Corona Virus Carrier

[ilovecornfields]

22 minutes ago, bradp said:

I take care of kids in an ICU setting.  Issue is not so much with disease state in children (so far seems mild for kids on a population scale), but as a potential carrier pool.   Kids carry multiple viruses at any one time.  Current health department screening algorithms exclude COVID screening if another virus is detected.  Most kids with respiratory symptoms carry multiple pathogens.  You’re going to miss a big carrier pool by excluding kids from testing.   
 

One kid with that virus that arrives undiagnosed would likely close the unit, quarantine 40% of the day or night nursing staff and significantly impact ability to deliver care.  I fear that with the current public health guidance there is a “let’s wait till it’s here locally” approach to screening and proper PPE provisioning.  
 

The hospital I work at ran short of surgical masks yesterday.  These are not the N95 respirators used for COVID19.  Just regular masks for flu etc.  The system is already stretched as thin as possible.   The hospitals are already at capacity for winter respiratory viruses- flu seems to be of high prevalence.  The Toyota inspired cost cutting and efficiency principles like “just in time” and “lean” that all the middle tier MBAs (who run hospitals) subscribe to so heavily to are about to come crashing down on the healthcare system in a big way.  

Sadly, I agree with everything you said.

[Gagarin]

1 hour ago, Greg Ellis said:

The danger right now is that the grocery stores around here are out of toilet paper!!!! 

Phone book directories, Sears catalog, newspaper and others are an alternative. I installed a bidet adapter to my toilet for no paper cleaning.

Edited March 10, 2020 by Gagarin

[thinwing]

12 hours ago, tigers2007 said:

I’ve been sick for about three months. Had the death flu and for the last 2.5mos I’ve had shortness of breath; feels like heavy pressure on chest all the time. Tired and weak. Dr’s have slammed me with meds and don’t know what’s going on. All I know is that I did a lot of intermixing with Wuhan Plague travellers at DTW (multiple daily flights to CN). I work at a hospital and they aren’t really saying much either as I hack and cough all day.

Don’t worry Tiger..it’s just a little cold you have,,...recommend you leave country 

 

 

[MooneyDriver1]

Would wait the 14 days after symptoms resolved.  Why take risk?  No chance it's going to get better before it gets MUCH MUCH worse.  

[Shadrach]

On 3/10/2020 at 3:23 PM, aviatoreb said:

A danger would be if the healthcare system were to become dramatically overwhelmed to the point that there simply are no more beds in hospitals and maybe even the healthcare workers are significantly impacted with their own illnesses, then our modern high intensive but high human-hours intensive methods might simply become mostly unavailable, in which case, we would be right back at 1918 level of home care.

I read a second hand message that suggested that hospitals in the Lombardy region of Italy are overwhelmed. In the neighborhood of 200% of design capacity. Not enough ventilators.  This person‘s account read like they were making very difficult triage decisions based on age and comorbidities. 

Edited March 12, 2020 by Shadrach

[aviatoreb]

19 minutes ago, Shadrach said:

I read a second hand message that suggested that hospitals in Lomabardy region of Italy are overwhelmed. In the neighborhood of 200% of design capacity. Not enough ventilators.  This person‘s account read like they were making very difficult triage decisions based on age and comorbidities. 

I read similarly - and a description from a doctor reported that they were triaging away people over 65 - in other words save those you have a much higher probability of saving and save the heroic measures.  :-(  So without intensive care the death rate would be much higher than it would be with.  This is why it is so important to slow down the spread to attempt to stay within capacity of the healthcare system.  That plus a hope would be that eventually a vaccine would come (in a year?) to save some people.

[DXB]

1 hour ago, aviatoreb said:

I read similarly - and a description from a doctor reported that they were triaging away people over 65 - in other words save those you have a much higher probability of saving and save the heroic measures.  :-(  So without intensive care the death rate would be much higher than it would be with.  This is why it is so important to slow down the spread to attempt to stay within capacity of the healthcare system.  That plus a hope would be that eventually a vaccine would come (in a year?) to save some people.

The whole thing is surreal! 

There will undoubtedly be horrific stories out of northern Italy in the days and weeks to come, despite their modern healthcare resources.  In addition to harming the old and infirm, this virus is undoubtedly cutting down many relatively young and healthy people without rhyme or reason. And there is no reason to think it couldn't pass through densely populated areas of the US in much the same way.  I don't see any evidence over-reaction by institutions and public health agenies - possibly some denial and under-reaction. One bright spot at the moment seems to be a lack of massive community spread so far in India, a country full of urban areas containing jam-packed slums with awful sanitation.  They were relatively spared by SARS and MERS too, which one might attribute to the hot humid climate.  It's too early to tell exactly how much summer temps will benefit us, but there's legit reason for hope.  

