wuhan - coronavirus

[Pawz4me]

Add Duke University to those who are doing away with live classes. They've extended their spring break until March 22 and online classes will begin on the 23rd. They've asked all students who are out of town to not return to campus if at all possible.

[Ausmumof3]

Past 120,000 cases tonight

[Ausmumof3]

New cases

germany - 48

Iran 958 (63 deaths)

bahrain -79

Denmark - 78

Spain - 35

Belgium - 47

lots of others with smaller numbers but that was the biggest jumps 

 

Edited March 11, 2020 by Ausmumof3

[Ausmumof3]

Spain reported 372 more and 11 deaths - total is 2067 and 47

[Kassia]

47 minutes ago, Ausmumof3 said:

Spain reported 372 more and 11 deaths - total is 2067 and 47

 

My son has a trip to Barcelona for the end of April.  I wonder if he'll be able to go.  

[73349]

Wake County, NC has more cases, affecting two private schools. https://www.wral.com/raleigh-private-school-reports-parent-tests-positive-for-coronavirus/19005556/

One of the schools is not closing, because local government is telling them they don't need to. Just going to play petri dish until somebody else gets it?

ETA: Governor Cooper has declared a state of emergency to make price-gouging and other laws/capacities kick in.

Edited March 11, 2020 by whitehawk

[73349]

27 minutes ago, Dotwithaperiod said:

My son’s adviser told him WPI should announce tomorrow about closing the coming quarter, which runs next week thru April 5.

 I drove up to spend a week with him, thinking the MA cases were in Boston. Then he tells me the first person in Worcester was confirmed.

Boston has a lot of people who work there but live as far west as the Worcester area because of the housing prices, so this doesn't surprise me.

[Acadie]

5 hours ago, MissLemon said:

 

I'm kind of in the middle of a low-level freak out from the cognitive dissonance of the news being so, so bad and everyone I see acting like it's No Big Deal. 

     

 

Thank you for naming my emotional state for the last several weeks!

I actually feel a little relief since dh's university announced they're switching to online instruction and our state governor is being very proactive, recommending cancellation of public events after our first 3 cases were reported. Dd17 will be on spring break for two weeks starting Friday, and I'm really hoping dd13's school closes, We may just take her out at some point, even if they don't. 

One of my sisters dismissed my concerns, but now she needs to move her college age daughter out of her dorm because her university is moving to online instruction for the rest of the semester. So it's not just her wacko sister sounding the alarm anymore. 

[Ausmumof3]

37 minutes ago, Kassia said:

 

My son has a trip to Barcelona for the end of April.  I wonder if he'll be able to go.  

If the six to eight week forecasts are right it might be slowing by then.  
I guess we’re all wondering what’s next though.

[Matryoshka]

37 minutes ago, whitehawk said:

Boston has a lot of people who work there but live as far west as the Worcester area because of the housing prices, so this doesn't surprise me.

Apparently most of the cases here are in Middlesex County,  which is between Boston and Worcester.  But Boston and Worcester are only about an hour away from each other anyway.  MA is small, and pp is right that lots of people commute an hour or more.

[Lanny]

51 minutes ago, Kassia said:

My son has a trip to Barcelona for the end of April.  I wonder if he'll be able to go.  

 

I understand that my response will disappoint your DS but I think he should assume that he should not travel to Spain at the end of April 2020 or at any time during 2020,  Or, anywhere in Europe...

We live in South America (Colombia) and there are now I believe a total of three (3) cases here. I believe all of them came from people who were on nonstop flights from Spain?

A few days ago, the ACS (American Citizen Services) in the U.S. Embassy sent an email about this. All travelers arriving in Colombia, from 9   countries,  including the USA. Those found to be ill will be quarantined or whatever.

This is not as drastic as what Israel has apparently implemented, or, will soon implement, which is to quarantine EVERYONE arriving in Israel.

Your DS was planning to go to Spain, which is in Europe, which has been badly hit (Italy, etc.)  Not a good idea IMO...  My DD was contemplating going to China and/or Japan in May. That idea died in January...  

[Kassia]

4 minutes ago, Lanny said:

 

I understand that my response will disappoint your DS but I think he should assume that he should not travel to Spain at the end of April 2020 or at any time during 2020,  Or, anywhere in Europe...

