Coronavirus Numbers

[+ tassojunior]

Airborne Coronavirus Detected in Wuhan Hospitals

 

 

Do other people buy this? I don't really.

 

It is similar to the findings on one of those cruises. They found COVID-19 RNA a few weeks later - like in cabins, on floors, all over the place I think. But I searched and I could not find anything that said the virus was still alive and contagious weeks later. My assumption is that passengers were unwittingly spreading it everywhere - through hands, touch, hugs, kisses, close breathing, door knobs, plates, whatever. But I never read that you could get it from something left behind two weeks prior. In a few interviews I've watched Fauci has suggested that, outside of lab experiment conditions, the virus mostly doesn't last on surfaces for more than a few hours. I've been assuming two days is a pretty good margin of error.

 

This One Number Shows Why Measles Spreads Like Wildfire

 

 

What I've read about measles is that it has such a high R nought for one specific reason: aerosols. Some of what I've read suggests that anybody who is essentially breathing from the small piece of air of someone with measles is going to end up with measles. We know for sure that it is one of the most infectious diseases.

 

COVID-19, on the other hand, is one of the least infectious diseases, at least by the standards above. Maybe I am in denial. But I have a hard time believing that virus hanging in the air for hours is a path of transmission. If that were the case, like it is with measles, it seems like the exponential growth would be way higher.

 

If anything, the idea that you can be contagious and asymptomatic for days and still ONLY two or three people catch it suggests this is not the most contagious virus ever. In a typical four days in a big city a worker who commutes and hangs out with friends could be within 6 feet of hundreds or even thousands of people. I think what we know from cluster outbreaks is that they tend to be in places where people spend a lot of time together: # 1 is among families, at home, China found; # 2 is at offices, like the South Korea call center outbreak. Other candidates are churches, where people sit close together and hold hands or share food or drink.

 

I think we do know that doctors, nurses, and hospital staff have gotten it. I think there are at least three factors in that. First, those setting are viral petri dishes, by definition. Second, the lack of adequate PPE. Third, which is the part I understand least well, the severity of symptoms in part depends on the race between the virus spreading through a body, and the immune system trying to kill it. So if a doctor is getting exposed to higher doses of virus, or getting it more frequently, it may give the virus a head start in the race.

 

There's two other generic situations I can think of having read about that involve airborne infection: restaurants, and airplanes:

 

Restaurant’s air conditioning tied to 9 COVID-19 cases among diners who sat near single infected person

 

 

My takeaway from that diagram is that the social distancing rules of 6' or so basically make sense. The issues in this diagram is not that people were more than 6' feet apart. It is that the air flow moved viral particles immediately. Assuming the people at Table B may have been 10' to 20' feet away, it seems quite doable to move viral particles over that distance. The part that is less clear to me is Table C, if in fact the air flow was moving in the direction indicated.

 

'We’re a part of the spread': flight attendant's guilt over Covid-19

 

 

I've not read any examples where everybody on a plane or most people on a plane or even many people on a plane all got COVID-19. In the case of this point, my assumption is that the people who got it came into close contact with others who had it. As the flight attendant said, there may have been a number of passengers on the flight that were spreading it unknowingly.

 

I posted these two examples because even if I am right, and it is hard to get COVID-19 simply from breathing the wrong air, I still think that restaurants and airplanes are screwed unless we can get the number of cases way down - from like 30,000 to maybe 300 in the US. 300 cases would be ten times the number of daily new cases in a whole bunch of nations that have populations in the tens of millions.

 

I think the numbers are very simple, and the vast majority of Americans get it. If you are in a place where lots of people are infected, like a hospital ER, your chances of infection skyrocket. That is why everybody is afraid of being in an ER right now. If you live in a country where 30 people a day get it, and you wear a mask and socially distance and practice proper hygience, your chances of getting it or spreading it are actually extremely low. Until we get to the point, I don't see how most people are going to get on planes, or go eat out. It's just not going to happen - with the possible exception of healthy young adults.

 

I don't think that 1st article is about now in currently virus-free hospitals. It's more like the other cafe one you mention and like one I read in the South China Post in February about a passenger followed by cameras on a bus in Wuhan spreading the virus to others on a bus who were seated 20 feet from him, perhaps because of the rapid air circulation in the bus. That's what convinced me this was a potent airborne virus and I went on eBay and bought several masks asap.

[+ keroscenefire]

 

Restaurant’s air conditioning tied to 9 COVID-19 cases among diners who sat near single infected person

 

 

My takeaway from that diagram is that the social distancing rules of 6' or so basically make sense. The issues in this diagram is not that people were more than 6' feet apart. It is that the air flow moved viral particles immediately. Assuming the people at Table B may have been 10' to 20' feet away, it seems quite doable to move viral particles over that distance. The part that is less clear to me is Table C, if in fact the air flow was moving in the direction indicated.

