases has likely been lack of testing).

So many large events being cancelled now: South By Southwest, Comic-Con,the Ultra Music Festival in Miami and this basketball game and more. At work, we just pulled out of going to the American Chemical Society Meeting in 2 weeks in Philly (15-20K attendees most years) and it's possible the whole event will be cancelled, but that hasn't happened yet.

And my family is on the very conservative side of all this, with our son moving home temporarily to get away from his slovenly roommates, as he can take his grad school courses at RU on line - we've stocked up on about a month's worth of non-perishable foods, so in theory we wouldn't "have" to go out at all if it came to it. He and my wife were very against me going to the MD game on Tuesday and are very unhappy about me going to the NCAA tourney. I said it's not negotiable and I'd stay in a hotel afterwards to self-quarantine, lol.

https://www.nytimes.com/2020/03/06/...P_BANNER&context=storyline_menu#link-1ae6ea51

https://rutgers.forums.rivals.com/t...on’t-allow-spectators-in.191450/#post-4432473

 

[RU848789]

Hal Turner is reporting that 75,000 of our troops have been infected.

Turner scooped the NY Post by 2 days about the prescription drug shortage,so who knows?

Revealing you listen to Hal Turner and actually believe anything he says should disqualify you from participation in this thread. This is one of the few times I wish I had moderator capabilities.

 

[RU848789]

I'm trying to detail how it's working in the United States on the home front in real life.
There were comments about the early diagnostic use of a CAT scan as opposed to obtaining the diagnosis by virus antigen testing.
So as it is true that CAT scan is better than plain X-ray and can be of utility but it's also true that we are encountering roadblocks getting these scans done.
Beginning last night our big labs like LabCorp are making their test available as well as the test done by the CDC. However, the test has drawbacks and a few day turnover time, so many patients who are moderately or severely ill have predominant lower respiratory tract symptoms - obtaining naso pharyngeal or oropharyngeal swabs can be misleading and of poor quality. In other words testing snot is not great when there's no snot around .the virus has a preference for invading the cells deep in your lung substance.You're not going to get great diagnostic yields unless you go into the intubated patient and grab some samples so a lot of moderately ill but stable patients that we keep at home are going to be very difficult to diagnose and add as "definite case" stats as we begin to talk about community spread.

Great stuff, doc - keep posting when you can. I know our society has become focused on military, fire, and police professionals as our main "heroes," but I find our medical professionals to be just as heroic, especially in situations like these, where they know they're putting themselves in harm's way to try to prevent an epidemic and in order to treat the serious cases, while being handcuffed by our byzantine systems at many turns.

Didn't realize the depth of the infection issue with regard to ability to get appropriate/representative samples for testing. That's where I would think the CT scan would really be useful, as it's quick and easy and very unlikely to miss a positive result, since you already know you have a serious deep lung infection and this just tells you whether it's from SARS-CoV-2 or not (with the not presumably being influenza). Maybe it's time for the $8.3BB bill to open up paths to use these devices at the discretion of the doctors to help identify COVID-19 patients, at no cost to them.

Been wondering about the logistics of all this after seeing the very innovative SK drive through example. At the very least one would think all hospitals ought to have separate entrances/waiting rooms for suspected COVID-19 patients, with masks and handwashing/sanitization stations right at the entrance (and exits). I can imagine it might be even riskier at GP offices, where there's no infrastructure to accommodate such things, yet that's where most patients will go first. This is also an opportunity for technology to really help here by doing video interviews/diagnoses (but how many elderly would be able to do that and they're the most at risk of being seriously impacted and are at risk of contracting the virus by leaving the home).

 

[RU848789]

It's only political if people make it so. My potential response to RUfubar's post would have been political.. so I shall refrain (hint: my "solution" is to get rid of health insurance companies.. yeah, a political hot potato that is better discussed on the CE board). But for news on a (potential) pandemic? It should be everywhere.