We live in South America (Colombia) and there are now I believe a total of three (3) cases here. I believe all of them came from people who were on nonstop flights from Spain?

A few days ago, the ACS (American Citizen Services) in the U.S. Embassy sent an email about this. All travelers arriving in Colombia, from 9   countries,  including the USA. Those found to be ill will be quarantined or whatever.

This is not as drastic as what Israel has apparently implemented, or, will soon implement, which is to quarantine EVERYONE arriving in Israel.

Your DS was planning to go to Spain, which is in Europe, which has been badly hit (Italy, etc.)  Not a good idea IMO...  My DD was contemplating going to China and/or Japan in May. That idea died in January...  

 

I'd rather he didn't go but he's already exposed to so much.  He lives in Boston, is planning on going to Chicago next week (flying), then NYC the following week (by train), then Spain next month.  I'm hoping he'll change some (or all) of his plans but don't say much since he's an adult (29) and he's not going to listen to me.  His girlfriend lives with him and her job involves traveling all over Boston.  

[alewife]

8 hours ago, Arcadia said:

https://ktla.com/news/california/most-california-coronavirus-patients-are-between-18-and-64-new-data-shows/

“California officials on Tuesday released age breakdowns of the coronavirus cases so far as the spread of the disease continued.

The data showed 91 cases of people 18-64 and 60 cases of people 65 and over. There were only two cases of people younger than 18.

 

It is ridiculous that we are unable to test everyone that shows symptoms.  If the country had actual numbers for the under 18 age group, I bet many of our K-12 schools would be closed in an attempt to slow the spread.

 

[mumto2]

8 hours ago, Farrar said:

In terms of the food issue... around here, they open summer breakfast and lunch at several locations in every city ward. They don’t check the kids - they just feed all of them. Is there nothing like that in other places?

in England our village council has ran a sports program over the summer holidays just to feed children for years......people donate time, money, and local businesses pick up the extra to make the program happen every summer.  It’s ran to feed but advertised as football fun with rounders etc.  .   I admit I have wondered about that happening this summer.  

 

[Paige]

9 hours ago, Jean in Newcastle said:

I have a question:  can you estimate from Wuhan how long an outbreak might affect an area?  Ie. If Seattle truly has had the virus circulating for six weeks (or less time if you count from the first deaths) can people realistically extrapolate when we are “safe”?  

My DH sent me a podcast to watch this morning and the medical guy on there said we can't know if Wuhan has controlled the virus or just delayed the virus until they let people out and business returns to normal. 

Wuhan is also complicated by the fact that once they reopen, they'll be vulnerable to it coming back in from the rest of the world. I feel it's premature to expect a curve that peaks and levels out within a few months. 

[TravelingChris]

17 hours ago, Pawz4me said:

Yes. But there's always a group of people who feel the need to play "holier (or wiser) than thou" even when there's zero logic to doing so. Most of us should ignore them, IMO.

I notice those are the same people who tell us how we do not need to take our meds, we need to take vitamins or use essential oils or exercise or whatever.  Interestingly enough, the two people on Facebook page who argued with me that this is all overblown were the two people who could not believe that I would not vote for Roy Moore for senate.  (He is a extreme candidate who wanted to put gays in camps, get rid of Muslims, make Christianity a condition for elected office, was the worst student in his law class, was nearly fragged in Vietnam because he was such a lousy leader, was kicked of our state Supreme Court two different times, and was accused by women of having used his position as an assistant district attorney to molest them years ago)--they only vote on abortion.  In that election, I wrote in a candidate because, yes, I wasn't going to vote for a man who believed in partial birth abortions.  Then we had our legislature write a badly written law against abortion----I was against that too even though I am pro-life--- i didn't like our state wasting more than one million dollars on useless defense of a law that would definitely be overturned even by the US Supreme Court because it was poorly written and didn;t have the wording so that exceptions could be made.  They also didn't understand, why I, a person who abhors abortion, was okay with a judge ruling that a 10.5 year old girl who had been in the child 'welfare' system where she had been taken from both physical abuse and sexual abuse to a home where she also was sexually abused and then returned home to where mom's boyfriend raped her and got her pregnant.  In that case, the doctors were saying if she carried the baby to term, she was so young and not fully grown that there was a very high riskof internal injuries such that she could never have a baby in adulthood in a loving, healthy relationship.    It is black and white thinking- precautions are good, precautions are bad.  Medications are good, medications are bad.  and on and on and on.