 

I think the restaurant case is interesting too because on average these diners at the tables with infections were eating with each other for an hour or longer. A lot of the places where we see outbreaks: Nursing homes, churches, cruise ships, jails, meatpacking plants, etc., have both close contact and long periods of time with contact. Short, passing contact with an infected individual is likely a lower-risk for infection than a longer time especially in areas with poor ventilation or when the ventilation brings the virus to you.

[+ stevenkesslar]

I think the restaurant case is interesting too because on average these diners at the tables with infections were eating with each other for an hour or longer. A lot of the places where we see outbreaks: Nursing homes, churches, cruise ships, jails, meatpacking plants, etc., have both close contact and long periods of time with contact. Short, passing contact with an infected individual is likely a lower-risk for infection than a longer time especially in areas with poor ventilation or when the ventilation brings the virus to you.

 

Yes. I think that is almost a proven fact.

 

While it was authoritarian, part of the reason infected people in China were forcibly removed from their homes and put in quarantine centers is that the # 1 form of transmission was among families, at home. It of course makes sense, since it's people in close contact for long periods of time. So doing that broke the predominant chain of transmission. I think that's pretty much a fact, at least based on China's methods. Arguably, it also not only prevented more infection, but helped the infected person survive by forcibly being in a treatment center, in effect. I don't see the involuntary part as an option even worth debating. But the science of how transmission works seems to be solid.

[+ purplekow]

We have just started a study of antibodies in the personal in the ICU. One would expect ICU personnel should have higher rates of antibody formation than the regular population simply by the likelihood of contact. After the complete the ICU they are planning on testing on the other Covid units and then on the non CoVid units to check for percentages there compared to the study of the state. Now it is conceivable that the numbers for hospital personnel will not be higher than the population as a whole because PPE is actually doing exactly what it is supposed to do. But realistically, based on some data that suggested in some countries health care workers represented 10% of the hospitalizations, it seems that the antibody levels in the hospital workers should be higher with the areas seeing the most CoVid patients having the personnel with the highest rate of immunity. I do not know I this study plans to include a CoVid test to see I people have both the disease and antibodies, which should be the case. After all, the viral load should trigger antibody formation and as the antibody formation goes up, hopefully the viral load will go down. But until the infection is gone the antibodies and the virus should be present simultaneously.

This study will be done in all due haste and answers should be forthcoming in a few weeks.

[+ tassojunior]

We have just started a study of antibodies in the personal in the ICU. One would expect ICU personnel should have higher rates of antibody formation than the regular population simply by the likelihood of contact. After the complete the ICU they are planning on testing on the other Covid units and then on the non CoVid units to check for percentages there compared to the study of the state. Now it is conceivable that the numbers for hospital personnel will not be higher than the population as a whole because PPE is actually doing exactly what it is supposed to do. But realistically, based on some data that suggested in some countries health care workers represented 10% of the hospitalizations, it seems that the antibody levels in the hospital workers should be higher with the areas seeing the most CoVid patients having the personnel with the highest rate of immunity. I do not know I this study plans to include a CoVid test to see I people have both the disease and antibodies, which should be the case. After all, the viral load should trigger antibody formation and as the antibody formation goes up, hopefully the viral load will go down. But until the infection is gone the antibodies and the virus should be present simultaneously.

This study will be done in all due haste and answers should be forthcoming in a few weeks.

 

I really hope there is an immunity built and that it's triggered by a small enough exposure to the virus to not cause a serious case normally. Wow that would be nice.

[+ stevenkesslar]

I don't think that 1st article is about now in currently virus-free hospitals. It's more like the other cafe one you mention and like one I read in the South China Post in February about a passenger followed by cameras on a bus in Wuhan spreading the virus to others on a bus who were seated 20 feet from him, perhaps because of the rapid air circulation in the bus. That's what convinced me this was a potent airborne virus and I went on eBay and bought several masks asap.

 

Weeks ago I posted a video of the Seoul subway and how they are sort of making a show of disinfecting it.

 

I think some part of this is actually more marketing than science. Since I assume 99.9 % of us really would like to do everything we can to save small businesses, this matters hugely. Because people will need to feel relatively safe to patronize small businesses.

 

The real issue in Seoul was not known infections on the subway. It was a large infection cluster at a call center. So, again, it seems like the work force challenge is wherever you have people working for long periods of time close together, there is risk. I don't think there is anything specific about a meat packing plant in South Dakota or a call center in Seoul that would make it more risky. Honestly, my guess is that the meat packing plant in South Dakota would be less risky, simply because the nature of the work means constant exposure to nasty stuff. Either way, these are where outbreak clusters occur.