RU#s clearly has a big brain and if he wants to use his retirement time to think about this issue and share his thoughts and what he learns.. that's great. The thing about South Korea's drive-thru testing centers.. fantastic. He found out.. he shared it. Love it.

Thanks, that's very nice of you to say, especially when we're arguing like cats and dogs in the other thread, but I know you usually rise above that for more important things, like this, and it's appreciated in this thread.

 

[Joey Bags]

I would have to imagine DoD and DARPA would be hard at work on a vaccine given the potential national security implications of this, no? Ft. Detrick and the other class 4 labs would have to be working overtime.

Some of these private sector firms working on a vaccine are borderline startups, not what I’d want to put our NatSec in the hands of.

 

[Salvi's Headband]

As the SXSW liberal utopia cluster in the SF-wannabe to my north is canceled, their dumb ass mayor called the situation a “disaster”

mind you...it is la beyond absurd statement. There hasn't been one confirmed case of Covid19 in the Austin area, let alone any deaths. How the *#%¥ can your declare the situation a "disaster!" just moronic. Way to cost your city around 1/2 a BILLION (typical SXSW revenue)

Since there is hardly any testing going on we really have no clue. Last thing any city needs is hundreds of thousands of out of town guests right now.

 

[RU848789]

Great stuff, doc - keep posting when you can. I know our society has become focused on military, fire, and police professionals as our main "heroes," but I find our medical professionals to be just as heroic, especially in situations like these, where they know they're putting themselves in harm's way to try to prevent an epidemic and in order to treat the serious cases, while being handcuffed by our byzantine systems at many turns.

Didn't realize the depth of the infection issue with regard to ability to get appropriate/representative samples for testing. That's where I would think the CT scan would really be useful, as it's quick and easy and very unlikely to miss a positive result, since you already know you have a serious deep lung infection and this just tells you whether it's from SARS-CoV-2 or not (with the not presumably being influenza). Maybe it's time for the $8.3BB bill to open up paths to use these devices at the discretion of the doctors to help identify COVID-19 patients, at no cost to them.

Been wondering about the logistics of all this after seeing the very innovative SK drive through example. At the very least one would think all hospitals ought to have separate entrances/waiting rooms for suspected COVID-19 patients, with masks and handwashing/sanitization stations right at the entrance (and exits). I can imagine it might be even riskier at GP offices, where there's no infrastructure to accommodate such things, yet that's where most patients will go first. This is also an opportunity for technology to really help here by doing video interviews/diagnoses (but how many elderly would be able to do that and they're the most at risk of being seriously impacted and are at risk of contracting the virus by leaving the home).

Well, this report from CIDRAP, linked and excerpted below, shows how health care workers can be very well protected, citing a paper published by a group detailing the procedures put in place in Hong Kong resulting in zero health care worker infections out of the 413 workers who have been involved in treating COVID-19 patients in hospitals in Hong Kong. I doubt we're doing things nearly this well in the US from what I've been reading, unfortunately.

http://www.cidrap.umn.edu/news-pers...-serial-covid-19-cases-may-hinder-containment

Protecting healthcare workers against COVID-19
A robust, multifaceted response to the COVID-19 outbreak protected healthcare workers against the virus in a Hong Kong hospital, according to the second study, published today in Infection Control & Hospital Epidemiology.

Led by researchers at Queen Mary Hospital in Hong Kong, the study describes the hospital's infection control response in the first 42 days after a cluster of pneumonia in Wuhan, China, was reported on Dec 31.

The hospital, like other public hospitals in Hong Kong, immediately stepped up its infection control procedures using enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers who had been unprotected against exposure.

Workers were educated about personal protective equipment, infection control, and hand hygiene in staff forums and in-person sessions. When screening identified a patient infected with the coronavirus, he or she was immediately isolated in an airborne isolation room or a ward with at least one meter of space between patients.

