This is not what Worldometers is reporting.
https://www.worldometers.info/coronavirus/country/south-korea/
Japan on the other hand is seeing a spike.
https://www.worldometers.info/coronavirus/country/japan/
COVID-19 Pandemic: Transmissions, Deaths, Treatments, Vaccines, Interventions and More...
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https://www.worldometers.info/coronavirus/country/south-korea/
Japan on the other hand is seeing a spike.
https://www.worldometers.info/coronavirus/country/japan/
Similar story for me, though as of yesterday we were somewhere around 50%. Wasn't there today. But law is in effect tomorrow, I'm interested to see if people try to come in without them.
Anecdotally, I find that my covid patients who use antihistamines are doing/feeling worse as they dry out secretions and cause drowsiness generally. Many over-the-counter preps feature antihistamines but I urge avoid.
There are other options for allergy sufferers including singular.
There are other options for allergy sufferers including singular.
I was already seeing the percent of customers wearing some type of face covering rise before Murphy's exec order...
I was as well, but not as much as you were. This weekend we were probably at 25%. Wednesday was somewhere around 50%.
Some guys I think would never wear one without this law. I'm not positive they will wear them even with the law.
My post had nothing to do with number of cases. Not sure what you’re referring to in my post, the post was about SK seeing some people test positive again after having supposedly recovered and negative. That was seen a in some people in China and Japan as well.
I’m probably going to even wear work goggles I have at home the next time I go out...whenever that is. Was debating it but I have an elderly person in my house who would be very vulnerable if I brought something home. For that little extra peace of mind to prevent that why not.
Lots of disagreement on this topic,as I know you know, but others might not. The opinion of most infectious disease experts, like Fauci, is that "reinfection" is much more likely a function of testing accuracy of the viral PCR test, which is not particularly accurate (~30+% false negatives and some false positives). Scientifically, it simply makes no sense for a person who recovers from a viral infection to not then have the antibodies to be immune from reinfection, at least for some time, except for people with immunological issues, as was reported this past weekend in my post below - this was based on the best antibody test out there, now. Since this is a new virus, there are no guarantees that reinfection isn't possible, but it's not the way to bet. From the article you linked, below...
The Korea Centers for Disease Control and Prevention (KCDC) said in a statement a formal investigation was underway looking into dozens of patients that reportedly tested positive for the disease for a second time.
“While we are putting more weight on reactivation as the possible cause, we are conducting a comprehensive study on this,” KCDC Director-General Jeong Eun-kyeong said, according to Bloomberg. “There have been many cases when a patient during treatment will test negative one day and positive another.”
Similar reports have come out of China, where the virus emerged late last year, and Japan in February reported a woman tested positive for the coronavirus a second time.
But some researchers say reinfection is an unlikely explanation for patients who test positive twice, and note the possibility that testing errors, and releasing patients from hospitals too early, are more likely to be the cause of patients who retest positive.
“If you get an infection, your immune system is revved up against that virus,” Keiji Fukuda, director of Hong Kong University’s School of Public Health, told The Los Angeles Times in March. “To get reinfected again when you’re in that situation would be quite unusual unless your immune system was not functioning right.”
Some great progress being made on serological antibody tests at Mass General. Have to click on "see replies" in the lower left hand corner of the tweet (at least I did - I could only see the title slide). Looks like infected patients don't show measurable antibodies until about 7 days after symptom onset and younger people had faster antibody growth rates (separate slide) and immunosuppressed people had the slowest growth rates (the two black circles in the grey shaded part of the graphic below).
The red "healthy convalescent" dot represents a patient given the convalescent plasma with antibodies treatment (didn't think they were doing that at Mass General, though - maybe they were sent a sample from NYC). Was also good to see they now have confidence in the accuracy of the antibody assays (including developing a better ELISA assay themselves; ELISA is "enzyme-linked immunosorbent assay" a plate-based assay technique designed for detecting and quantifying substances such as peptides, proteins, antibodies and hormones).
Rutgersguy wasn't posting about overall infection rates, he was posting about potential reinfection of a small number of previously infected people. Certainly, Singapore and Japan are seeing significant spikes, but South Korea tamped down a recent spike and is back down below 50 new cases per day. And Taiwan remains below 10 new cases per day.