 

So my understanding of what happened in Seoul is that they figured out that a lot of these workers at the call center rode the subway to work. So then they figured they have to make a symbolic point of showing that you are safe in the subways. Even if you just happened to be sitting next to some call center worker who got infected at work.

 

They actually interviewed a small business owner of a little concession in the Seoul subway who talked about how she appreciated the effort, because it kept things clean and made people feel safe. Obviously that is just one more person whose livelihood depends on safety and people who feel okay about riding the subway.

 

To stretch it a little bit, that particular story is not unlike New York right after 9/11. I still lived in Portland then. And the Mayor of Portland, Vera Katz, was this awesome woman who grew up in New York. So she actually took a contingent of Portland people to New York to see plays or shop or whatever. The whole point was that she wanted to say that America and Portland stood with New York. I was in NYC escorting, and they were requiring IDs to get into hotel rooms. So in a few cases I had to show my ID to somebody, which was an Oregon license. So people were aware of this Portland group. They asked me if I was part of this group with the Mayor, which I said I wasn't. But it was clear that it meant something to them. They appreciated the symbolism. And of course the risk that there was going to be a 9/12 or a 10/11 was very low.

 

My point is that I think the void here is that there is some part of America that wants to pull together and stand together, if we feel there is a safe way to do that. We did do that after 9/11. I think that is actually the national unity they are feeling in Seoul. Even if it is hidden behind the image of people darting around in masks.

Edited April 30, 2020 by stevenkesslar

[mike carey]

An interesting milestone today, although not yet the time to claim any sort of victory, but the ACT is Covid-19 free today, with the last couple of patients having recovered. That doesn't mean that there won't be more cases in the coming days, and we have an open border with NSW, one that it's not feasible to close. The Territory hadn't recorded any new cases for a week. There have been nine new cases nation wide in the last 24 hours (numbers aren't in for Tasmania yet and it's had a bad few days, but still single figures each day). Several other jurisdictions have had no new cases over recent days.

 

Australia's national death toll is now 91. Of those 20 were from one cruise liner, 12 in a rural area in NW Tasmania (most likely originating from that cruise liner) and 12 in an aged-care home in western Sydney.

 

*Edited to say nine rather than none (which didn't actually make sense anyway).

Edited April 30, 2020 by mike carey

[samhexum]

[+ stevenkesslar]

'A drug can block this virus': Fauci hails Covid-19 treatment breakthrough

Positive data from the NIAID trial would be a landmark in the race to find a coronavirus treatment.

 

Trial participants who received remdesivir recovered in an average of 11 days compared with 15 days for patients in the control group, who received a placebo. Eight percent of remdesivir patients died during the trial versus 11 percent in the placebo group.

 

The death rate is just slightly lower in the remdesivir group, but more data remains to be analyzed, Fauci said. But the scientist, who has led NIAID since 1984, said the news reminded him of the day 34 years ago when modest results for the drug AZT signaled the first potential weapon against HIV.

 

"That was not the end game, because building on that every year after we did better and better, we had better drugs of the same type, and we had drugs against different targets," Fauci said.

 

It's nice to be getting some good news.

[+ Pensant]

An interesting milestone today, although not yet the time to claim any sort of victory, but the ACT is Covid-19 free today, with the last couple of patients having recovered. That doesn't mean that there won't be more cases in the coming days, and we have an open border with NSW, one that it's not feasible to close. The Territory hadn't recorded any new cases for a week. There have been nine new cases nation wide in the last 24 hours (numbers aren't in for Tasmania yet and it's had a bad few days, but still single figures each day). Several other jurisdictions have had no new cases over recent days.

 

Australia's national death toll is now 91. Of those 20 were from one cruise liner, 12 in a rural area in NW Tasmania (most likely originating from that cruise liner) and 12 in an aged-care home in western Sydney.

 

*Edited to say nine rather than none (which didn't actually make sense anyway).

That’s a remarkable statistic. 91 deaths in a country of 25 million. Florida, with about 20 million, reported 1,240 deaths as of yesterday.

[mike carey]

That’s a remarkable statistic. 91 deaths in a country of 25 million. Florida, with about 20 million, reported 1,240 deaths as of yesterday.

I continue to be rather incredulous at the mixture of luck and timely government action that has enabled us to do so well. Restrictions on personal life and business activity have been extensive and there has only been a little timid loosening of the controls even with that level of success. Even with no remaining cases, the ACT isn't relaxing anything, probably for the next two weeks (at least). That said, controls here weren't as strict as they were in some states, for example, although non-essential travel was discouraged, it was never banned here and there was no legal enforcement to restrict travel within the territory.

