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42 minutes ago, Corraleno said:

They seem to have a rather intense interest in getting the economy reopened ASAP. They published the absurd essays (which are still up) by Richard Epstein, who predicted that deaths in the US would not exceed 500, and then when we passed that number like 2 days after he published the article, he claimed he "meant" to say the maximum would be 5,000. He is still claiming that it's no worse than the flu, and insists that it will become much less lethal very quickly because that's how viruses work. (He is a law professor with no background in medicine or even biology.) He is very much in favor of letting the old & infirm, who aren't productive workers anyway, die to avoid crashing the markets and tanking the economy. His essays have reportedly had a significant impact on administration policy. And the person from the Hoover Institute that was interviewed in that linked article, Victor Davis Hanson, is even less qualified — he is a military historian and professor of classics!

 

Ugh. 

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DS got home 3 hours ago!  ❤️❤️

Update-  my youngest is not only short of breath, coughing, dizzy, nausaues, and with headache-  she is also confused.  I called our doctor and talked with him and she is going to be going to the ER.

That's not a blanket right.  If my religion required human sacrifice, I can't practice it.  If my religion required sexual assault, I can't practice it. Freedom of religion isn't a blanket right

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6 hours ago, Mainer said:

 I was just expressing my opinion that I wish our country could have one medical system, to make coordination between hospitals easier, to make insurance less confusing for everyone, etc.

I'm not extremely informed about the nitty gritty of other countries' universal health systems, 

And if everyone was just enrolled in health insurance because they... are citizens.

I am also not familiar with the nitty gritty of healthcare systems, but, I think that the way our healthcare is designed is due to a combination of the American brand of Capitalism (where lobbyists for insurance companies and pharma giants control most of the decisions made in health care in order to keep stock prices up for their investors) and the political decisions made by politicians. Both of these topics are irrelevant to the WTM chat board, and also might derail this helpful thread, so, no comments from me.

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@Ausmumof3@StellaM

https://www.channelnewsasia.com/news/world/australia-ruby-princess-cruise-ship-covid-19-coronavirus-12623580

“SYDNEY: Australian police raided the coronavirus-stricken Ruby Princess cruise ship and seized its black box as part of a criminal investigation after thousands of passengers were allowed to disembark in Sydney and 15 people later died of the illness.

Police wearing protective suits and masks boarded the vessel in Port Kembla, about 80km south of Sydney, on Wednesday (Apr 8  ) night, New South Wales (NSW) Police said on Thursday.

"Police officers entered the Ruby Princess to gather evidence ... ships have a black box very similar to international planes and that and other evidence has been seized," NSW Police Commissioner Mick Fuller told media.

The Ruby Princess berthed on Monday after weeks stranded at sea to allow doctors to assess sick crew members and take the most serious cases ashore for medical treatment.

Police have launched a criminal investigation into operator Carnival Australia over the circumstances that led to thousands of passengers disembarking in mid-March despite some exhibiting flu-like symptoms.

Hundreds of passengers were later diagnosed with coronavirus and at least 15 have died, accounting for nearly a third of Australia's death toll of 51. The country has recorded more than 6,000 confirmed cases of COVID-19.

Over a thousand crew members remain on the vessel and the majority wanted to stay onboard, Fuller said, adding: "They feel safe on the ship."

The Ruby Princess could remain at port for up to 10 days to refuel and restock before leaving Australia, but authorities said crew would not be allowed off unless it was an emergency.”

Edited by Arcadia
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@TCB

https://www.hhs.gov/about/news/2020/04/08/hhs-statements-on-authorizing-licensed-pharmacists-to-order-and-administer-covid-19-tests.html

“Earlier today, the Office of the Assistant Secretary for Health issued new guidance under the Public Readiness and Emergency Preparedness Act authorizing licensed pharmacists to order and administer COVID-19 tests that the U.S. Food and Drug Administration has authorized.

HHS Secretary Alex Azar issued the following statement:

"Giving pharmacists the authorization to order and administer COVID-19 tests to their patients means easier access to testing for Americans who need it. Pharmacists play a vital role in delivering convenient access to important public health services and information. The Trump Administration is pleased to give pharmacists the chance to play a bigger role in the COVID-19 response, alongside all of America's heroic healthcare workers."

HHS Assistant Secretary for Health Brett P. Giroir, M.D. issued the following statement:

"In an effort to expand testing capabilities, we are authorizing licensed pharmacists to order and administer COVID-19 tests to their patients. The accessibility and distribution of retail and independent community-based pharmacies make pharmacists the first point of contact with a healthcare professional for many Americans. This will further expand testing for Americans, particularly our healthcare workers and first responders who are working around the clock to provide care, compassion and safety to others."

OASH's Guidance for Licensed Pharmacists, COVID-19 Testing, and Immunity under the PREP Act is available here - PDF.

FDA's Emergency Use Authorizations for diagnostic and therapeutic medical devices to diagnose and respond to public health emergencies is available here.

Priorities for testing patients with suspected COVID-19 infection are available here - PDF.”

