Slitherine

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When I asked him if there are consequences from over-stating the mortality impact of flu, Jefferson answered: "Yes. Scaring people justifies evidence-free policies. Yes, no one knows exactly what the threat is. The only certainty are the returns for industry."

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ORIGINAL: witpqs

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ORIGINAL: RangerJoe

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ORIGINAL: witpqs

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ORIGINAL: RangerJoe

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ORIGINAL: witpqs

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ORIGINAL: Anachro

Analysis of the Chinese cases, from research I've read, leads me to think heat/humidity of summer months very well might reduce outbreak in the northern hemisphere. Hopefully, this turns out to be the case and gives us time to develop a vaccine, etc.

The specialist who was interviewed (the link Erik provided) said at this time there is no reason to believe warmer temperatures will slow it down, although it was too early to tell. IIRC he said it's similar to the MERS virus, which transmits just fine at 110F.

From what I read, it is more similar to the SARs virus. In fact, if the vaccine for that would have been made, that vaccine might provide some immunity to this latest Corona virus.

He talked about it with respect to SARS as well. The first 15 minutes (which Erik linked) was great, the full interview (about 2 hours, which I linked) I do recommend.

Yes, I listened to the full interview and that is where I got that information from.

As I recall, in that sequence he mentioned its relationship to MERS after mentioning its relationship to SARS. The MERS comment was about MERS transmission in high temperatures as an example of COVID-19 not necessarily being stymied by high temperatures.

But, while he did say at the time he did not see anything in the data that suggested warmer temps would slow it down, he also said it was too early to tell. And he was obviously going on what he had seen by the time of the interview; continued research and data might tell more. Of course as temps warm up that will tell a lot.

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ORIGINAL: RangerJoe

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ORIGINAL: obvert

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ORIGINAL: Canoerebel

In the USA, many school systems have already closed. We've postponed or cancelled major events. We've limited travel. In some ways, the US has responded more quickly than European countries because we've had the benefit of seeing what they're experiencing and how they're dealing with it. Europe is about three weeks into this; we're about ten days into hit.

The first case I the US was Jan. 21 in the Seattle area. From the time of your post that's almost exactly seven weeks.

On top of that there were no tests at that time for the majority of people who had symptoms, so the first case may have been even sooner, and we have no idea how many there were in WA.

South Korea's first case was on Jan 20. So both the US and SK had the example of the Chinese model to slow the disease and only one country followed that example. For whatever reason, testing in the US has been a disaster.

The private sector closed events and stopped large groups. The travel ban came 6-7 weeks after the first case, long after community transmission was rampant throughout the US, rendering it completely meaningless.

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We have a federal system of government. Localities, states, and some federal departments have responded more quickly than others. Overall, the ramp-up in the past two days has been marked. That's good.

In Georgia, the governor authorized each school system to respond as it felt appropriate, encouraging them to consider closing. Many systems in and near affected areas are already closed. Some in more rural and isolated regions have the latitude to try to work around upcoming spring breaks, to smooth out the process. This might not work perfectly, but across the state school superintendents seem to appreciate the flexibility to handle it locally. Most will likely err on the side of acting quickly to minimize the possibility of making the wrong call.

It is exactly this partial and haphazard locally designed methods of countering the outbreak that will fail. The virus doesn't recognise county, state of even national boundaries.

You have posted relentlessly on the example of China and how their numbers have flattened. If you're meaning to use that as an example of what we'll see elsewhere then the only way it will happen is to follow their steps of limiting transmissions.

s the US building new hospitals in 10 days? Is the US setting up quarantine centers to isolate large numbers of infected individuals away from the family and communities? Is the US testing relentlessly, sometimes door to door? Are state borders closed with temperature checkpoints? Are whole industries, including factories and all non-essential businesses closed? Are people required to stay at home at risk of being arrested, for up to 3-4 weeks?

I could go on, but the only countries doing anything similar to China are South Korea and now Italy.

The United States is not China. We have a different governmental system and are much more spread out than China and Western Europe. Unless it is a stated emergency what you are suggesting is not allowable in the United States.