[Beancounter]

I continue to be rather incredulous at the mixture of luck and timely government action that has enabled us to do so well. Restrictions on personal life and business activity have been extensive and there has only been a little timid loosening of the controls even with that level of success. Even with no remaining cases, the ACT isn't relaxing anything, probably for the next two weeks (at least). That said, controls here weren't as strict as they were in some states, for example, although non-essential travel was discouraged, it was never banned here and there was no legal enforcement to restrict travel within the territory.

ACT = Australian Capital Territory. (Canberra area, similar to Washington DC in concept). Is that correct, MC?

[MikeBiDude]

Manhattan Beach? I see the El Segundo power plant in the distance

Yes!

Governor Newsom taking the reigns on this beach issue:

 

https://www.cnn.com/travel/article/california-newsom-close-beaches-parks/index.html

[LivingnLA]

Interesting info coming from Sweden's central bank. The Riksbank is saying Sweden will experience the same or worse economic damage as neighbors who locked down. That makes sense given how deeply interrelated economies are and the fact that lock downs aren't driving the economic damage, human fear and panic are in the driver's seat. It'll be interesting to see if there are any benefits derived from letting more people die. Data from the 1918 flu pandemic supported the lockdown approach. I hope Swedes didn't die for nothing.

[samhexum]

Interesting info coming from Sweden's central bank. The Riksbank is saying Sweden will experience the same or worse economic damage as neighbors who locked down. That makes sense given how deeply interrelated economies are and the fact that lock downs aren't driving the economic damage, human fear and panic are in the driver's seat. It'll be interesting to see if there are any benefits derived from letting more people die. Data from the 1918 flu pandemic supported the lockdown approach. I hope Swedes didn't die for nothing.

Trump pointed out that Sweden is “paying heavily” for its decision not to lockdown the country as coronavirus deaths in the Scandanavian country begin to rise.

 

“Despite reports to the contrary, Sweden is paying heavily for its decision not to lockdown. As of today, 2462 people have died there, a much higher number than the neighboring countries of Norway (207), Finland (206) or Denmark (443),” the president wrote in a tweet on Thursday. “The United States made the correct decision!”

 

Unlike many of its Nordic neighbors and countries in Europe, Sweden did not impose strict restrictions on its citizens and allowed many businesses, including restaurants and hair salons, and schools to remain open.

 

By contrast, Finland declared a state of emergency on March 16 and shut down schools, restaurants and bars on April 1 and Denmark announced the first round of closures on March 11.

 

Sweden’s death rate per 1 million population – 244 – is significantly higher than Finland, 37, Denmark, 76, and Norway, 38, according to worldometers, which has been tracking the number of worldwide cases.

 

Finland has 4,995 cases, Norway has 7,710 and Denmark has 9,158.

 

Sweden, with a population of 10.3 million, has 20,301 cases.

 

The World Health Organization on Wednesdaypraised Sweden as a “model” for fighting the coronavirus pandemic.

 

Dr. Mike Ryan, the WHO’s top emergencies expert, said Wednesday there are “lessons to be learned” from the Scandinavian nation, which has largely relied on citizens to self-regulate. “I think there’s a perception out that Sweden has not put in control measures and just has allowed the disease to spread,” Ryan told reporters. “Nothing can be further from the truth.”

 

 

SEE ALSO

WHO lauds lockdown-ignoring Sweden as a 'model' for countries going forward

 

Japanese island hit by second wave of coronavirus after ending lockdown early

 

Japan’s northern island of Hokkaido — the first area of the country to see a major coronavirus outbreak — was forced back into lockdown after lifting its stringent restrictions too early, according to new reports.

 

The prefecture of 5.3 million people, known for its rugged mountainous terrain and history of farming and fishing, went into lockdown in late February in response to a sharp acceleration in infections, which largely stemmed from its annual Sapporo Snow Festival, TIME reported.

 

The region, at first, was lauded for quickly containing the outbreak with a 3-week lockdown, but when prefectural governor Naomichi Suzuki lifted the restrictions, a second wave of infections slammed the island even harder, according to the report.

 

The region was forced back into lockdown.

 

“Now I regret it, we should not have lifted the first state of emergency,” Dr. Kiyoshi Nagase, chairman of the Hokkaido Medical Association, who helped coordinate the government response, told the outlet.

 

The island’s story serves as a wake-up call for leaders of other nations — including the US — as they consider loosening restrictions, Kazuto Suzuki, Vice Dean of International Politics at Hokkaido University, told TIME.

 

“Hokkaido shows, for example, that what’s happening in the U.S. with individual governors opening up is very dangerous; of course you can’t close interstate traffic but you need to put controls in place,” he said. “That’s what we now know: Even if you control the first wave, you can’t relax.”

 

Japan has so far confirmed about 15,000 coronavirus cases, including about 700 from the ill-fated Diamond Princess cruise ship quarantined near Tokyo in February, Kyodo News reported Thursday.