 

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U.S. Deaths
 
April 8 14,800 5 days to double (14592)
April 3 7400 3 days to double (7296)
March 31 3900 3 days to double (3648)
March 28 2200 3 days to double (1824)
March 25 1030 2 days to double (912)
March 23 550 3 days to double (456)
March 20 250 3 days to double (228)
March 17 110 3 days to double (114)
March 14 57
 
A slowdown in the doubling rate for the first time.
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Chicago, Illinois https://www.channelnewsasia.com/news/world/us-man-covid-19-spread-chicago-social-distancing-12623618

“WASHINGTON: Back in late February, when the United States thought it had sealed itself off from the coronavirus, a Chicago resident with mild respiratory symptoms went to pay his respects at a funeral as a friend of the family.

Three days later, he attended a birthday party with his relatives.

The man, who was unaware he had the COVID-19 illness, set off a chain of transmissions that infected 15 other people, three of whom died, the Centers of Disease Control and Prevention (CDC) said on Wednesday (Apr 8).

"INDEX PATIENT"

It all started when the man, referred to as the "index patient," enjoyed a takeout meal using shared plates the night before the funeral with two members of another family he was friends with.

Over dinner, which lasted about three hours, and the funeral, which lasted about two hours and involved a shared "potluck-style" meal, the man reported embracing four people, including the two he met the night before to express condolences.

Three developed COVID-19 symptoms within two to six days, including one who had to be hospitalised and eventually died almost a month later.

The other two were managed as outpatients and recovered.

While the patient who eventually died was being treated in intensive care, they were visited by another member of their family who had been in contact with the index patient at the funeral.

This individual, who did not wear protective gear, later developed a cough and fever but recovered.

CHAIN REACTION

Three days after the funeral, the index patient went to a birthday party that was attended by nine members of his own family, and came into close contact with all of them over the course of three hours.

Seven subsequently developed COVID-19 three to seven days after the event. Two were hospitalised and required ventilation, and both died.

Two people involved in caring for one of the people who died, including a family member and a home care professional who was not related, both developed probable COVID-19.

The family member likely transmitted the virus to another relative, who did not attend the party.

Three of the birthday attendees who had symptoms went to church six days after developing their first symptoms, where they likely infected an unrelated healthcare professional.

The healthcare worker sat in close proximity and conversed with them over a period of 90 minutes.

The CDC wrote that the patients ranged in age from five to 86 years.

"Extended family gatherings (a birthday party, funeral, and church attendance), all of which occurred before major social distancing policies were implemented, might have facilitated transmission of SARS-CoV-2 beyond household contacts into the broader community," it said.”

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I don't know if I'm on information overload or what. But is anybody else a little confused by mixed messaging? It seems that over the past few days I'm picking up on a lot of "Oh, it really isn't going to be so bad," conflicting with "This is what is actually happening, and it's horrible," and it's making me feel more confused as to what to expect. We live in an area where everything has been slower to take off--responses and cases. Maybe it really won't get too bad here, because we've had more time to prepare, population density is less, etc. But people haven't been great until this week to actually follow distancing and staying home guidelines very well. I'm watching figures, but with lack of testing, then lots of testing, then ??--it's just hard to follow what the real situation is.

ETA: A couple more things: I read about the chloroquine treatment, and how it is very promising, and how it's just anecdotal, and how it should be used, and why it shouldn't, and it drives me nuts.

Then there is the confusion I refer to above, and I'm getting the feeling, especially here, that people are becoming really impatient over it all. Maybe because I've taken this seriously all along, I find it disturbing that they will be saying, "See, it was all just a big overreaction so that gov't/whoever could tank our economy and cause everybody to panic so they could take away our liberties, and the virus wasn't anything as bad as they said." Then it will cause that suspicion which seems pretty rampant to grow even more so. So...I don't want to be right and have a bunch of people sick and dying here--not by any means! But I don't want the conspiracy theorists to mock (even more than they already are) and grow even more confident in their theories. Am I even making any sense at all?

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21 minutes ago, Arcadia said:

Chicago, Illinois https://www.channelnewsasia.com/news/world/us-man-covid-19-spread-chicago-social-distancing-12623618

“WASHINGTON: Back in late February, when the United States thought it had sealed itself off from the coronavirus, a Chicago resident with mild respiratory symptoms went to pay his respects at a funeral as a friend of the family.

Three days later, he attended a birthday party with his relatives.

The man, who was unaware he had the COVID-19 illness, set off a chain of transmissions that infected 15 other people, three of whom died, the Centers of Disease Control and Prevention (CDC) said on Wednesday (Apr 8).

"INDEX PATIENT"

It all started when the man, referred to as the "index patient," enjoyed a takeout meal using shared plates the night before the funeral with two members of another family he was friends with.

Over dinner, which lasted about three hours, and the funeral, which lasted about two hours and involved a shared "potluck-style" meal, the man reported embracing four people, including the two he met the night before to express condolences.

Three developed COVID-19 symptoms within two to six days, including one who had to be hospitalised and eventually died almost a month later.

The other two were managed as outpatients and recovered.