Zero infections or deaths in hospital workers
Eleven unprotected healthcare workers out of 413 involved in treating patients with confirmed illness were quarantined for 14 days. No hospital workers were infected, and no hospital-acquired infections were identified after the first 6 weeks of the epidemic. This was despite the health system testing 1,275 patients with suspected infection and treating 42 patients with active, confirmed infection.

"Vigilance in hand hygiene practice, wearing of surgical masks in the hospital, and appropriate use of personal protective equipment in patient care, especially performing aerosol-generating procedures, are the key infection control measures to prevent nosocomial transmission of SARS-CoV-2 [the COVID-19 virus]," the authors wrote.

The investigators also collected air samples from near the mouth of a patient with a moderate viral load. The virus was not detected in any test, and tests of objects in the room detected it only on a window bench, suggesting that environmental transmission may not be as important as person-to-person transmission.

The same story in CIDRAP link above also details that the virus's serial interval (the time between successive cases) is close to or shorter than its median incubation period, suggesting pre-symptomatic transmission may play a key role in the outbreak and case isolation alone might not be as effective as hoped. This was based on a small 28-person study in Japan, but if it holds true, it clearly makes containment harder.

In addition, CIDRAP highlighted a report crediting public health efforts for rapid containment of the spread of COVID-19 in Hangzhou, China. The city's COVID-19 cases climbed from an initial 6 on Jan 19 to 169 by Feb 27. In the last week that they studied, the number of new cases decreased sharply, and only 1 case was confirmed from Feb 17 to 20, according to the authors. There were no deaths among the patients. They instituted an aggressive red-yellow-green zone system with varying levels of quarantine on travel from outsiders into the city and on residents leaving the house in the red/yellow zones, supplemented by delivery of necessities to such people. That takes a lot of planning and coordination, obviously, but appears to be working so far.

 

[Salvi's Headband]

Well, this report from CIDRAP, linked and excerpted below, shows how health care workers can be very well protected, citing a paper published by a group detailing the procedures put in place in Hong Kong resulting in zero health care worker infections out of the 413 workers who have been involved in treating COVID-19 patients in hospitals in Hong Kong. I doubt we're doing things nearly this well in the US from what I've been reading, unfortunately.

http://www.cidrap.umn.edu/news-pers...-serial-covid-19-cases-may-hinder-containment

Protecting healthcare workers against COVID-19
A robust, multifaceted response to the COVID-19 outbreak protected healthcare workers against the virus in a Hong Kong hospital, according to the second study, published today in Infection Control & Hospital Epidemiology.

Led by researchers at Queen Mary Hospital in Hong Kong, the study describes the hospital's infection control response in the first 42 days after a cluster of pneumonia in Wuhan, China, was reported on Dec 31.

The hospital, like other public hospitals in Hong Kong, immediately stepped up its infection control procedures using enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers who had been unprotected against exposure.

Workers were educated about personal protective equipment, infection control, and hand hygiene in staff forums and in-person sessions. When screening identified a patient infected with the coronavirus, he or she was immediately isolated in an airborne isolation room or a ward with at least one meter of space between patients.

Zero infections or deaths in hospital workers
Eleven unprotected healthcare workers out of 413 involved in treating patients with confirmed illness were quarantined for 14 days. No hospital workers were infected, and no hospital-acquired infections were identified after the first 6 weeks of the epidemic. This was despite the health system testing 1,275 patients with suspected infection and treating 42 patients with active, confirmed infection.

"Vigilance in hand hygiene practice, wearing of surgical masks in the hospital, and appropriate use of personal protective equipment in patient care, especially performing aerosol-generating procedures, are the key infection control measures to prevent nosocomial transmission of SARS-CoV-2 [the COVID-19 virus]," the authors wrote.

The investigators also collected air samples from near the mouth of a patient with a moderate viral load. The virus was not detected in any test, and tests of objects in the room detected it only on a window bench, suggesting that environmental transmission may not be as important as person-to-person transmission.