Feel bad for my very good friend and his fiancee who left Jersey City as cases were rising quickly about 2 weeks ago and got the last flight to Singapore from the US and he just got out of the 14-day quarantine just in time for Singapore's spike. Their wedding is in Singapore in May - was originally going to go, but that's out the window now...
Anything else you're seeing medically? Especially curious about any of the repurposed drug trials, the convalescent plasma therapy, and antibody testing, which has been a bit bogged down with technical issues from what I read. As always, thanks for your service.
That was generally my thought the first time I heard these reports in China and Japan, that it must be some sort of testing snafu for false negatives but it does seem curious seeing it happen again and SK like Japan I have more faith in. 51 cases out 10000+ is like .5% so I guess that could be an acceptable margin of error for false negatives.
Oops. Was recently looking at the Worldometer chart and then jumped to conclusion when I read your post.
I think part of the reason I jumped to the conclusion in Rutgersguy's post is I had recently heard someone say that SK had a recent spike, but looking at their chart, there is not much of a spike. Looks more like slight variations in an overall downward trend.
I'm seeing a lot of interesting stuff on twitter regarding use of ventilators on covid patients. A number of doctors questioning the standard protocols which are based on ARDS, they are saying the covid patients don't really have ARDS and the ventilators are causing damage to lungs, especially when started too early. More and more talk about the blood issues related to covid, especially hypercoagulation (blood clotting too easily) causing blockages in blood flow in the lungs. Thinking that is impacting oxygenation more than fluid buildup (which is more typical of pneumonia/ARDS), at least in some cases.
Note this thinking is being driven by the very low survival rates of people who wind up on ventilators, considerably lower than for people with typical ARDS.
I don't know if @RUfubar is working in a hospital treating critically ill patients or more in an outpatient/primary care setting but would be interested in his thoughts about this.
Pretty sure my post from the other day explains at least 75% of the disparity. Starting social distancing a week earlier (vs. when each state hit 10 cases per 1MM people, so it's apples to apples) makes a huge impact. Obviously, this also points out that the leadership in NY/NJ acted more slowly than they should have, in hindsight, given the exponentially growing infection rates in early/mid-March, while CA (and WA) leaders were clearly more proactive, although lack of Federal support in having a national strategy for a national security threat, like a pandemic was a major issue also. As an aside, at least in the big cities in CA vs. NYC, there are similar total people in fairly densely populated areas (although nobody approaches Manhattan), so I'm sure this is a factor, but not the biggest one.
Look at my post from yesterday. California started aggressive social distancing around the same time as NY/NJ, but had far fewer cases per capita, so they were at least a week behind us in the progression of the outbreak. Starting SD a week earlier makes a huge difference in the eventual outcome. There could be other contributing factors, but that's the biggest factor, IMO. Same analysis shows why NY did so much better than Italy in an earlier post.
In my comparison of the US and Italy yesterday, I showed how the US starting aggressive SD about 9 days earlier than Italy did vs. the same reference standard starting point of 10 cases per 1 million in population (needs to be per capita to be apples to apples) and we now have a much lower death rate per day than Italy does and, assuming we continue with aggressive SD will end up with well less than half their total deaths per capita (and less than half their cases per capita).
It's why all the states that have not started aggressive social distancing, despite everyone knowing what I just posted above, are just fukking stupid and their governors should be fired - and that's also why this should be coordinated nationally and not left with the states.
https://rutgers.forums.rivals.com/t...social-distancing.191275/page-55#post-4491470
https://covidly.com/graph?country=United States&state=New York
https://covidly.com/graph?country=United States&state=California
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In case anyone thinks I only criticize the POTUS and Republicans, read on - there's a decent mix of bipartisan criticism in this post. Hopefully enough to keep this from getting out of control, but I did want to share what I thought was a well balanced article in this thread.