While the patient who eventually died was being treated in intensive care, they were visited by another member of their family who had been in contact with the index patient at the funeral.

This individual, who did not wear protective gear, later developed a cough and fever but recovered.

CHAIN REACTION

Three days after the funeral, the index patient went to a birthday party that was attended by nine members of his own family, and came into close contact with all of them over the course of three hours.

Seven subsequently developed COVID-19 three to seven days after the event. Two were hospitalised and required ventilation, and both died.

Two people involved in caring for one of the people who died, including a family member and a home care professional who was not related, both developed probable COVID-19.

The family member likely transmitted the virus to another relative, who did not attend the party.

Three of the birthday attendees who had symptoms went to church six days after developing their first symptoms, where they likely infected an unrelated healthcare professional.

The healthcare worker sat in close proximity and conversed with them over a period of 90 minutes.

The CDC wrote that the patients ranged in age from five to 86 years.

"Extended family gatherings (a birthday party, funeral, and church attendance), all of which occurred before major social distancing policies were implemented, might have facilitated transmission of SARS-CoV-2 beyond household contacts into the broader community," it said.”

 

😞🤔😞

Sounds like several other asymptomatic (or presymptomatic) “superspreader” reports from other countries. 

 

And is a reason why “it’s just a family gathering “ becomes a problem. 

There seemed to be some sort of family party going on across street this past weekend— I sure hope there wasn’t an asymptomatic spreader there. 

 

Edited by Pen
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26 minutes ago, Jaybee said:

ETA: A couple more things: I read about the chloroquine treatment, and how it is very promising, and how it's just anecdotal, and how it should be used, and why it shouldn't, and it drives me nuts.

I think is because there is just no way to know yet.  Unfortunately we don't have the time right now to do a good double blind study to find the truth.  It might work, it might now, it might work sometimes.  

 

28 minutes ago, Jaybee said:

Then there is the confusion I refer to above, and I'm getting the feeling, especially here, that people are becoming really impatient over it all. Maybe because I've taken this seriously all along, I find it disturbing that they will be saying, "See, it was all just a big overreaction so that gov't/whoever could tank our economy and cause everybody to panic so they could take away our liberties, and the virus wasn't anything as bad as they said." Then it will cause that suspicion which seems pretty rampant to grow even more so. So...I don't want to be right and have a bunch of people sick and dying here--not by any means! But I don't want the conspiracy theorists to mock (even more than they already are) and grow even more confident in their theories. Am I even making any sense at all?

  I fully understand this and feel the same way. 

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New York Times--NYC outbreak tied to Europe, not Asia.

New research indicates that the coronavirus began to circulate in the New York area by mid-February, weeks before the first confirmed case, and that it was brought to the region mainly by travelers from Europe, not Asia.

https://www.nytimes.com/2020/04/08/science/new-york-coronavirus-cases-europe-genomes.html


 

Edited by Acadie
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14 minutes ago, kdsuomi said:

How bad it is currently is highly location dependent. It's not turning out to be terrible where I live but has been worse in the big population centers of the state. If I were in a state where it hasn't taken hold yet, I withhold want to be a CA, OR, or WA and not say a NY or NJ numbers wise. The problem is that no one knows for sure why it's hitting all these places so differently. 

 

Although there is around 3 - 5 weeks delay to see effects, it seems to be quite responsive to actually having significant Physical Distancing and Stay Home.  Not so much the official rules as the actual actions in real life.  (There often seems to be 3-5 weeks delay to see effects of Social closeness as well— parties and the like.) 

Some places Physical Distancing  is harder even if the Willingness is there, like in high rise apartments, where elevators become small spaces used by many.  I hope that mask wearing will also help significantly including in those types of situations, but it will still be hard if virus drops out around mask and then dries and then takes to the air. 

 

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I feel the same way,  and have noticed a marked difference in opinion since the beginning of the week.  I live rural and there is currently 1 case in my county, 4 in the county next to us.  Having everything shut down feels like a big overreaction when there are no cases.  Now, there are just 12 ICU beds, so it wasn't a bad decision to shut down!  I'm not arguing that point, but I do think that there is a perception here that it's a political hoax totally overblown by the media, only a problem in big cities, we are almost protected bc of where we live.  (Again *I* am not saying these things, but going by what others are posting, this is the sentiment.)   We are already the second highest poverty rate in my state, and keeping people from work is going to really hurt- for a long time.  Without a long term plan, there isn't going to be adherence to any rules.  Until we know sick people and some younger ones have died, it really isn't going to sink in- unfortunately.   

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FYI, weekly Stanford Medicine COVID Grand Rounds are available online:  

https://medicine.stanford.edu/education/medicine-grand-rounds.html
 
 
Here are some notes from this morning:  
 

Wednesday, 8 April 2020

13 total COVID patients, 5 in ICU on ventilators

54 open ICU beds  

 

Surge Capacity teams are deactivated at this time, not needed.