[Farrar]

22 minutes ago, alewife said:

It is ridiculous that we are unable to test everyone that shows symptoms.  If the country had actual numbers for the under 18 age group, I bet many of our K-12 schools would be closed in an attempt to slow the spread.

 

In China, when they tested kids with symptoms, they showed it at much lower rates. However, when they tested all children, they found it was in rates about the same as the rest of the population. They're the one group that seems to be pretty asymptomatic. So you would have to test all the kids.

[TravelingChris]

15 hours ago, prairiewindmomma said:

Yeah, kinda feeling like Plaquenil is liquid gold right now. Have you been following the studies?!!

Yes.  And I also know that I am on a anti-TNF.  Now they have been using Actmera against COVID19 which is not a anti TNF but there are studies out there that Anti-TNf medications are good for SARS and MERS so if I or anyone one in my family is having a cytokine storm reaction and medical personal aren't available or aren;t treating correctly- I have it.  Two kinds actually because I never threw away my Humira and it is still sitting in my frig in case-- I thought in case I fail Cimzia- but heah. whatever works. 

I would not hesitate to give my youngest some Plaquenil anyway-  she needs to get her life insurance squared away before going to the rheumatologist again.  

[73349]

CDC: If you're sick, don't touch your pets!

My cat: *sits by her full dish and meows about Animal Neglect until I cave in and come pet her and sing "Soft Kitty" so she can eat*

#welltrainedpeople

Edited March 11, 2020 by whitehawk

[Carrie12345]

12 minutes ago, whitehawk said:

CDC: If you're sick, don't touch your pets!

My cat: *sits by her full dish and meows about Animal Neglect until I cave in and come pet her and sing "Soft Kitty" so she can eat*

#welltrainedpeople

They say animals can sense things before people. Is this why my jerk cat has been buttering me up lately? I thought he was done trying to kill me, but maybe he decided to play the long game.

Just forget it with my dog. My daughter practices attachment parenting with him. He’s ON her nearly every minute that she’s home.

[Guest]

12 hours ago, lewelma said:

Just had a heart attack. MIT has sent all students home effective Tuesday at noon. We live in NZ, so not a small bit of organizing to do. 

Are there any local friends he can stay with for a few weeks? I know of a few Vanderbilt international students who are staying with people I know rather than going home. I cannot imagine the logistics of a trip to NZ on short notice, and it's definitely a major financial burden on international students.

[73349]

12 minutes ago, dmmetler said:

Are there any local friends he can stay with for a few weeks? I know of a few Vanderbilt international students who are staying with people I know rather than going home. I cannot imagine the logistics of a trip to NZ on short notice, and it's definitely a major financial burden on international students.

Worth reaching out to New England-based alumni groups, even.

[*Jessica*]

I feel like this could be a really fantastic opportunity for a middle to high school level unit study on COVID-19.  We’re just getting over a cold (no fever, so not coronavirus! lol) and it is Spring break for our co-op so we’ve done very little school this week.  Instead of diving back in and doing our usual routine, I’m thinking that spending the rest of the week learning about different things that this coronavirus has brought to attention might be interesting.  Maybe I’ll start a new thread on the HS board.  

[Joker]

And just like that 3 cases in my county. Fortunately, we did a bit more stocking up last night since college boy will be home for the next three weeks so we plan on just staying in for now. Thankfully we can since dh already works from home. 

[Pen]

1 hour ago, Farrar said:

In China, when they tested kids with symptoms, they showed it at much lower rates. However, when they tested all children, they found it was in rates about the same as the rest of the population. They're the one group that seems to be pretty asymptomatic. So you would have to test all the kids.

 

I read somewhere iirc that the positives rate on testing was ~ same for kids on DP as the adult rate.  Seemed kids didn’t get severe illness if even any noticeable illness at all, but did contract the virus at equal rate to adults. 