The Times has also picked up on the relative differences in implementing social distancing in NYC Metro vs. CA that I posted about a few days ago and again above, detailing how the State and the City missed opportunities to start SD earlier, which would likely have saved several thousand lives. In many ways it was unlucky, although probably predictable, that the NYC Metro area would become the earliest major epicenter (along with Seattle), given how much international travel there is, how high the population density is and how many people commute and play among large crowds almost everywhere in the area. So failure to act early in our area was more impactful than it would have been anywhere else. NY/NJ have about 3/4 of CA's population, but have over 15X as many deaths (8760 vs. 509, so far), although we do need to see how this finishes out.
How this all happened is a complex story, but the Times does a good job with it IMO. Basically, there was a combination of overconfidence and slow recognition of the exponentially growing risk in people like Cuomo and DeBlasio (and Murphy), as well as their old rivalry leading to arguments over what to do, leading to delays, plus significant lack of Federal support with regard to even recognizing there was a pandemic roaring towards the US (with the POTUS downplaying the threat for weeks) and with respect to planning, testing, and supplies, as many of us have detailed over the past 2 months.
This all goes to show how much difference a week or so can make: a week+ earlier in implementing aggressive testing/social distancing, and NY/NJ likely could have had a CA-level outbreak and a week+ later and NY/NJ likely would've had a far worse outbreak, like Italy/Spain. And IMO, given that this was clearly a threat to National Security, there should have been a nationwide shutdown by 3/10, at the latest (instead of the slow roll of restrictions put in place from about 3/16 to 3/20 in our area), given what we were seeing coming - and maybe even earlier. If my family went into lockdown on 3/3, surely the experts could have been as proactive, although the article clearly shows how much pressure there was on government officials to not hurt the economy (that's a bipartisan concern, obviously).
Having said all that, I think Cuomo, in particular has been the epitome of a leader and his leadership, along with the leadership of numerous other governors, is the main reason we're now looking at 50-60K US deaths instead of the 100-240K US deaths projected from this first wave not long ago, since I don't know when we ever would have gotten national shutdown orders from the Administration. And we still haven't and I'll never understand that.
https://www.nytimes.com/2020/04/08/nyregion/new-york-coronavirus-response-delays.html
Epidemiologists have pointed to New York City’s density and its role as an international hub of commerce and tourism to explain why the coronavirus has spread so rapidly. And it seems highly unlikely that any response by the state or city could have fully stopped the pandemic.
From the earliest days of the crisis, state and city officials were also hampered by a chaotic and often dysfunctional federal response, including significant problems with the expansion of coronavirus testing, which made it far harder to gauge the scope of the outbreak.
Normally, New York would get help from Washington in such a time, as it did after Sept. 11. But President Trump in February and early March minimized the coronavirus threat, clashing with his own medical experts and failing to marshal the might of the federal government soon after cases emerged in the United States.
As a result, state and city officials often had to make decisions early on without full assistance from the federal government. Even so, the initial efforts by New York officials to stem the outbreak were hampered by their own confused guidance, unheeded warnings, delayed decisions and political infighting, The New York Times found...
...Dr. Frieden said that if the state and city had adopted widespread social-distancing measures a week or two earlier, including closing schools, stores and restaurants, then the estimated death toll from the outbreak might have been reduced by 50 to 80 percent. But New York mandated those measures after localities in states including California and Washington had done so.
Great article on the behind the scenes efforts to get the convalescent plasma-antibody approach moving over the last coupl, where blood plasma from infected, but recovered patients containing antibodies to the virus are infused into patients with the virus - it's been very promising in very small studies in China so far and we should know a ton more in about 2-3 weeks.
Great article on the behind the scenes efforts to get the convalescent plasma-antibody approach moving over the last couple of months, as doctors and researchers work around the clock to develop the science and clinical protocols to evaluate this treatment technology. If this ends up being as effective as many think it will be, Dr. Arturo Casadevall will be taking home the Nobel Prize in Medicine for his work to make the pitch to get this on the radar of the medical community and public health leaders and his efforts to marshall the far flung forces required to bring this from concept to a scalable treatment for at least tens of thousands, so that death is no longer a common outcome from this virus. According to the article we should know how it works in larger scale trials by late April. Crossing fingers as humanity could use a break here.