Staffing is full and readily available

 

Employees tested this week  - 300, only 1 was positive

Total tested 1800, 68 are positive (3.5% positive rate)

 

Deaths in Santa Clara County - 66% male, 79% have comorbidities

  

Peak is expected at approx. April 15th; Stanford has more than enough beds/resources to handle this. "Peak" is going to be quite small at current rate. Very few cases.

 

 

PCR Testing, Clinical Lab Update

 

  •  
  • Current capacity - 2K tests/day
  • E gene PCR assay, multiple workflows to protect against supply chain issues; TAT is 9hrs mean
  • Cepheid GeneXpert test - 45 min test, TAT 90min; sample goes into cartridge, which goes into instrument.
    • Most of slow down is time for sample to get from draw to lab
    • Limited number of these tests; so using patient priority for this test
  • Evaluating the 15min Abbott test 
  • Serology test went live yesterday for early evaluation/testing  
  • Elisa against SARS-Cov2 Spike Receptor binding domain protein (RBD) which has low crossreactivity with other coronaviruses
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1 minute ago, square_25 said:

It makes sense, because NY was largely driving the rate, and we're locked down. 

Now the question is whether the IHME projections are actually about right and no one else will have things seriously take off, or whether they are way too optimistic and we're going to have serious explosive growth elsewhere :-/. 

 

My thoughts are that if it’s taking 3-4 weeks from onset of symptoms to many of these deaths, then the numbers we are seeing now should be the deaths of those who were infected right before the big lockdowns started. Of course, not all areas have been locked down from 3-4 weeks.... but it does seem like a move in the right direction. 

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9 minutes ago, square_25 said:

It makes sense, because NY was largely driving the rate, and we're locked down. 

Now the question is whether the IHME projections are actually about right and no one else will have things seriously take off, or whether they are way too optimistic and we're going to have serious explosive growth elsewhere :-/. 

Unfortunately I think that we're going to have explosive growth elsewhere.  I would be more than happy to be wrong on this, though. 

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5 minutes ago, kdsuomi said:

The first confirmed case in CA was in January, and ours came from China. I wonder if there's a difference in the strains that is also contributing to differences we're seeing. 

 

“They” afaik still say no, but from what I have read it seems that there is.  The Asian strain seems less bad than the European.  However, I have to keep remembering to toss all the China statistics out of my brain as unreliable.  

I think west coast USA has also had some come in from Italy and other parts of Europe 

Anecdotally, I think quite a lot more people on west coast seemed to personally “get it” and start some Distancing even before SIP  /Stay Home rules.  More than in New York.    And I think the Distancing is much harder because of density in NYC than even SF.  So that could be more relevant than where the virus arrived from. Maybe.

But there did seem to be differences in the descriptions of cases out of Asia versus Italy . 

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On 4/4/2020 at 3:08 PM, Plum said:

This plus vent shortage (eta plus the PPE required to intubate, the danger to HCW during intubation), plus the struggle to get intubated patients off the ventilator is why many are looking at how to avoid intubation completely through high oxygen nasal cannula, non-invasive ventilation helmets, positive airway pressure units, and anything else they can figure out to avoid it. 

You have a 50/50 chance to get off of a ventilator once put on. (see MedCram #49) 

Yeah, but that 50/50 chance is under "normal" disease conditions, right?  I'm reading that 80%+ of coronavirus patients on ventilators are dying.  There is speculation that ventilators are actually harming those patients instead of helping.

https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d

Honestly, I don't understand the push for great quantities of ventilators (seems it is constantly on the news) if they are ineffective, at best, for 8 out of 10 critically ill covid19 patients.

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21 minutes ago, Cecropia said:

Yeah, but that 50/50 chance is under "normal" disease conditions, right?  I'm reading that 80%+ of coronavirus patients on ventilators are dying.  There is speculation that ventilators are actually harming those patients instead of helping.

https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d

Honestly, I don't understand the push for great quantities of ventilators (seems it is constantly on the news) if they are ineffective, at best, for 8 out of 10 critically ill covid19 patients.

 

I had posted before YouTube link to a plea from an ICU Doctor, Cameron Kyle-Sidell, who thinks the ventilators need to be set at the lowest possible pressure setting , and that might help hugely he thinks, and apparently other doctors think too.  

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50 minutes ago, Jean in Newcastle said:

Unfortunately I think that we're going to have explosive growth elsewhere.  I would be more than happy to be wrong on this, though. 

We have around 10,000 cases in one county here.  Detroit and Wayne County report individually but Detroit is in Wayne County.  Our local numbers are starting to climb and if you look at all these little counties that has just a few cases, they now have 100+.  Unless something drastically changes it’s only a matter of time, and sadly a large majority of people here want back to work regardless of the consequences.

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5 minutes ago, Cecropia said:

Yeah, but that 50/50 chance is under "normal" disease conditions, right?  I'm reading that 80%+ of coronavirus patients on ventilators are dying.  There is speculation that ventilators are actually harming those patients instead of helping.

https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d

Honestly, I don't understand the push for great quantities of ventilators (seems it is constantly on the news) if they are ineffective, at best, for 8 out of 10 critically ill covid19 patients.