The same story in CIDRAP link above also details that the virus's serial interval (the time between successive cases) is close to or shorter than its median incubation period, suggesting pre-symptomatic transmission may play a key role in the outbreak and case isolation alone might not be as effective as hoped. This was based on a small 28-person study in Japan, but if it holds true, it clearly makes containment harder.

In addition, CIDRAP highlighted a report crediting public health efforts for rapid containment of the spread of COVID-19 in Hangzhou, China. The city's COVID-19 cases climbed from an initial 6 on Jan 19 to 169 by Feb 27. In the last week that they studied, the number of new cases decreased sharply, and only 1 case was confirmed from Feb 17 to 20, according to the authors. There were no deaths among the patients. They instituted an aggressive red-yellow-green zone system with varying levels of quarantine on travel from outsiders into the city and on residents leaving the house in the red/yellow zones, supplemented by delivery of necessities to such people. That takes a lot of planning and coordination, obviously, but appears to be working so far.

The USA is incapable of doing anything remotely resembling what China did.

 

[RU848789]

Stark differences continue in comparing the outbreaks in South Korea and Italy. SK reported 483 new infections on Saturday, bringing its total caseload to 7041, including 48 deaths, for the lowest reported fatality rate anywhere in the world, of about 0.6%, which is very likely due to their highly aggressive testing rates, with over 158,000 people being tested to date - as I've posted before, this appears to confirm a likely actual lower mortality rate one would truly expect if most/all of the cases are factored in (and not just the fairly serious cases that have generally been tested for in most countries, to date). Interestingly, more than 5,000 of those infected are Daegu residents and a vast majority of them belong to the Shincheonji Church.of Jesus, which is considered a cult by many other South Korean Christian churches.

https://www.nytimes.com/2020/03/07/...show&region=TOP_BANNER&context=storyline_menu

In contrast, Italy, which has the worst outbreak outside of Asia, saw its number of cases rise 4,636, with 197 of them fatal, for an overall mortality rate of 4.2% (and only China has seen more deaths)! However, it should be noted that the media age of those dying from the infection is 81, which further confirms how dangerous this infection is to people over 65, as has been seen in China and other countries and on the Diamond Princess cruise ship where all the deaths were in people over 70. The government has ordered the closure of all schools for 10 days as it battles to contain the outbreak and all professional sports, including Serie A football matches, will also be played without fans in attendance until at least 4/3. NCAA Tourney, NBA, NHL, baseball, etc.?

https://www.reuters.com/article/us-...ar-200-after-biggest-daily-jump-idUSKBN20T2ML

Testing rates are very interesting comparing countries. As of 3/2, the last date available on the World-o-Meter site for the coronavirus (a great resource for stats/stories). SK has a fairly similar number of cases to Italy, for example, but has tested about 5X as many people (110K to 23K as of 3/2 and SK is up to 158K tested now).

And guess who the worst laggard is in the list - yep, the USA with 472 tests performed as of 3/2, which I'm sure is a large part of why we've only seen 300+ cases, when that number is likely in the thousands and is also why our mortality rate is the highest I've seen (5.1% - denominator is so small). The US-CDC also stopped reporting testing rates, supposedly since States are now doing so, but I haven't seen that data and not having a country-wide dataset is unacceptable IMO.

Below are a couple of tables from that site, summarized here, with selected countries, as the tables can't be cut/pasted and I didn't feel like copying the data for every country, lol. Sorry for the ugly tables - I put hard spaces in so they'd look like tables (after finding out soft spaces were ignored). Anyone know of a way to either copy/paste the source tables or how to enter them here manually so they look like a table? Bueller?