It's not too hard to make various vaccines, including by some newer types based on innovative modern biotechnology that can be made very rapidly. - it's just difficult and time consuming to prove that any particular vaccine you make will be effective and safe.  Traditionally we've insisted on high standards of evidence for efficacy and safety through clinical trials before pouring resources into production and distribution of a new vaccine.  In is case, it may be worth some best guesses and short cuts to at least attempt not ending up in the same situation again in the fall.  

[aviatoreb]

46 minutes ago, DXB said:

The whole thing is surreal! 

There will undoubtedly be horrific stories out of northern Italy in the days and weeks to come, despite their modern healthcare resources.  In addition to harming the old and infirm, this virus is undoubtedly cutting down many relatively young and healthy people without rhyme or reason. And there is no reason to think it couldn't pass through densely populated areas of the US in much the same way.  I don't see any evidence over-reaction by institutions and public health agenies - possibly some denial and under-reaction. One bright spot at the moment seems to be a lack of massive community spread so far in India, a country full of urban areas containing jam-packed slums with awful sanitation.  They were relatively spared by SARS and MERS too, which one might attribute to the hot humid climate.  It's too early to tell exactly how much summer temps will benefit us, but there's legit reason for hope.  

It's not too hard to make various vaccines, including by some newer types based on innovative modern biotechnology that can be made very rapidly. - it's just difficult and time consuming to prove that any particular vaccine you make will be effective and safe.  Traditionally we've insisted on high standards of evidence for efficacy and safety through clinical trials before pouring resources into production and distribution of a new vaccine.  In is case, it may be worth some best guesses and short cuts to at least attempt not ending up in the same situation again in the fall.  

We would be in a world of hurt if a rushed and unsafe vaccine made for its own and massive public health emergency.

[Hank]

3 minutes ago, aviatoreb said:

We would be in a world of hurt if a rushed and unsafe vaccine made for its own and massive public health emergency.

I think it's more likely that a rushed vaccine would be ineffective rather than actually harmful itself. But I work in Medical Devices, not Pharma . . . . .

[DXB]

1 hour ago, aviatoreb said:

We would be in a world of hurt if a rushed and unsafe vaccine made for its own and massive public health emergency.

Safety issues are really very unusual in testing conventional vaccines, at least for the standard viral vaccine development approaches - the novel ones might warrant a bit more scrutiny but the RNA or DNA nanoparticle vaccines for instance seem even safer in principle and are very quick to make.  Efficacy is of course the higher bar and should be tested in larger at risk populations in real time in a serious epidemic.  As with testing any drug, the risk / benefit balance must be calibrated for any particular individual or population receiving it.  This situation is certainly unique in all of our lifetimes - the last time anything like this happened was in 1918, and it killed more people than WW1. A stepwise formulaic approach to vaccine testing simply won't do.

[aviatoreb]

21 minutes ago, DXB said:

Safety issues are really very unusual in testing conventional vaccines, at least for the standard viral vaccine development approaches - the novel ones might warrant a bit more scrutiny but the RNA or DNA nanoparticle vaccines for instance seem even safer in principle and are very quick to make.  Efficacy is of course the higher bar and should be tested in larger at risk populations in real time in a serious epidemic.  As with testing any drug, the risk / benefit balance must be calibrated for any particular individual or population receiving it.  This situation is certainly unique in all of our lifetimes - the last time anything like this happened was in 1918, and it killed more people than WW1. A stepwise formulaic approach to vaccine testing simply won't do.

Let me qualify my remarks on the topic of vaccine development by noting that I don’t know what I am talking about.  I’m just noting general uninformed concern.

[bonal]

Description

Influenza A virus subtype H1N1 is the subtype of influenza A virus that was the most common cause of human influenza in 2009, and is associated with the 1918 outbreak known as the Spanish flu. It is an orthomyxovirus that contains the glycoproteins haemagglutinin and neuraminidase.

You mention that nothing like this virus  has happened since 1918 yet H1N1 happened in 2009 and nearly 13 thousand  people died in the US and over 500k world wide. So far we are just over 1100 infected and just over 30 dead. I think people are a bit too panicked over this. Yes it's serious but I think folks need to take a chill pill. With all the cancellation of big events and now no flights from Europe as well as all the existing restrictions as well as school closures etc. this pandemic is going to fade just as fast as it began. At least I hope so. 