I got that from ICNARC (Intensive Care National Audit & Research Center) report that was featured in both MedCram and Dr. John Campbell. I have heard recently the numbers are as high as 75% chance of never getting off of the ventilator. Those numbers can get skewed especially if they are more successful at helping patients avoid the ventilator to begin with. 

At the beginning of this, the only treatment for this was time on the ventilator to give time for the lungs to rest and recover. Traditionally, ARDS is treated with low tidal volume and high PEEP and proning. Now, it looks like high flow oxygen might be better. The important difference between having to sedate and paralyze in order to ventilate and keeping someone sitting up in one of those helmets or on high oxygen is that you can communicate with the awake patient, you can easily see when they are struggling and help them more quickly.

 

Quote

 

Ventilators have been seen as critical to treating coronavirus patients because the devices are very successful when used to treat common forms of pneumonia, says Hajizadeh.

"We treat patients for several days, and then we get the antibiotics into the body and the patient recovers," she says. "Unfortunately with this COVID-associated pneumonia, there are no treatments that we know work for sure."

Also, the coronavirus often does a lot more damage to a person's lungs than pneumonia associated with the flu. "There is fluid and other toxic chemicals, cytokines we call them, raging throughout the lung tissue," she says.

In some patients, the damage is so bad that even ventilation won't help. So doctors have sometimes tried an even more extreme measure called extracorporeal membrane oxygenation, or ECMO, which delivers oxygen directly to a patient's bloodstream.

But this is still a stopgap measure. "Remember, ECMO too is a life-supporting treatment," Hajizadeh says. "So it's a bridge while we are allowing the lung to heal itself from a pneumonia."

Ventilators Are No Panacea For Critically Ill COVID-19 Patients

 

ECMO is basically a heart lung bypass. It's last resort stuff. 

 

Dr. Fauci has been saying he's puzzled why some patients young, with no underlying conditions suddenly take a turn for the worse. He keeps mentioning it could be genetic. Which reminded me of something I read a long time ago about ancestors of plague survivors having markers in their DNA. Just something to think about. 

Quote

 

One immune-related cluster included three altered genes, making it the most obvious candidate for closer perusal. The cluster, called TLR2, was already known to be involved in building the receptors on the surface of leukocytes, immune cells that recognize and destroy foreign invaders.

Because plague was such a widespread and devastating event in Europe, Netea and his colleagues reasoned that the Black Death outbreak, which occurred after the Roma arrived, might have put pressure on this gene cluster to evolve. To test the idea, they looked at how cells engineered to express TLR2 would hold up against Y. pestis and Yersinia pseudotuberculosis, an ancestor of Y. pestis. They found that TLR2 caused a heightened immune response when exposed to both bacteria.

Other diseases could have altered the same genes, Netea said, but plague is a strong candidate, because it affected Europe and not northwest India, and because it had such a widespread, devastating influence. The findings could have medical implications even in today's world, where plague is no longer such a danger. For example, autoimmune disorders, in which the body attacks its own tissues, may arise because of immune systems programmed by epidemics to respond strongly to the threat of invasion, Netea said.

Humans "were modified, basically, by the infections," he said.

https://www.livescience.com/43063-black-death-roma-evolution.html

 

 

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9 hours ago, Acadie said:

 

A good friend who is running the COVID unit in her hospital told me they rewrote their protocols yesterday, subject to further change of course. MDs across the US are communicating directly with each other, adapting their practices, and finding new and better ways to help patients. 

Dh said he gets several studies a day in his email that are from all over the world and he isn't even a frontline HCW. It's good we're all working together to figure this thing out. 

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8 hours ago, Jean in Newcastle said:

People in NY clap for the Heroes every night.  People here across the country on the West Coast do the same.  There are YouTubes, Memes etc. that all thank the heroes. 

Is there one for grocery store workers? They've been through a battle on multiple fronts. 

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@square_25@kdsuomi@Jean in Newcastle@Pen@Plum@TCB@mathnerd

https://www.nbcbayarea.com/news/local/difference-between-covid-19-cases-in-ca-vs-ny-is-likely-sheer-luck-experts/2269934/

Experts in disease control say the main difference between California and New York isn’t density or area, but when people started staying home and sheer luck.

All in all, New York has had nine times as many cases, seven times the people in hospitals and 14 times the deaths.

...

UCSF Epidemiologist George Rutherford said that when it comes to New York, some of it is simply a matter of bad luck.

“In New York, one of the very original patients was a so-called super spreader,” said Rutherford. “A man in New Rochelle and it was something like 113 people who became infected.”

Then, there are social distancing differences. Bay Area leaders ordered residents to shelter-at-home starting March 17, five days before New York and before a major social event.

“One of the things I think the health officers deserve a lot of credit for was that we went to shelter-in-place before St. Patrick’s Day,” said Rutherford.

Other researchers are looking at environmental differences. In a new Harvard study, they found New York County’s long-term air pollution levels were 42% higher than San Francisco County’s.