"Arturo Casadevall and collaborators at Johns Hopkins and beyond have worked around the clock to develop a convalescent serum therapy to treat COVID-19 using blood plasma from recovered patients. If early promising studies on the therapy done in China are confirmed by U.S. trials, thousands of survivors might soon line up to donate their antibody-rich plasma. "I absolutely think this could be the best treatment we have for the next few months," Hopkins pathologist Aaron Tobian says."
https://hub.jhu.edu/2020/04/08/arturo-casadevall-blood-sera-profile/
Great article on the behind the scenes efforts to get the convalescent plasma-antibody approach moving over the last couple of months, as doctors and researchers work around the clock to develop the science and clinical protocols to evaluate this treatment technology. If this ends up being as effective as many think it will be, Dr. Arturo Casadevall will be taking home the Nobel Prize in Medicine for his work to make the pitch to get this on the radar of the medical community and public health leaders and his efforts to marshall the far flung forces required to bring this from concept to a scalable treatment for at least tens of thousands, so that death is no longer a common outcome from this virus. According to the article we should know how it works in larger scale trials by late April. Crossing fingers as humanity could use a break here.
"Arturo Casadevall and collaborators at Johns Hopkins and beyond have worked around the clock to develop a convalescent serum therapy to treat COVID-19 using blood plasma from recovered patients. If early promising studies on the therapy done in China are confirmed by U.S. trials, thousands of survivors might soon line up to donate their antibody-rich plasma. "I absolutely think this could be the best treatment we have for the next few months," Hopkins pathologist Aaron Tobian says."
https://hub.jhu.edu/2020/04/08/arturo-casadevall-blood-sera-profile/
It really sucks that NY acted too slow, late, NJ took the brunt of their inaction
NY has a massive subway system. LA doesn't. NYC population density 26403 ppl per square mile. LA 7545 ppl per square mile. NJ has a lot of people commuting to the city on trains. LA is a car city.
I bet that has a lot to do with it too in addition to starting a week earlier on shutting things down.
Cuomo, DeBlasio, and Murphy have really shit the bed on this one. They really are the Three Democrat Stooges of the Apocalypse!
I referred recovered patients to donate to Columbia, UPenn but it's a problem catching them at the right time and getting follow up testng to prove that they're negative several times before they'll take their plasma. It's an exhausting process.
By the way have you seen the list of companies who have applied to the FDA testing for point of service? It reads like a takeout menu from a Chinese restaurant.
https://www.fda.gov/medical-devices...al-devices/faqs-diagnostic-testing-sars-cov-2
We've been told many times that it doesn't matter. Look at New Orleans, Ecuador
Unfortunately I'm both in and out of hospital but I have to tell you the nurses are doing the yeoman's work. We limit the The amount of people going in and out of the room and use the nurse as an arm.
The sick patients are not behaving like typical ARDS and their lung s are fairly flexible but they're requiring a ridiculous amount of what we call peep which is probably damaging their lungs. I think it's going to turn out to be more like what we call high altitude pulmonary edema. Keeping the patient on their belly especially if they're overweight half the day is now the protocol. One of the troubles is the truly ill patients are hypercoagulable and I think eventually we're just going to put everybody on standard anticoagulation because they all look like they have pulmonary emboli even as outpatients. So we want to keep the lungs as dry as possible because those alveoli , air sacs are drowning and some hospitals are using Lasix drips but we need to maintain blood pressure and perfusion to other areas so it's a double-edged sword. I had a lady 2 days ago who was improving greatly at home on day 15 and then she started getting chest pain again which I swore she had to develop a pulmonary embolus and sent her d-dimer which was off the wall And I was dreading calling her back but when she answered the phone she was like I'm great It's all gone I feel better so I'm crossing my fingers. And we can't keep testing them because we don't want to expose radiology and ultrasound people just for the sake of testing. I've never seen these kind of inflammatory numbers and hyper coagulation numbers this far out so the two week thing is so arbitrary. I really think our best that is to use the meds that will interfere with the cytokine storm because this reminds me of how some young healthy people react to the equipment when they're in open heart bypass surgery and they have such rocky roads because their immune systems are reacting to the materials like the tubing of the bypass machine. it seems like it's a two-phase illness where you have the initial infection which doesn't seem like too big of a deal and then the immunological part which is causing the most problem.
One more thing I have to add and this is anecdotally driven.