Dont forget, wash your hands and cover your face when you sneeze 

Edited March 12, 2020 by bonal

[ilovecornfields]

34 minutes ago, bonal said:

Description

Influenza A virus subtype H1N1 is the subtype of influenza A virus that was the most common cause of human influenza in 2009, and is associated with the 1918 outbreak known as the Spanish flu. It is an orthomyxovirus that contains the glycoproteins haemagglutinin and neuraminidase.

You mention that nothing like this virus  has happened since 1918 yet H1N1 happened in 2009 and nearly 13 million people died in the US and over 500k world wide. So far we are just over 1100 infected and just over 30 dead. I think people are a bit too panicked over this. Yes it's serious but I think folks need to take a chill pill. With all the cancellation of big events and now no flights from Europe as well as all the existing restrictions as well as school closures etc. this pandemic is going to fade just as fast as it began. At least I hope so. 

Dont forget, wash your hands and cover your face when you sneeze 

You sure about your numbers? or conclusions?

http://www.cidrap.umn.edu/news-perspective/2012/06/cdc-estimate-global-h1n1-pandemic-deaths-284000

[bonal]

The Centers for Disease Control and Prevention (CDC) estimates that swine flu infected nearly 61 million people in the United States and caused 12,469 deaths. Worldwide, up to 575,400 people died from pandemic swine flu.

same source so yes

[bonal]

As for my conclusions lets just say I'm trying to be optimistic I have never been one to panic. 

[Hank]

1 hour ago, bonal said:

Description

Influenza A virus subtype H1N1 is the subtype of influenza A virus that was the most common cause of human influenza in 2009, and is associated with the 1918 outbreak known as the Spanish flu. It is an orthomyxovirus that contains the glycoproteins haemagglutinin and neuraminidase.

You mention that nothing like this virus  has happened since 1918 yet H1N1 happened in 2009 and nearly 13 million people died in the US and over 500k world wide. So far we are just over 1100 infected and just over 30 dead. I think people are a bit too panicked over this. Yes it's serious but I think folks need to take a chill pill. With all the cancellation of big events and now no flights from Europe as well as all the existing restrictions as well as school closures etc. this pandemic is going to fade just as fast as it began. At least I hope so. 

Dont forget, wash your hands and cover your face when you sneeze 

While I certainly agree with washing hands, and covering sneezes then washing again, I think your H1N1 numbers are wrong. The U.S. has never lost 13 million people in one year to any single cause, much less a disease . . . . And even the most pessimistic projections for COVIC-19 are for a tiny fraction of this number again.

[bonal]

8 minutes ago, Hank said:

While I certainly agree with washing hands, and covering sneezes then washing again, I think your H1N1 numbers are wrong. The U.S. has never lost 13 million people in one year to any single cause, much less a disease . . . . And even the most pessimistic projections for COVIC-19 are for a tiny fraction of this number again.

Your right I meant nearly 13 thousand not million...my bad

[Steve W]

On 3/10/2020 at 12:31 PM, Greg Ellis said:

The danger right now is that the grocery stores around here are out of toilet paper!!!! 

I've carried hand sanitizer in my car for years and it picked a lousy time to start getting low. Mostly it cuts the diesel smell when I fuel up, but it's also nice to have when I have to venture into the unwashed masses. Luckily I invested in masks for my drywall sanding before the virus hit.

[DXB]

Annual flu deaths in US range from 10 to 60 thousand (see CDC website data).  There is no clear comparison right now on how communicable COVID19 is relative to flu, but it is clearly about 10-20 fold more lethal if you get it. In contrast to influenza, there is no vaccine and no effective medication for COVID19. From the perspective of a biologist and a physician, it is at the moment worthy of far more respect than flu (not that flu is trivial). If unchecked, COVID19 seems likely to produce at least an order of magnitude more deaths and far exceed the health systems capacity to care for scores of critically ill - Italy is a stark illustration of what can happen.  The only things we have going for us relative to the flu are virus having appeared relatively late in the winter season and ongoing countermeasures taken by individuals and institutions - that should make a substantial difference but how much is as yet to be seen. 