While we cannot say for certain that air pollution caused the differences in any two counties' COVID-19 outcomes, we can say that on average, we would expect a county with long-term exposure of 13.5 to have an 82% increase in COVID-19 mortality rate compared to a county with exposure 9.5," said the study's lead author Rachel Nethery, of the Harvard T.H. Chan School of Public Health.”

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4 hours ago, Ausmumof3 said:

We have the weird situation here where private hospitals were actually looking at having to lay off health care workers . The cancellation of all elective surgery effects them much more than the public system.  I think the latest I heard the public system were going to handle Covid and the private would handle non Covid stuff so they are effectively working together.

Dh has to take a PTO day off a week until this is over starting this week. That goes for all admin and it's corporate-wide. They've managed to keep most of their staff this way so far. But it's only the first week. At least he gets 3 day weekends again. 

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13 minutes ago, Plum said:

Is there one for grocery store workers? They've been through a battle on multiple fronts. 

I don’t know about clapping, but there are three online shout-outs in my area for grocery store workers, pharmacy employees and delivery drivers. Lots of people joining in to thank them. I have seen posters up thanking them as well. 

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This is just anecdoctally speaking from CA (San Diego area). Even before the SIP order was announced, there were plenty of social distancing actions being taken prior to this. We were seeing large events, field trips, competitions, etc. being cancelled well before the first SIP orders went into effect - like Bay Area 3/15. The state wide order to avoid large gatherings >200 was on 3/12.  I know within the Asian communities, there was plenty of pull back in unnecessary outside activities well before this because we were paying attention to what was happening in Asia. Enough that it was noticeable by other people, and they started to take notice as well. My thinking is that there were social behavioral changes happening locally already - enough that it may have had a significant difference in CA versus NY outcomes. 

@Arcadia were you seeing similar in the Bay Area? Other CA folks, do you recall what you were seeing? My friends and relatives in the Bay Area were pulling back already prior to the SIP order. My family was essentially SIP since 3/5.

 

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46 minutes ago, square_25 said:

Yeah, I've posted a few things in support of that, I think! I assume you looked. 

 

I did!  And, I hope you don’t mind, I forwarded some of that onward to some people I know who might have access to right people in a 6 or 10 degrees of separation way! 

 

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2 minutes ago, calbear said:

This is just anecdoctally speaking from CA (San Diego area). Even before the SIP order was announced, there were plenty of social distancing actions being taken prior to this. We were seeing large events, field trips, competitions, etc. being cancelled well before the first SIP orders went into effect. The state wide order to avoid large gatherings >200 was on 3/12.  I know within the Asian communities, there was plenty of pull back in unnecessary outside activities well before this. My thinking is that there were social behavioral changes happening locally already. 

 

Yeah. I'm in a different state but I know we were social distancing and I was personally SIP before the official order. I wish I had started that plague journal so I'd have a more accurate record. 

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10 minutes ago, Plum said:

Dh has to take a PTO day off a week until this is over starting this week. That goes for all admin and it's corporate-wide. They've managed to keep most of their staff this way so far. But it's only the first week. At least he gets 3 day weekends again. 

 

I am glad. 

I think that would be a good idea for all medical and first responder type people!!!

I think people like postal service carriers are also getting overwhelmed with too much work.  And needs some pto.

 

 

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18 minutes ago, calbear said:

This is just anecdoctally speaking from CA (San Diego area). Even before the SIP order was announced, there were plenty of social distancing actions being taken prior to this. We were seeing large events, field trips, competitions, etc. being cancelled well before the first SIP orders went into effect - like Bay Area 3/15. The state wide order to avoid large gatherings >200 was on 3/12.  I know within the Asian communities, there was plenty of pull back in unnecessary outside activities well before this because we were paying attention to what was happening in Asia. Enough that it was noticeable by other people, and they started to take notice as well. My thinking is that there were social behavioral changes happening locally already - enough that it may have had a significant difference in CA versus NY outcomes. 

@Arcadia were you seeing similar in the Bay Area? Other CA folks, do you recall what you were seeing? My friends and relatives in the Bay Area were pulling back already prior to the SIP order.

 

The West Coast has all these introverted tech people!!

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21 minutes ago, calbear said:

 

@Arcadia were you seeing similar in the Bay Area? Other CA folks, do you recall what you were seeing? My friends and relatives in the Bay Area were pulling back already prior to the SIP order.
 


Once Seattle was affected, the tech companies in my area started switching to work from home. Also news reported a Lockheed Martin Corp. employee in Sunnyvale has tested positive for COVID-19 on March 5th. 

A few of the company bus shuttles stop near my home and those buses stopped coming once work from home was activated. FAANG and other tech companies also pulled out of conferences and cancelled their own conferences.

I don’t know about New York but in the Bay Area, Japanese And Koreans do tend to mask up in winter/spring. Chinese not so much but if they mask, they do so mostly in winter/spring

From March 6th

“Atlanta (CNN Business)Amazon, Facebook, Google and Microsoft are all encouraging employees in the Seattle area to work from home due to concerns about the novel coronavirus as the outbreak in Washington grows. 