 

About 470 deaths have been reported.

 

The Tokyo metropolitan government confirmed 46 new infections Thursday, according to the report.

 

The country is considering extending its nationwide state of emergency until the end of May to help contain the spread of the virus, government sources told the outlet Thursday.

 

Prime Minister Shinzo Abe is expected to seek opinions from a panel of experts Friday before coming to a decision.

[mike carey]

ACT = Australian Capital Territory. (Canberra area, similar to Washington DC in concept). Is that correct, MC?

Yes, in concept, but it's different. DC is the core of a much larger metropolitan agglomeration, the ACT is much more self-contained. As a 'metropolitan area' there is only a New South Wales city of 35,000, about 10% the size of Canberra that is linked to it, and effectively part of the city of Canberra. The ACT has a rural area, a large area that is a national park, and the water catchment that supplies the city. Although not a state, to all intents and purposes it is. It has a government that looks like and functions like a state government, including a parliament. Unlike anywhere else in the country, there is no local government, and no mayor, so the territory government performs all the functions that local councils do in the states, streets, parks, rubbish collection and the like. There is a central area with all the ceremonial spaces (but where nobody lives) that is run by a federal government agency, the National Capital Authority. So it was the NCA that made an incredibly popular 5km running circuit around part of the lake in the centre of the city one way (clockwise) for the duration of the Covid-19 restrictions.

[+ tassojunior]

Airborne Coronavirus Detected in Wuhan Hospitals

 

 

Do other people buy this? I don't really.

 

It is similar to the findings on one of those cruises. They found COVID-19 RNA a few weeks later - like in cabins, on floors, all over the place I think. But I searched and I could not find anything that said the virus was still alive and contagious weeks later. My assumption is that passengers were unwittingly spreading it everywhere - through hands, touch, hugs, kisses, close breathing, door knobs, plates, whatever. But I never read that you could get it from something left behind two weeks prior. In a few interviews I've watched Fauci has suggested that, outside of lab experiment conditions, the virus mostly doesn't last on surfaces for more than a few hours. I've been assuming two days is a pretty good margin of error.

 

This One Number Shows Why Measles Spreads Like Wildfire

 

 

What I've read about measles is that it has such a high R nought for one specific reason: aerosols. Some of what I've read suggests that anybody who is essentially breathing from the small piece of air of someone with measles is going to end up with measles. We know for sure that it is one of the most infectious diseases.

 

COVID-19, on the other hand, is one of the least infectious diseases, at least by the standards above. Maybe I am in denial. But I have a hard time believing that virus hanging in the air for hours is a path of transmission. If that were the case, like it is with measles, it seems like the exponential growth would be way higher.

 

If anything, the idea that you can be contagious and asymptomatic for days and still ONLY two or three people catch it suggests this is not the most contagious virus ever. In a typical four days in a big city a worker who commutes and hangs out with friends could be within 6 feet of hundreds or even thousands of people. I think what we know from cluster outbreaks is that they tend to be in places where people spend a lot of time together: # 1 is among families, at home, China found; # 2 is at offices, like the South Korea call center outbreak. Other candidates are churches, where people sit close together and hold hands or share food or drink.

 

I think we do know that doctors, nurses, and hospital staff have gotten it. I think there are at least three factors in that. First, those settings are viral petri dishes, by definition. Second, the lack of adequate PPE. Third, which is the part I understand least well, the severity of symptoms in part depends on the race between the virus spreading through a body, and the immune system trying to kill it. So if a doctor is getting exposed to higher doses of virus, or getting it more frequently, it may give the virus a head start in the race.

 

There's two other generic situations I can think of having read about that involve airborne infection: restaurants, and airplanes:

 

Restaurant’s air conditioning tied to 9 COVID-19 cases among diners who sat near single infected person

 

 

 

My takeaway from that diagram is that the social distancing rules of 6' or so basically make sense. The issue in this diagram is not that people were more than 6' feet apart, or sat at the same table two hours later. It is that the air flow apparently moved live viral particles immediately. Assuming the people at Table B may have been 10' to 20' feet away, it seems quite doable to move live viral particles over that distance. The part that is less clear to me is Table C, if in fact the air flow was moving only in the direction indicated.

 

'We’re a part of the spread': flight attendant's guilt over Covid-19

 

 

I've not read any examples where everybody on a plane or most people on a plane or even many people on a plane all got COVID-19. In this case, several crew members appear to have gotten it from people they came into close contact with. As the flight attendant said, there may have been a number of passengers on the flight that were spreading it unknowingly.

 

I posted these two examples because even if I am right, and it is hard to get COVID-19 simply from breathing the wrong air, I still think that restaurants and airplanes are screwed unless we can get the number of cases way down - from like 30,000 new cases a day to maybe 300 new cases a day in the US. 300 cases a day would be ten or twenty times the number of daily new cases in a whole bunch of nations that have populations in the tens of millions.