[bradp]

1 hour ago, DXB said:

Annual flu deaths in US range from 10 to 60 thousand (see CDC website data).  There is no clear comparison right now on how communicable COVID19 is relative to flu, but it is clearly about 10-20 fold more lethal if you get it. In contrast to influenza, there is no vaccine and no effective medication for COVID19. From the perspective of a biologist and a physician, it is at the moment worthy of far more respect than flu (not that flu is trivial). If unchecked, COVID19 seems likely to produce at least an order of magnitude more deaths and far exceed the health systems capacity to care for scores of critically ill - Italy is a stark illustration of what can happen.  The only things we have going for us relative to the flu are virus having appeared relatively late in the winter season and ongoing countermeasures taken by individuals and institutions - that should make a substantial difference but how much is as yet to be seen. 

Italy has a more efficient healthcare delivery, higher numbers of hospital and ICU beds per capita, healthier baseline population statistics, better outcomes, plus all the wiz bang technology of our healthcare system.  If the virus takes off here in in a similar way it will be like 1918 as our healthcare capacity is overwhelmed. The Italian death rate is approaching 7% in a thoroughly modern healthcare setting. 
 

 

[DXB]

48 minutes ago, bradp said:

Italy has a more efficient healthcare delivery, higher numbers of hospital and ICU beds per capita, healthier baseline population statistics, better outcomes, plus all the wiz bang technology of our healthcare system.  If the virus takes off here in in a similar way it will be like 1918 as our healthcare capacity is overwhelmed. The Italian death rate is approaching 7% in a thoroughly modern healthcare setting. 
 

 

7pct is far too high, probably reflecting death rate among confirmed diagnoses for hospital admissions, not all cases in Italy

[bradp]

It may be limited to hospitalized patients- although I’d be interested because they had an uptick in reported deaths yesterday.  The Johns Hopkins GIS suite is useful because it’s updated frequently, but you don’t get many details about the denominators.  So population level tests reporting may lag behind the more up to date hospital mortality reporting.  That site is being used among other sources in the hospitals command center.  

[aviatoreb]

2 hours ago, bradp said:

It may be limited to hospitalized patients- although I’d be interested because they had an uptick in reported deaths yesterday.  The Johns Hopkins GIS suite is useful because it’s updated frequently, but you don’t get many details about the denominators.  So population level tests reporting may lag behind the more up to date hospital mortality reporting.  That site is being used among other sources in the hospitals command center.  

I was reading yesterday that the death rate has uptick dramatically because the locals where the outbreak is most severe has reached healthcare saturation.  They are triaging people over 65 and otherwise those with pre-existing conditions like cancer, heart disease, etc, to focus on those they hope they can help.  So there are sick people who are not getting modern health care.  I read that they are trying to transport sick people by helicopter to hospitals in other parts of the country, but this is a very bad situation.

As for what are the mortality rates, I agree, I don't know how they are counting. Is it 7% amongst those who present themselves as very sick at the hospital, or is it amongst those who catch it and get sick, or those who catch it but may not even know they are sick, the later two statistics being numbers that are very difficult to capture at an early stage of an epidemic.

[chrisk]

10 hours ago, bonal said:

Description

Influenza A virus subtype H1N1 is the subtype of influenza A virus that was the most common cause of human influenza in 2009, and is associated with the 1918 outbreak known as the Spanish flu. It is an orthomyxovirus that contains the glycoproteins haemagglutinin and neuraminidase.

You mention that nothing like this virus  has happened since 1918 yet H1N1 happened in 2009 and nearly 13 thousand  people died in the US and over 500k world wide. So far we are just over 1100 infected and just over 30 dead. I think people are a bit too panicked over this. Yes it's serious but I think folks need to take a chill pill. With all the cancellation of big events and now no flights from Europe as well as all the existing restrictions as well as school closures etc. this pandemic is going to fade just as fast as it began. At least I hope so. 

Dont forget, wash your hands and cover your face when you sneeze 

 

Here is the problem, and the reason not to take a chill pill.  The rate of infection is not saturated.  It's growing rapidly.  You can see it is not under control in Italy.  Their health care system is already taxed to the limit and will only be taxed more in the days to come as the number of folks with active infections increases.   For me, caution (not panic) is in order.   It seems wise to slightly modify my behavior to avoid large crowds and public/mass transportation.    That said, I really don't understand the run on toilet paper.  Maybe its a millennials idea of a critical survival item.    --An item that didn't exist 200 years ago.

[MooneyMitch]

Some reality to this now with Tom Hanks announcement!

Let’s see how well, and when, he and Rita recover.   

Best to them.