Amazon (AMZN) revealed earlier this week that one of its Seattle-based employees has been diagnosed with the virus. On Wednesday, Facebook said a contractor who works at one of its offices in Seattle had tested positive.” https://www.cnn.com/2020/03/05/tech/amazon-seattle-coronavirus/index.html
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I’m in CA. Our last day of school was March 13. Last day at the dance studio March 14 (hard to believe that was almost 4 weeks ago).There had been changes for at least the previous week though. Students were not allowed to come to school with *any* signs of illness. At the dance studio, parents and siblings weren’t allowed to hang out, it was drop off/pickup only. Barres, door handles, etc. were being wiped down between classes. I would say from the beginning of March people were being more cautious. 

It seems like it was sometime around the beginning of March, after the first death and the cruise ship incident, that people started taking this seriously state-wide. They had already been taking things seriously in certain areas since February.

Here is a nice timeline for CA’s response:

https://calmatters.org/health/coronavirus/2020/04/gavin-newsom-coronavirus-updates-timeline/

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1 hour ago, StellaM said:

NSW introduces $5000 fine for anyone who spits or coughs on a health care worker.

Unbelievable that anyone would do this, but they have.

 

Sad emoji for the health care workers. 

I am glad of some stiff penalties to help keep people safe.  

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In the San Antonio area, there was no social distancing until maybe 2 weeks ago. Even up until last week, people were still clogging up the parks and griping that restaurants were not open. 

My husband's employer found out that a worker in the UK office was positive for COVID-19 on Monday, March 9.  Employer announced that they'd do a trial run of working from home for 70% of the staff that Thursday March 12, and then 100% of the staff the following Tuesday, "just in case" they needed to send everyone home.  By the time they completed the Thursday trial run, they'd found out that 2 workers in the Austin office had been exposed to COVID-19 cases AND had been in the San Antonio office recently. Employer never even bothered doing the 100% trial run the following week. They sent everyone home on the 13th and said they were working from home for at least a month, and then extended that out to two months.  I don't expect husband to be back in the office until July, truthfully. 

My husband's employer was one of the first to shut things down in the area, from what I can tell.  I'm really relieved they did that instead of waffling around. About 10 days after husband had been working at home, his boss emailed everyone to say there had been 2 positive COVID-19 cases from San Antonio employees. If husband's employer had not acted quickly, it would have been much, much worse.     

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Germany’s death/no of cases just passed 2pc.  This is significant I think because the widespread testing means this is likely to be a more accurate CFR.  South Korea is just short of 2pc as well.

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5 hours ago, Jaybee said:

I don't know if I'm on information overload or what. But is anybody else a little confused by mixed messaging? It seems that over the past few days I'm picking up on a lot of "Oh, it really isn't going to be so bad," conflicting with "This is what is actually happening, and it's horrible," and it's making me feel more confused as to what to expect. We live in an area where everything has been slower to take off--responses and cases. Maybe it really won't get too bad here, because we've had more time to prepare, population density is less, etc. But people haven't been great until this week to actually follow distancing and staying home guidelines very well. I'm watching figures, but with lack of testing, then lots of testing, then ??--it's just hard to follow what the real situation is.

ETA: A couple more things: I read about the chloroquine treatment, and how it is very promising, and how it's just anecdotal, and how it should be used, and why it shouldn't, and it drives me nuts.

Then there is the confusion I refer to above, and I'm getting the feeling, especially here, that people are becoming really impatient over it all. Maybe because I've taken this seriously all along, I find it disturbing that they will be saying, "See, it was all just a big overreaction so that gov't/whoever could tank our economy and cause everybody to panic so they could take away our liberties, and the virus wasn't anything as bad as they said." Then it will cause that suspicion which seems pretty rampant to grow even more so. So...I don't want to be right and have a bunch of people sick and dying here--not by any means! But I don't want the conspiracy theorists to mock (even more than they already are) and grow even more confident in their theories. Am I even making any sense at all?

One thing that’s frustrating is it seems like chloroquine is now being politicised because trump recommended it and then someone took it and died.  Politics aside I hope that doesn’t interfere with decent studies on it.

but I think the reason the info is confusing is because it’s new and no one actually knows.  Every new development can make a significant difference in outcomes.  We’re trying to extrapolate from a limited amount of poor quality data so we’re going to be changing tack constantly.

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3 hours ago, Pen said:

 

“They” afaik still say no, but from what I have read it seems that there is.  The Asian strain seems less bad than the European.  However, I have to keep remembering to toss all the China statistics out of my brain as unreliable.  

I think west coast USA has also had some come in from Italy and other parts of Europe 

Anecdotally, I think quite a lot more people on west coast seemed to personally “get it” and start some Distancing even before SIP  /Stay Home rules.  More than in New York.    And I think the Distancing is much harder because of density in NYC than even SF.  So that could be more relevant than where the virus arrived from. Maybe.

But there did seem to be differences in the descriptions of cases out of Asia versus Italy . 