 

I think the numbers are very simple, and the vast majority of Americans get it. If you are in a place where lots of people are infected, like a hospital ER, your chances of infection skyrocket. That is why everybody is afraid of being in an ER right now. If you live in a country where 30 people a day get it, and you wear a mask and socially distance and practice proper hygiene, your chances of getting it or spreading it are actually extremely low.

 

Until we get to that point in the US, I don't see how most people are going to get on planes, or go eat out. Maybe the exception is healthy young adults, or people who need to travel for work, or a certain percentage of people who just don't take it seriously. But until people feel safe, there's going to be an ongoing massive loss of revenue, I think.

 

Every single poll strongly suggests the vast majority of people would rather be safe than sorry.

 

Here's the link to the article I citied above that convinced me almost 2 months ago that this was airborne and made me go buy masks quick. https://www.dailymail.co.uk/news/article-8094933/How-one-man-spread-coronavirus-NINE-people-bus.html

 

One of the few benefits of a surveillance state is that there are cameras and trackers everywhere for disease tracking and this man evidently was traced to spreading it to people far apart on the bus.

Edited May 2, 2020 by tassojunior

[Guest]

...

 

Australia's national death toll is now 91. Of those 20 were from one cruise liner, 12 in a rural area in NW Tasmania (most likely originating from that cruise liner) and 12 in an aged-care home in western Sydney...

 

Lucky you! Australia does have the benefit of being hundreds of miles from its nearest neighbor. I don't think that even a bat, let alone any other mammal, could survive that journey. California was probably right to act as it did, although the forecasters were quite off compared to what they predicted, thank God.

https://kcbsradio.radio.com/articles/questions-persist-as-california-coronavirus-projections-off

 

I suspect that a gradual loosening of restrictions would probably be a good idea at this time. We must not forget that some people are being seriously harmed by excessively strict restrictions. Without even talking about loss of jobs, insurance, etc., medical care is being delayed and will be difficult to catch up on. Cancer chemotherapy is being delayed, as are certain procedures. I have a patient who had a positive stool test who hasn't been able to get a colonoscopy scheduled. Another patient's kidney transplant was cancelled, and I have a patient who says he's in "agony" because his knee replacement surgery was cancelled. A couple of months may not make a big difference, but if we delay things like mammograms, etc., until there's a safe and effective vaccine that's widely available, which may take over a year (or may never come to pass), there will be other, perhaps uncounted deaths. Right now I'm encouraged to try to treat most patients over the phone. Yes, I can get some idea of how a heart failure patient is doing by asking him "Are you having trouble breathing when going upstairs? Are you able to sleep flat? Do you wake up short of breath during the night?", I'm going to miss some patients who are taking on water by not being able examine the patient.

We need to make sure the curve stays flat, and keep an eye out if hospital admissions start to spike. But I really don't think we can stay in total lockdown until there's a universal availability of a safe and effective vaccine.

[BSR]

Lucky you! Australia does have the benefit of being hundreds of miles from its nearest neighbor. I don't think that even a bat, let alone any other mammal, could survive that journey. California was probably right to act as it did, although the forecasters were quite off compared to what they predicted, thank God.

https://kcbsradio.radio.com/articles/questions-persist-as-california-coronavirus-projections-off

 

I suspect that a gradual loosening of restrictions would probably be a good idea at this time. We must not forget that some people are being seriously harmed by excessively strict restrictions. Without even talking about loss of jobs, insurance, etc., medical care is being delayed and will be difficult to catch up on. Cancer chemotherapy is being delayed, as are certain procedures. I have a patient who had a positive stool test who hasn't been able to get a colonoscopy scheduled. Another patient's kidney transplant was cancelled, and I have a patient who says he's in "agony" because his knee replacement surgery was cancelled. A couple of months may not make a big difference, but if we delay things like mammograms, etc., until there's a safe and effective vaccine that's widely available, which may take over a year (or may never come to pass), there will be other, perhaps uncounted deaths. Right now I'm encouraged to try to treat most patients over the phone. Yes, I can get some idea of how a heart failure patient is doing by asking him "Are you having trouble breathing when going upstairs? Are you able to sleep flat? Do you wake up short of breath during the night?", I'm going to miss some patients who are taking on water by not being able examine the patient.

We need to make sure the curve stays flat, and keep an eye out if hospital admissions start to spike. But I really don't think we can stay in total lockdown until there's a universal availability of a safe and effective vaccine.

 

"until there's a universal availability of a safe and effective vaccine" seems to be the mantra of those who urge extending lockdown, but are we so sure that a vaccine will ever be developed? I think political leaders need to factor in the possibility that instead of 12-18 months to develop a vaccine, it might take years. I am growing increasingly nervous that we seem to be banking too much on the speedy development of a vaccine even though we have none for other coronaviruses like SARS (outbreak 17 years ago) & MERS (7 years ago).