[itsheresomewhere]

Just left Costco.  I got there when they opened and you would have thought it was a Saturday.  I looked down the aisle as I don’t need any but no paper towels or toilet paper.  The check out lines were to the back of the store. 

[Pen]

10 hours ago, Jean in Newcastle said:

I have a question:  can you estimate from Wuhan how long an outbreak might affect an area?  Ie. If Seattle truly has had the virus circulating for six weeks (or less time if you count from the first deaths) can people realistically extrapolate when we are “safe”?  

 

No.

It depends on too many factors.

Many of them outside of Seattle area’s control. 

[Pen]

Just now, itsheresomewhere said:

Just left Costco.  I got there when they opened and you would have thought it was a Saturday.  I looked down the aisle as I don’t need any but no paper towels or toilet paper.  The check out lines were to the back of the store. 

 

I’ll be going into city today, not to a Costco type place, but I will pass a Walmart and plan to take a look at whether parking lot looks similar to usual fullness.  Someone I know elsewhere said her supermarket was much more empty of people than usual. She speculated that people were already stocked up per cdc recommendations and not shopping. 

[itsheresomewhere]

3 minutes ago, Pen said:

 

I’ll be going into city today, not to a Costco type place, but I will pass a Walmart and plan to take a look at whether parking lot looks similar to usual fullness.  Someone I know elsewhere said her supermarket was much more empty of people than usual. She speculated that people were already stocked up per cdc recommendations and not shopping. 

There is a rumor that the next town over will close the schools on Monday ( huge district).  And that the other town has a potential case.  All that combined with everything else,  just made it worse. 

[Arcadia]

https://fortune.com/2020/03/10/gilead-coronavirus-treatment-remdesivir-being-used-washington-cdc/

“Gilead’s experimental drug remdesivir has been touted by public health officials at the Centers for Disease Control (CDC) and the World Health Organization (WHO) as one of the most—if not the most—promising antivirals to fight the new coronavirus strain.

CDC director Robert Redfield added to the buzz on Tuesday, stating that that Gilead’s pathogen-fighting COVID-19 treatment is already being deployed in Washington state, where the virus had claimed nearly two dozen lives as of Monday.

Redfield, during Congressional testimony before a House of Representatives committee regarding the CDC’s budget and spending priorities in the wake of the coronavirus outbreak, said that “remdesivir is available right now on compassionate use,” in Washington. Preliminary results for the treatment’s effectiveness will likely become clearer in mere months, according to Redfield.

Compassionate use is an analogue of the Food and Drug Administration’s expanded access program, which speeds up access to treatments that haven’t received marketing approval to patients who may direly need them—especially in emergency situations.

That could include a patient who has “a serious disease or condition, or whose life is immediately threatened by their disease or condition,” according to the FDA. It appears that coronavirus cases, at least in hard-hit regions, clear that standard.

But Gilead’s therapy has rapidly progressed through the clinical trial process in the midst of the COVID-19 crisis. It’s already being used in human clinical trials in the U.S. on top of later-stage studies in other nations that are being affected by coronavirus.

Washington’s public health department and Gilead have not yet responded to Fortune‘s multiple requests for comment about how remdesivir is being used in the state.”

[Pen]

13 hours ago, lewelma said:

Just had a heart attack. MIT has sent all students home effective Tuesday at noon. We live in NZ, so not a small bit of organizing to do. 

 

Many universities I read about were giving international students extra time to make arrangements, or even keeping dorms and eating halls open for students who could not get home. 

Maybe he could get permission to stay an extra week or two if needed to make travel arrangements?  

”

PERMISSION FOR UNDERGRADUATES TO REMAIN ON CAMPUS

We will consider limited exceptions to allow certain undergraduate students to remain on campus. However, to remain, you must receive official permission. Students will receive direct communications about this in a follow-up email.

”

Edited March 11, 2020 by Pen

[gardenmom5]

19 hours ago, Pawz4me said:

Yes. But there's always a group of people who feel the need to play "holier (or wiser) than thou" even when there's zero logic to doing so. Most of us should ignore them, IMO.