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«With our actions we influence
the life and death of many people »
With a long post on Facebook, Dr. Daniele Macchini, a doctor at Humanitas Gavazzeni, talks about his life on the front lines to combat coronavirus. It is a creepy testimony, to be read from the first to the last line.
Here is the post

In one of the constant emails that I receive from my health department on a more than daily basis now these days, there was also a paragraph entitled "doing social responsibly", with some recommendations that can only be supported. After thinking for a long time if and what to write about what is happening to us, I felt that the silence was not at all responsible. I will therefore try to convey to people "not involved in the work" and more distant from our reality, what we are experiencing in Bergamo during these pandemic days from Covid-19. I understand the need not to panic, but when the message of the danger of what is happening does not reach people and I still feel who cares about the recommendations and people who gather together complaining that they cannot go to the gym or be able to do soccer tournaments I shudder.

I also understand the economic damage and I am also worried about that. After the epidemic, the tragedy will start again. However, apart from the fact that we are literally also devastating our NHS from an economic point of view, I allow myself to raise the importance of the health damage that is likely throughout the country and I find it nothing short of "chilling" for example that a red zone already requested by the region has not yet been established for the municipalities of Alzano Lombardo and Nembro (I would like to clarify that this is pure personal opinion).

I myself looked with some amazement at the reorganizations of the entire hospital in the previous week, when our current enemy was still in the shadows: the wards slowly "emptied", the elective activities interrupted, the intensive therapies freed to create as many beds as possible. Containers arriving in front of the emergency room to create diversified routes and avoid any infections. All this rapid transformation brought into the corridors of the hospital an atmosphere of surreal silence and emptiness that we still did not understand, waiting for a war that was yet to begin and that many (including me) were not so sure would never come with such ferocity . (I open a parenthesis: all this in silence and without publicity, while several newspapers had the courage to say that private health care was not doing anything).

I still remember my night guard a week ago passed unnecessarily without turning a blind eye, waiting for a call from the microbiology of the Sack. I was waiting for the outcome of a swab on the first suspected patient in our hospital, thinking about what consequences it would have for us and the clinic. If I think about it, my agitation for one possible case seems almost ridiculous and unjustified, now that I have seen what is happening.

Well, the situation is now nothing short of dramatic. No other words come to mind. The war has literally exploded and the battles are uninterrupted day and night. One after the other, the unfortunate poor come to the emergency room. They have anything but the complications of a flu. Let's stop saying it's a bad flu. In these 2 years I have learned that the people of Bergamo do not come to the emergency room at all. They did well this time too. They followed all the indications given: a week or ten days at home with a fever without going out and risking contagion, but now they can't take it anymore. They don't breathe enough, they need oxygen.

Drug therapies for this virus are few. The course mainly depends on our organism. We can only support it when it can't take it anymore. It is mainly hoped that our body will eradicate the virus on its own, let's face it. Antiviral therapies are experimental on this virus and we learn its behavior day after day. Staying at home until the symptoms worsen does not change the prognosis of the disease.

Now, however, that need for beds in all its drama has arrived. One after the other, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the patients, in different colors depending on the operating unit they belong to, are now all red and instead of the surgical operation there is the diagnosis, which is always the same damn: bilateral interstitial pneumonia.

Now, tell me which flu virus causes such a rapid tragedy. Because that's the difference (now I'm going down a bit in the technical field): in classical flu, apart from infecting much less population over several months, cases can be complicated less frequently, only when the VIRUS destroying the protective barriers of the Our respiratory tract allows BACTERIA normally resident in the upper tract to invade the bronchi and lungs, causing more serious cases. Covid 19 causes a banal influence in many young people, but in many elderly people (and not only) a real SARS because it arrives directly in the alveoli of the lungs and infects them making them unable to perform their function. The resulting respiratory insufficiency is often serious and after a few days of hospitalization, the simple oxygen that can be administered in a ward may not be enough.