Testing Rates as of March 2, 2020 (when the CDC stopped reporting number of tests in the US)
Country.........Tests Performed....Tests per Million....Population
China (no data in table)
S Korea........109,591................. 2,138.....................51,269,185
Italy.................23,345..................386........................60,461,826
UK..................13,525..................199.........................67,000,000
USA.................. 472....................1...........................331,000,000

https://www.worldometers.info/coronavirus/covid-19-testing/

Case Rates (via confirmed tests) and Death Rates (deaths/cases) as of March 7, 2020
Country........Cases Confirmed....Deaths..Death Rate
China...........80651.......................3071.....3.8%
S. Korea.......7041.........................48.........0.7%
Italy...............4636........................197........4.2%
UK..................164...........................2.........1.2%
USA................335.........................17.........5.1%

https://www.worldometers.info/coronavirus/#countries

 

[anon_ivydyf0amkzay]

Maybe Bryan Williams and msnbc can be put in charge of computing rates and such...they seem to be so good at numbers and they do it so quickly!

 

[RU848789]

And we have our first two East Coast deaths, as two elderly people died in Florida, after returning from undisclosed interenational travel. The CDC is advising all people over 60 and those with severe chronic medical conditions to stay at home as much as possible. Good advice, probably, as it doesn't appear we're doing much testing yet and we don't appear to have good infection controls in place in our medical facilities, so going to a hospital right now, might be one of the more dangerous trips one could make.

https://www.cnn.com/2020/03/07/us/florida-coronavirus-deaths/index.html

 

[rutgersguy1]

And we have our first two East Coast deaths, as two elderly people died in Florida, after returning from undisclosed interenational travel. The CDC is advising all people over 60 and those with severe chronic medical conditions to stay at home as much as possible. Good advice, probably, as it doesn't appear we're doing much testing yet and we don't appear to have good infection controls in place in our medical facilities, so going to a hospital right now, might be one of the more dangerous trips one could make.

https://www.cnn.com/2020/03/07/us/florida-coronavirus-deaths/index.html

Even without this hospitals are dangerous places for elderly....can pick up something instead of curing/healing it. Also saw article with CDC recommending people over 60 limit how much they go out and avoid crowded places.

https://www.cnn.com/2020/03/06/health/coronavirus-older-people-social-distancing/index.html

Also hotel collapse in China that was used to house coronavirus quarantine.

https://www.cnbc.com/2020/03/07/70-...us-quarantine-collapses-in-china-reuters.html

 

[RU4Real]

And we have our first two East Coast deaths, as two elderly people died in Florida, after returning from undisclosed interenational travel. The CDC is advising all people over 60 and those with severe chronic medical conditions to stay at home as much as possible. Good advice, probably, as it doesn't appear we're doing much testing yet and we don't appear to have good infection controls in place in our medical facilities, so going to a hospital right now, might be one of the more dangerous trips one could make.

https://www.cnn.com/2020/03/07/us/florida-coronavirus-deaths/index.html

So how does this work? If people over 60 are supposed to stay home all the time, do you and I have to stay home 96.7% of the time?

 

[RU848789]

So how does this work? If people over 60 are supposed to stay home all the time, do you and I have to stay home 96.7% of the time?

Yep, same here, lol. With my lack of confidence in the CDC these days, as you may recall from previous posts, we went from not taking many precautionary steps to mostly hunkering down at home starting about a week ago with about a months worth of non-perishable food on hand and only going out sparingly since then, with lots of handwashing, just in case (wife and son have asthma and son has low immunoglobulin levels; no issues for me, but I'm also at 96.7% just due to age and don't want to bring anything home). Might need to borrow some of your weapons, though, to keep the zombies out.

 

[RU848789]

The USA is incapable of doing anything remotely resembling what China did.

Yes, but we also have an acutely "nervous" population very attuned to avoiding risks and liabilities (at least in the suburbs, lol), so I think we're going to see a lot more self-quarantining early on in any outbreak hotspots and cancellation of large gatherings of people, like we're seeing now, which should reduce transmission rates. In the early days in Wuhan they had nothing in place, which is why it got so bad. We're way ahead of that, but will agree that we're also unlikely to become as aggressive and organized as they've been in Hangzhou, which is why I'm guessing we're going to parallel Italy to some extent with a very high reported death rate, due to lack of testing (so total cases looks very low), and that that death rate will be mostly people over 65.