The Chinese figures are ever more confusing.  They are currently reporting a lot of asymptomatic cases.  But the previous study showed that 2/3 asymptomatic cases became symptomatic after a week or so.  But there’s no reports on that.  The Wuhan lockdown is “ended” with trains leaving and private vehicles.  But they still have a 14 day quarantine.  And some buildings are still locked down.  And there’s still videos from somewhat dubious sources apparently showing people collapsing in the streets.  But there aren’t many reliable on the ground sources...

just in case you needed any more reminders to take it all with a pinch or a ladleful of salt.

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3 hours ago, Cecropia said:

Yeah, but that 50/50 chance is under "normal" disease conditions, right?  I'm reading that 80%+ of coronavirus patients on ventilators are dying.  There is speculation that ventilators are actually harming those patients instead of helping.

https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d

Honestly, I don't understand the push for great quantities of ventilators (seems it is constantly on the news) if they are ineffective, at best, for 8 out of 10 critically ill covid19 patients.

I’m seeing similar.  If it turns out the main issue is actually the blood/haem thing not primarily a lung issue we may have a lot of ventilators that don’t help.  But because we don’t have firm science on that I guess it’s better to make ventilators that may not ended up used than not to have them when we need them.

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I wonder if some of the racial difference with Coronavirus death rates are because of Vitamin D differences.  I wrote a LinkedIn Article about it.  

Short version: Vitamin D helps with other respiratory illnesses, 75% of black Americans deficient in Vitamin D, 40% of all Americans deficient in Vitamin D, low rates of racial death rate differences in California and Florida, southern latitudes where people are often outside with sufficient skin exposure to make vitamin D production possible.

https://www.linkedin.com/pulse/vitamin-d-coronavirus-gap-liz-brown/?published=t

ETA: Louisiana is an outlier in the data, but there are a lot of unique things about Louisiana. (Southern latitude but high death rate disparity.)

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I had posted the other day about an article on a local patient who claimed he was only allowed 1 test per household. Yesterday, someone I know confirmed that... because she tested positive, and her family members aren’t allowed to be tested.  (She’s doing well. Statistically, could have been contagious when we were supposed to attend a party but I was already on COVID/general illness alert and declined!)

This does freak me out. While our county’s increases are slowing down, I don’t know if testing has always been 1 per household, or if that changed at some point, accounting for the slow down.  By yesterday’s numbers, we had 4 cases per thousand.  Thinking about what the actual rate might be when adding untested household members hurts my head.

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9 hours ago, BusyMom5 said:

I feel the same way,  and have noticed a marked difference in opinion since the beginning of the week.  I live rural and there is currently 1 case in my county, 4 in the county next to us.  Having everything shut down feels like a big overreaction when there are no cases.  Now, there are just 12 ICU beds, so it wasn't a bad decision to shut down!  I'm not arguing that point, but I do think that there is a perception here that it's a political hoax totally overblown by the media, only a problem in big cities, we are almost protected bc of where we live.  (Again *I* am not saying these things, but going by what others are posting, this is the sentiment.)   We are already the second highest poverty rate in my state, and keeping people from work is going to really hurt- for a long time.  Without a long term plan, there isn't going to be adherence to any rules.  Until we know sick people and some younger ones have died, it really isn't going to sink in- unfortunately.   

Not quite as rural, there are more cases in the county, but yes, that is what I am seeing and sensing.

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Just now, square_25 said:

I'd ignore Russia's numbers, like I ignore China's and Iran's. 

Ignoring the specific numbers but not the trends.  Increasing reports of deaths plus China closing that town that jade orchid song said was on the border and China reporting imported cases sounds to me like Russia may have a bigger problem than they are talking about.  

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Yesterday my governor extended the stay at home order. In his briefing he discussed the modeling that prompted his decision. He said a few things I found interesting. 

He said it has become clear as they learn more that the early models were far too pessimistic. He said it is also clear that the current IHME model is too optimistic. The only models that matter to him are ones using data specific to our state, and even those should not be taken too seriously. I found it funny to hear him echoing what has been said on this board over the last couple days. 😋

Anyway, my main point/question... He said that over the last 2 weeks they have learned that the infection rate is not 2.2, but closer to 4. On a more positive note, he also said the hospitalization stays are shorter and the disease less severe than they originally understood. Has anyone heard anything similar?

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5 minutes ago, TracyP said:

Yesterday my governor extended the stay at home order. In his briefing he discussed the modeling that prompted his decision. He said a few things I found interesting. 

He said it has become clear as they learn more that the early models were far too pessimistic. He said it is also clear that the current IHME model is too optimistic. The only models that matter to him are ones using data specific to our state, and even those should not be taken too seriously. I found it funny to hear him echoing what has been said on this board over the last couple days. 😋

Anyway, my main point/question... He said that over the last 2 weeks they have learned that the infection rate is not 2.2, but closer to 4. On a more positive note, he also said the hospitalization stays are shorter and the disease less severe than they originally understood. Has anyone heard anything similar?

Does that mean R0?  Is that infection rate?
 

I was starting to have the opposite impression that it was maybe less contagious but more lethal than we thought but I haven’t seen recent estimates. 

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