Sorry, but to me as a doctor it doesn't reassure you that the most serious are mainly elderly people with other pathologies. The elderly population is the most represented in our country and it is difficult to find someone who, above 65 years of age, does not take at least the tablet for pressure or diabetes. I also assure you that when you see young people who end up in intubated intensive care, pronated or worse in ECMO (a machine for the worst cases, which extracts the blood, re-oxygenates it and returns it to the body, waiting for the organism, hopefully, heal your lungs), all this tranquility for your young age passes there.

And while there are still people on social networks who pride themselves on not being afraid by ignoring the indications, protesting that their normal lifestyle habits are "temporarily" in crisis, the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us. The cases multiply, we arrive at the rate of 15-20 hospitalizations a day all for the same reason. The results of the swabs now arrive one after the other: positive, positive, positive. Suddenly the emergency room is collapsing.

Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the first aid management software works and a few minutes later they are already downstairs, next to the warriors on the war front. The screen of the PC with the reasons for the access is always the same: fever and respiratory difficulty, fever and cough, respiratory insufficiency etc ... Exams, radiology always with the same sentence: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized. Someone already to intubate and go to intensive care. For others it is late ...

Intensive care becomes saturated, and where intensive care ends, more are created. Each fan becomes like gold: those of the operating rooms that have now suspended their non-urgent activity become places for intensive care that did not exist before. I found it incredible, or at least I can speak for Humanitas Gavazzeni (where I work) how it was possible to put in place in such a short time a deployment and a reorganization of resources so finely designed to prepare for a disaster of this magnitude. And every reorganization of beds, wards, staff, work shifts and tasks is constantly reviewed day after day to try to give everything and even more.

Those wards that previously looked like ghosts are now saturated, ready to try to give their best for the sick, but exhausted. The staff is exhausted. I saw fatigue on faces that didn't know what it was despite the already grueling workloads they had. I have seen people still stop beyond the times they used to stop already, for overtime that was now habitual. I saw solidarity from all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?" or "leave alone that shelter that I think of it." Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we are unable to save everyone and the vital signs of several patients at the same time reveal a fate that has already been marked.

There are no more shifts, schedules. Social life is suspended for us. I have been separated for a few months, and I assure you that I have always done everything possible to constantly see my son even on the days of taking the night off, without sleeping and postponing sleep until when I am without him, but for almost 2 weeks I have not voluntarily I see neither my son nor my family members for fear of infecting them and in turn infecting an elderly grandmother or relatives with other health problems. I'm happy with some photos of my son that I regard between tears and a few video calls.

So have patience, too, that you cannot go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate. It is not your fault, I know, but of those who put it in your head that you are exaggerating and even this testimony may seem just an exaggeration for those who are far from the epidemic, but please, listen to us, try to leave the house only to indispensable things. Do not go en masse to stock up in supermarkets: it is the worst thing because you concentrate and the risk of contacts with infected people who do not know they are higher. You can go there as you usually do. Maybe if you have a normal mask (even those that are used to do certain manual work) put it on. Don't look for ffp2 or ffp3. Those should serve us and we are beginning to struggle to find them. By now we have had to optimize their use only in certain circumstances, as the WHO recently suggested in view of their almost ubiquitous impoverishment.

Oh yes, thanks to the shortage of certain devices, I and many other colleagues are certainly exposed despite all the means of protection we have. Some of us have already become infected despite the protocols. Some infected colleagues have in turn infected family members and some of their family members already struggle between life and death. We are where your fears could make you stay away. Try to make sure you stay away. Tell your elderly or other family members to stay indoors. Bring him the groceries please.

We have no alternative. It's our job. Indeed what I do these days is not really the job I'm used to, but I do it anyway and I will like it as long as it responds to the same principles: try to make some sick people feel better and heal, or even just alleviate the suffering and the pain to those who unfortunately cannot heal.

On the other hand, I don't spend many words about the people who define us heroes these days and who until yesterday were ready to insult and report us. Both will return to insult and report as soon as everything is over. People forget everything quickly. And we're not even heroes these days. It's our job. We risked something bad every day before: when we put our hands in a belly full of blood of someone we don't even know if he has HIV or hepatitis C; when we do it even if we know that he has HIV or hepatitis C; when we sting with the one with HIV and take the drugs that make us vomit from morning to night for a month. When we open with the usual anguish the results of the tests at the various checks after an accidental puncture hoping not to be infected. We simply earn a living with something that gives us emotions. It doesn't matter if they are beautiful or ugly, just take them home.