I think this is the same group that glom onto conspiracy theories so they can feel "smarter" than everyone else.  

I also think there is a group that when you get below the surface - are fearful of reality, and just want to go on and smell the roses (even if there aren't any).  so they ignore the skunks who've been spraying in the rose garden.  iow: they think it will go away/not exist if they ignore it.

[Carrie12345]

My hometown (small town) school district is getting their plans in order.  Kids already have school chrome books. The town has hotspots but are looking to add more for kids without internet access. They’re looking into delivering as many therapy services as possible online. They’re also looking into the legalities of having cafeteria workers come in to prepare meals to be delivered by district transportation for free/reduced lunch.

But they do say that they will not choose to close schools. If they’re closed, it’ll come from higher up.

[SeaConquest]

From all the data that I have seen, the U.S. is 10 days behind the disaster that is happening in Italy. Nine days now. At least Merkel is being honest with the Germans about what they will face; we are going to get creamed, IMO:

Chancellor Angela Merkel said on Wednesday that the coronavirus was likely to infect about two-thirds of the German population. “Given a virus for which there is no immunity and no immunization, we have to understand that many people will be infected, the consensus among experts is that 60 to 70 percent of the population will be infected,” she said.

 

[Pen]

2 hours ago, Kassia said:

 

I'd rather he didn't go but he's already exposed to so much.  He lives in Boston, is planning on going to Chicago next week (flying), then NYC the following week (by train), then Spain next month.  I'm hoping he'll change some (or all) of his plans but don't say much since he's an adult (29) and he's not going to listen to me.  His girlfriend lives with him and her job involves traveling all over Boston.  

 

It’s hard to know what future will bring.  You might want to briefly express your concern even though he won’t listen. Who knows, by next month Spain may be limiting travelers from USA to try to decrease how many Covid19 cases they get. 

[Pen]

6 minutes ago, SeaConquest said:

From all the data that I have seen, the U.S. is 10 days behind the disaster that is happening in Italy. Nine days now. At least Merkel is being honest with the Germans about what they will face; we are going to get creamed, IMO:

Chancellor Angela Merkel said on Wednesday that the coronavirus was likely to infect about two-thirds of the German population. “Given a virus for which there is no immunity and no immunization, we have to understand that many people will be infected, the consensus among experts is that 60 to 70 percent of the population will be infected,” she said.

 

 

Thanks. I ran out of likes already so quoting and thanking.

I think people are not understanding how fast a transmissible disease can multiply if behavior does not hugely change.    Well, maybe most on this thread are.  This is sort of the preaching to the choir thread in that regard.  Maybe the post would do more good on the no big deal thread. 

I wish people would make the changes voluntarily rather than being forced to by disaster. 

[Farrar]

15 minutes ago, SeaConquest said:

From all the data that I have seen, the U.S. is 10 days behind the disaster that is happening in Italy. Nine days now. At least Merkel is being honest with the Germans about what they will face; we are going to get creamed, IMO:

Chancellor Angela Merkel said on Wednesday that the coronavirus was likely to infect about two-thirds of the German population. “Given a virus for which there is no immunity and no immunization, we have to understand that many people will be infected, the consensus among experts is that 60 to 70 percent of the population will be infected,” she said.

 

A doctor friend had that same number. They're hearing the hospitals may be overwhelmed in that little time.

[Acadie]

A friend who is a family physician posted on FB this summary from an infectious disease symposium on 3/8/20 with doctors who have cared for COVID-19 patients in California. I was especially interested in #1, the description of the most common presentation of symptoms they've seen in their patients.

ETA: A few posters from PNW below have noted that doctors in their area are seeing some rapid onset cases, with healthy patients making a sudden downturn and needing acute care within an hour. I wanted to add this here so my post doesn't create the impression that there's only one possible progression for the disease.

For docs...
#COVID19

An ID doc with consensus info from an ID conference in California. Covid19

3/8/2020

Notes from the front lines:

I attended the Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7. In attendance were physicians from Santa Clara, San Francisco and Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence hospitals, who has 2 affected Seattle hospitals under his jurisdiction. Erin Epson, CDPH director of Hospital Acquired Infections, was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.