[+ bigjoey]

Lucky you! Australia does have the benefit of being hundreds of miles from its nearest neighbor. I don't think that even a bat, let alone any other mammal, could survive that journey. California was probably right to act as it did, although the forecasters were quite off compared to what they predicted, thank God.

https://kcbsradio.radio.com/articles/questions-persist-as-california-coronavirus-projections-off

 

I suspect that a gradual loosening of restrictions would probably be a good idea at this time. We must not forget that some people are being seriously harmed by excessively strict restrictions. Without even talking about loss of jobs, insurance, etc., medical care is being delayed and will be difficult to catch up on. Cancer chemotherapy is being delayed, as are certain procedures. I have a patient who had a positive stool test who hasn't been able to get a colonoscopy scheduled. Another patient's kidney transplant was cancelled, and I have a patient who says he's in "agony" because his knee replacement surgery was cancelled. A couple of months may not make a big difference, but if we delay things like mammograms, etc., until there's a safe and effective vaccine that's widely available, which may take over a year (or may never come to pass), there will be other, perhaps uncounted deaths. Right now I'm encouraged to try to treat most patients over the phone. Yes, I can get some idea of how a heart failure patient is doing by asking him "Are you having trouble breathing when going upstairs? Are you able to sleep flat? Do you wake up short of breath during the night?", I'm going to miss some patients who are taking on water by not being able examine the patient.

We need to make sure the curve stays flat, and keep an eye out if hospital admissions start to spike. But I really don't think we can stay in total lockdown until there's a universal availability of a safe and effective vaccine.

 

 

Reports of spousal abuse and child sexual abuse are on the up trend during the quarantine. Mental health problems need abating. Loss of education for young children will be hard to make up. There is starting to be a big toll beyond just the economic one.

 

This requires a difficult balancing of different interests. A multivariate analysis is needed rather than the single-variable analysis of some posters.

 

Society can not be put on hold until a vaccine is developed, if ever.

[samhexum]

One death that (maybe) could have been avoided:

 

Coronavirus patient dead after medical residents set ventilator too high

 

A New York coronavirus patient died after inexperienced medical residents rushed to the front line of the pandemic set her ventilator too high, according to a report.

 

The patient, who was in her 60s, was being cared for on an overnight shift at Montefiore Hospital in the Bronx last month by family medicine residents, who were not properly trained in how to use the respiratory support machine, according to the Wall Street Journal.

 

Medical residents are doctors-in-training who have graduated from medical school but are training for a specialty under the supervision of a senior physician. As family medicine residents, the young doctors typically wouldn’t work in an intensive care unit on critically ill patients — but as hospitals became overwhelmed with COVID-19 patients, they were thrust into roles they weren’t prepared for.

 

So when the patient’s illness worsened dramatically overnight and the residents hooked her up to a ventilator, they accidentally turned the device up too high — stopping her heart, according to the paper.

 

When a critical care physician rushed to the room, the doctors-in-training admitted they didn’t know how to properly work the settings on the ventilator.

 

The disturbing incident is just one of several reported by the Wall Street Journal. Other residents — such as those training to be dentists, ophthalmologists, podiatrists and psychiatrists — have also been pushed to the front line because the city’s doctors are stretched desperately thin.

 

At Yale New Haven Hospital in Connecticut, anesthesiology residents were sent to work as respiratory therapists — a licensed job that requires at least two years of training — after just one Zoom session and a Google document that instructed them to call an attending physician if they needed help, according to the paper.

 

And at NewYork-Presbyterian/Columbia, a resident admitted to being afraid that patients were being treated like “guinea pigs.”

 

Hospital officials contacted by the paper said the coronavirus crisis has created extraordinary conditions for all staff members, prompting an all-hands-on-deck response.

 

“Our mission is to save lives, and our heroic health care workers are on the front lines … navigating unprecedented challenges under enormous pressure,” a spokesperson for the institution formally known as NewYork-Presbyterian/Columbia University Irving Medical Center told the Wall Street Journal.

 

“We are constantly working to give them the support and resources they need.”

 

Montefiore Medical Center didn’t return a request for comment, according to the paper.

 

MORE ON: CORONAVIRUS

 

Soccer diehards fill empty stadium with cardboard-cutouts of fans

[+ José Soplanucas]

Reports of spousal abuse and child sexual abuse are on the up trend during the quarantine. Mental health problems need abating. Loss of education for young children will be hard to make up. There is starting to be a big toll beyond just the economic one.

 

This requires a difficult balancing of different interests. A multivariate analysis is needed rather than the single-variable analysis of some posters.