In the end we only try to make ourselves useful for everyone. Now try to do it too though: with our actions we influence the life and death of a few dozen people. You with yours, many more. Please share and share the message. We must spread the word to prevent what is happening here in Italy.

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ORIGINAL: Canoerebel

I think people could tolerate any disease in which hospitals weren't stuffed past capacity, as long as said sickness didn't cause some irreparable damage (such as measles causing blindness).

So if we can flatten the curve, giving this the appearance of a sickness in which the sick have access to medical care routinely, that would help a lot. And if, during the meantime, other countermeasures were found (vaccine, etc.) then so much the better.

But you're right about lockdowns, etc. creating mayhem. I think our population will go with this for a week, maybe two. Then they'll be antsy beyond belief.

But I also think the news will begin improving within a month, probably within two weeks.

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ORIGINAL: Kull

I posted this graph earlier as part of a different topic, but let's look at it again in a different context.

Let's assume for a second that a country gains control of the infection growth rate, perhaps even reverses it. New cases are dropping, and after a month the population of that country looks at their Covid-19 numbers and no longer sees the uncontrolled growth. Pressure on governments to loosen restrictions will rise. Are schools going to stay closed? Do the bans on social events and entire industries remain in effect?

Because the reality is that absent a vaccine, all of this has but a single goal - trying to ensure that healthcare systems can handle the caseloads. However, the reality of a "flatter curve" is a MUCH longer duration for the Covid-19 outbreak. Once you open the doors to "normal actvity, the curves will resume their exponential characteristics. Nobody is saying it, but the underlying assumption for the flatter curve is that it takes longer for Covid-19 to run it's course through the entire population. And if that takes 9-12 months, are people really prepared for that?

9-12 month shutdowns are not something that ANY business can sustain. I can't see any bar or restaurant businesses surviving, the cruise industry is gone, for-profit airlines will be a thing of the past, brick-and-mortar schools will be relics, the list goes on and on. What are all those workers going to do in the interim? How does society handle the long-term loss of a system which uses schools largely as daycare centers for kids so that parents can leave the house and hold jobs? The "law of unintended consequences" is going to play out in a big way here, and many of them are going to major and devastating.

More than a few people in this thread have noted that "the cure may be worse than the disease", and I think they are right.

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ORIGINAL: RangerJoe

Well George, I won't include that long quote but I did post where they are trying rheumatoid artheritis drugs for COViD-19 when the body develops what is called a cytokine storm. From what I read in the quote, that is what is needed. I am not a MD and those on the line like that doctor probably don't have time to read it, but someone should be collating that information and getting it out to the people who need it. Then again, those drugs may be too expensive and there may not be enough of them for those who urgently need it at this time.

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ORIGINAL: witpqs

Kull,

We are being told appropriate masks (N-95, surgical masks don't work for this) are not available here as they are in shortage for health care practitioners on the job, right?

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ORIGINAL: Kull

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ORIGINAL: witpqs

Kull,

We are being told appropriate masks (N-95, surgical masks don't work for this) are not available here as they are in shortage for health care practitioners on the job, right?

True, only masks of a certain type, properly worn, can keep the wearer "safe" The REAL benefit is to prevent cough-spreaders from leaving clouds of virus in their wake.

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ORIGINAL: Canoerebel

Yeah, South Korea gives a lot of important information. And it seems that SK is on the far side of things, as we noted in here yesterday or the day before.

The information from Singapore (anomalous, if accurate) and Japan is also interesting They also are about four weeks into this with non-apocalyptic numbers.

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ORIGINAL: RangerJoe

I understand and I agree with what you did. Thank you.

I would also like to point out that the Corona virus 19 appears to latch onto something on the human cell called ACE. Another treatment that is being tried is to flood the body with extra ACE so the virus latches onto that and then can't infect a cell. Whether or not this is the same ACE where some people with heart disease takes ACE inhibitors, I don't know.