I have had people who I have put on zithromax alone And I absolutely hate doing this for a variety of reasons. And overnight their pulse ox went from '80s to '90s with them feeling improved. I don't know what to make of it but the other day I have this construction company guy who's been at home with his elderly demented ill mother and her caretaker who's also ill and he had gone to medi merge and was given some cough medication and for some reason Biaxin. They didn't covid test him.
So he's deteriorating and And he has a history of coronary disease and MI so I'm avoiding plaquenil. chest x-ray shows peripheral bilateral pneumonia pretty typical and his labs aren't too terrible yet and I switch him to zithromax and he's dancing the next day (And now I've done this multiple times) Hope I didn't just jinx myself and him. So, I'm now wtf. I'm going to give it early but we're on strict watchdog regarding the plaquenil.
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I counter that with India. For a country of over 1B people they have very low number of cases.
There are of course other factors. New Orleans held Mardi Gras for goodness sake. And NOLA has very high rates of other health factors.
Overall warm weather climate areas have done much better.
Hope so with summer around the corner here.
But , back to the original point, Northern CA isn't too warm and very dense SF and Oakland have had very few CV cases
The Bay Area is much warmer than NY/NJ in Jan, Feb, Mar.
Yes San Francisco (the city itself) can get quite chilly as a micro-climate, but almost is never truly cold. When was the last blizzard in SFO?
The population density in SF is much lower than NYC. And the NYC subway system has about 37,000 riders per mile each day, while the Bay Area Rapid Transit system has only 3,700 riders per mile. That all contributes to a lower transmission rate.
Plus the SF area instituted a lockdown about a week earlier, while NYC delayed their lockdown. Also, SF is an international gateway from Asia, where travel was restricted earlier, while NYC is an international gateway from Europe, where travel wasn't restricted until very late. And it seems that NYC had the bad luck to have a spread of the virus before testing was available.
I’ve always pointed to India as the example that there’s a good chance humidity/heat affects transmission rates. The virus came from their neighborhood and many of the surrounding countries have it and still their number of cases aren’t much at all if you look at the population size, density and overall hygiene of the country.
They have 6000+ cases last I looked and that’s quite low even if testing is insufficient. I’d think you’d have seen it with hospitals bursting at the seams by now. It started in their neighborhood so it’s been in that region longer and they haven’t had nearly as many cases as us by many factors and they have 3-4 times the population and much higher density in areas.
it seems like it's a two-phase illness where you have the initial infection which doesn't seem like too big of a deal and then the immunological part which is causing the most problem.
I agree, 100%. Anecdotally, it appears this virus is "tricking" the immune system into doing more than it needs to. Almost like the old machine gun to kill a fly analogy. It could also explain why kids aren't as affected as much. The immune system of children aren't advance yet, so the immune system treats the virus as a common cold and responds accordingly. There's no "nuclear" option.
I'm not sure if it's a law but I thought he was referring to this.
https://www.nj.com/coronavirus/2020...pacity-under-new-coronavirus-restriction.html
Two points:
1) My son is a first year resident at Christiana Hospital in Newark Delaware. Their protocol is to put COVID pts that are admitted on therapeutic doses of anticoagulants because of exactly what you are seeing.
2) Pts admitted for oxygen are being given plaquenil and Zithromycin and if they need a ventilator, are being given remsidivir.
So it's not a law that you have to have a mask, which is good for those of us who have been unable to buy them.
Personal guidance? GFY Murphy!
I don’t know if it has to be a mask per se as much as just any facial covering makeshift or otherwise.
Thanks for both of your replies. I was reading a treatment protocol that was put out by a hospital system down in Virginia (can't remember which one) and they were talking about liberal use of anticoagulants. Also mentioned vitamin C, zinc, HCQ, zith, steroids...I'll have to see if I can find it. This disease is horrifying and fascinating at the same time.
Here's the treatment protocol I'm referring to. Would be interesting to know how this compares to what is being done at your hospitals.
https://www.evms.edu/media/evms_pub...cine/EVMS_Critical_Care_COVID-19_Protocol.pdf
I honestly don't know yet, since this was just instituted. Ask me in a week or two and I hope I'll have some real answers.
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