 

Society can not be put on hold until a vaccine is developed, if ever.

 

I think no one is proposing a lock down until we have a vaccine. The talk is about not being back to normal until the vaccine is found, which is not the same.

 

Although the lock down is the most effective prevention against the spread of the virus, it is just not sustainable beyond a couple of months. Besides not being economically sustainable, it is psychologically impossible.

 

We are going for the 7th week of lock down in DC, and I do not think I can go much longer. Consider I am supportive of quarantines and physical distancing (I am going for my 8th week of abstinence), I live comfortably and with full connectivity, I have a job, and still despite my privileged situation and my friendliness I cannot put out anymore with the isolation.

[LivingnLA]

https://abcnews.go.com/Health/accurate-us-coronavirus-death-count-experts-off-tens/story?id=70385359

 

Daniel Weinberger, an epidemiologist from the Yale School of Public Health, analyzed NCHS death count data to estimate how many COVID-19 deaths may have gone uncounted during the five-week period from March 1 to April 3.

 

He concluded the official death toll in the U.S. is "probably a substantial underestimate of the true number by tens of thousands." The actual figure, he said, may be "in the ballpark of double the reported cases."

 

And supposedly another 100,000 body bags have been ordered by the federal government. If we keep seeing 2k official deaths every day and the real number of deaths is more in the 3-4k range, we will see another 100k deaths in about a month. I really hope they're wrong, but the data trends don't look good for poor Americans.

Edited May 1, 2020 by LivingnLA

[+ bigjoey]

I think no one is proposing a lock down until we have a vaccine. The talk is about not being back to normal until the vaccine is found, which is not the same.

 

Although the lock down is the most effective prevention against the spread of the virus, it is just not sustainable beyond a couple of months. Besides not being economically sustainable, it is psychologically impossible.

 

We are going for the 7th week of lock down in DC, and I do not think I can go much longer. Consider I am supportive of quarantines and physical distancing (I am going for my 8th week of abstinence), I live comfortably and with full connectivity, I have a job, and still despite my privileged situation and my friendliness I cannot put out anymore with the isolation.

 

I am not sure what the solution is for “older” people like myself (I am 74) or with other conditions like asthma, high blood pressure, obesity and others in high risk groups targeted by the virus.

 

If I venture out and get the virus and need hospitalization, there is no medical therapy beyond “supportive therapy” which means they just support my body as my own immune system fights the virus with things like a ventilator. Unless the Gilead drug (or something else) works as a medical therapy, I am in a group that is at high risk with really not much to help if I need hospitalization.

 

Even massive test-trace-treat is not valid for the high risk groups because there really is no “treat”. When a medical therapy is available, then OK. A vaccine is still a long way off.

 

How do I board an airplane? Will everyone be given an Abbott 5-minute test before being allowed to board? Will I be sitting next to an asymptotic carrier? How do I go into a movie theater and sit next to someone? Does the person behind the refreshment stand counter hand me a virus with the popcorn?

 

Now Denmark is opening up BUT not for those over 65. Those over 65 are still sheltering in place.

 

What do you suggest for those over 65 or in other high risk groups?

[mike carey]

I suspect that a gradual loosening of restrictions would probably be a good idea at this time. We must not forget that some people are being seriously harmed by excessively strict restrictions. Without even talking about loss of jobs, insurance, etc., medical care is being delayed and will be difficult to catch up on. Cancer chemotherapy is being delayed, as are certain procedures. I have a patient who had a positive stool test who hasn't been able to get a colonoscopy scheduled. Another patient's kidney transplant was cancelled, and I have a patient who says he's in "agony" because his knee replacement surgery was cancelled. A couple of months may not make a big difference, but if we delay things like mammograms, etc., until there's a safe and effective vaccine that's widely available, which may take over a year (or may never come to pass), there will be other, perhaps uncounted deaths. Right now I'm encouraged to try to treat most patients over the phone. Yes, I can get some idea of how a heart failure patient is doing by asking him "Are you having trouble breathing when going upstairs? Are you able to sleep flat? Do you wake up short of breath during the night?"

Some of those sort of things had already been addressed here when it became clear that the epidemic wasn't overwhelming the health care system. Elective surgery has resumed (joint replacement, cataracts and other eye surgery, even IVF) as have things like chemotherapy, mammograms and colonoscopy. Phone and video consultations by GPs and some specialists, previously 'impossible' were authorised and funded by our public health system within days. Messaging to the public is now stressing that people should definitely see their doctors for any conditions, not just respiratory ones. We had never formally been told otherwise, but people had been refraining from doing so anyway, and are now being told that they shouldn't wait. Despite indications yesterday, restrictions that prevented travel to see family have been eased, and shopping for non-essential items is now explicitly allowed.