As far as the lack/shortage of medical supplies go, there may be a reason for that:

https://www.nytimes.com/2020/02/18/business/china-coronavirus-charity-supplies.html

I won't post quotes, but if you read it the the lack of certain supplies may become evident.

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Individuals who try to organize relief supplies face violating the country’s strict charity law.

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The outbreak in the USA didn't really start the big upward curve until the first of March. From late January until then it was mostly confined to Washington State and a few pockets in California. Little testing was done, but people weren't getting sick nor were there hospitalizations.

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China had it for two months before they began to experience exponential growth. Then it took drastic measures that have apparently worked.

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I am indeed optimistic about the quality of healthcare in the USA. There's no place I'd rather be in a pandemic.

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It was growing fast in other parts of the world a week or ten days before it began exponential growth in the US. Europe is currently well ahead of the USA - a week or two. We learned and have taken action fairly quickly now. Maybe not enough, but things are beginning to roll fast now.

I see all kinds of information in numbers and trends. This is a medical problem with quantifiable trends. So it's interesting to search for those trends

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I remain optimistic. This seems to grate against those who are relentlessly pessimistic. It is a subset of that group whose conduct has been questionable in here, ranging from vicious to unthoughtful to contemptuous. Why is there a subset of people who will not tolerate different viewpoints? Why does the expression of contrary views agitate so much? Would yo uprefer that I keep my opinions to myself? Should I surrender them to the wisdom of those who see this otherwise? Is it better that I withdraw from the thread I started among a community I've been part of 18 years? Can we all march in lock-step?

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ORIGINAL: witpqs

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ORIGINAL: Kull

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ORIGINAL: witpqs

Kull,

We are being told appropriate masks (N-95, surgical masks don't work for this) are not available here as they are in shortage for health care practitioners on the job, right?

True, only masks of a certain type, properly worn, can keep the wearer "safe" The REAL benefit is to prevent cough-spreaders from leaving clouds of virus in their wake.

And for that the disease specialist said surgical masks do work.

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ORIGINAL: Canoerebel

Your opinions are colored by your political viewpoints. Mine are too.

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In 2018, 8.5 percent of people, or 27.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9 percent or 25.6 million).

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You have a jaundiced perception of the US healthcare system that doesn't match what actually takes place here. We discussed this two or three days ago in here - you and me. With a few exceptions, nobody in this country is denied healthcare, at least at the level of being seen and admitted. (You acknowledged that two days ago, moving from that to stating something about "hence the high cost of health care in the US.)

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Percent of persons who failed to obtain needed medical care due to cost: 4.8%

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ORIGINAL: Canoerebel

Your opinions are colored by your political viewpoints. Mine are too.

You have a jaundiced perception of the US healthcare system that doesn't match what actually takes place here. We discussed this two or three days ago in here - you and me. With a few exceptions, nobody in this country is denied healthcare, at least at the level of being seen and admitted. (You acknowledged that two days ago, moving from that to stating something about "hence the high cost of health care in the US.)

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ORIGINAL: Kull

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ORIGINAL: Canoerebel

Your opinions are colored by your political viewpoints. Mine are too.

You have a jaundiced perception of the US healthcare system that doesn't match what actually takes place here. We discussed this two or three days ago in here - you and me. With a few exceptions, nobody in this country is denied healthcare, at least at the level of being seen and admitted. (You acknowledged that two days ago, moving from that to stating something about "hence the high cost of health care in the US.)

The reality is that under "normal conditions", 100% of people that show up at the ER will be seen and if they have a life-threatening emergency, they will be admitted. 100%. That's how it is and how it has been. Nobody is turned away because they don't have insurance. This isn't a discussion on the pros and cons of for-profit healthcare, it's a single issue - will the extreme Covid cases be admitted? And the answer is yes.

However, if the healthcare system is overwhelmed by cases (as it apparently is in Italy), then that poses a different problem, but one that is not affected in any way by the "cost of the healthcare system". Even if were universal and free, you would still be dealing with triage.