1. The most common presentation was one week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.

2. Co-infection rate with other respiratory viruses like Influenza or RSV is <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China.

3. So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.

4. Patients with underlying cardiopulmonary disease seem to progress with variable rates to ARDS and acute respiratory failure requiring BiPAP then intubation. There may be a component of cardiomyopathy from direct viral infection as well. Intubation is considered “source control” equal to patient wearing a mask, greatly diminishing transmission risk. BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs.

5. To date, patients with severe disease are most all (excepting those whose families didn’t sign consent) getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5 vs 10 days of Remdesivir) or the NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, but didn’t seem to be much benefit.

6. If our local lab ran out of test kits we could use Quest labs to test. Their test is 24-48 hour turn-around-time. Both Quest and ordering physician would be required to notify Public Health immediately with any positive results. Ordering physician would be responsible for coordinating with the Health Department regarding isolation.

7. At facilities that had significant numbers of exposed healthcare workers they did allow those with low and moderate risk exposures to return to work well before 14 days. Only HCW with highest risk exposures were excluded for almost the full 14 days (I think 9 days). After return to work, all wore surgical masks while at work until the 14 days period expired. All had temperature check and interview with employee health prior to start of work, also only until the end of the 14 days. Obviously, only asymptomatic individuals were allowed back.

8. Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort.

9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart.

10. All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines.

11. Some larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments.

12. Health Departments state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in the area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.

Feel free to share. All PUIs in the county so far have been negative.

Martha.

Martha L. Blum, MD, PhD

 

Edited March 11, 2020 by Acadie

[Pen]

1 hour ago, Pen said:

11 hours ago, Jean in Newcastle said:

I have a question:  can you estimate from Wuhan how long an outbreak might affect an area?  Ie. If Seattle truly has had the virus circulating for six weeks (or less time if you count from the first deaths) can people realistically extrapolate when we are “safe”?  

 

No.

It depends on too many factors.

Many of them outside of Seattle area’s control

 

Is what you are really asking when can you personally expect to be relatively safe?

Probably either when there have been enough people get illness and recover and have antibody resistance that it no longer is able to travel rapidly from person to person (the way epidemics probably have ended for most of history), Or when you can get a vaccination. 

This assumes that it isn’t doing a significant amount of biphasic emerge and go dormant sort of process. 

[mlktwins]

1 hour ago, itsheresomewhere said:

Just left Costco.  I got there when they opened and you would have thought it was a Saturday.  I looked down the aisle as I don’t need any but no paper towels or toilet paper.  The check out lines were to the back of the store. 

My DH went this morning to pick up some meat (for his parents).  He never even went in - said that was crazy.  Ours was parked up like it was Saturday too.  We only have a few known cases in our area and none in our county yet.

I stopped to get gas there this morning also.  It was hard getting out of the gas station section because of all the traffic in the parking lot.

 

[prairiewindmomma]

10 hours ago, Arcadia said:

https://www.nbcnews.com/business/business-news/educators-scramble-bring-classes-cloud-coronavirus-shuts-schools-n1154636

“Whether administered by the school or a private company, online lessons are only effective if you can access them. According to the most recent government data, only 61 percent of children ages 3 to 18 had internet access at home.

“In our rural communities, decent internet isn’t always an option,” said Jessica Brogley, who teaches education technology at the University of Wisconsin-Platteville. “We do have a wealth of digital tools for learning, collaborating and communicating, but if teachers and students don’t have access, their value is useless.”

While cell phones, tablets and gaming systems have created a generation of tech-savvy kids accustomed to using online platforms for learning within their classrooms, it’s unclear how effective cloud-based learning can be for younger students and those with special needs, who often interact with technology with the help of an aide or teacher.

“The independence, that’s tough,” said Brogley. A simple change in schedule from a structured setting may be difficult for children who lack the maturity or drive to learn mostly on their own, she added.

“It’s a lot to ask of kids, honestly.””

This......but I saw last night that Shoreline(?) school district in WA had opened up childcare facilities for school children and meal pickups for those in this situation while allowing those with the resources to care for their own children to keep them safe and educated at home.  It seemed like a balanced and nouanced approach. 

[Amira]

My children aren’t technically international students in the US, but since our family doesn’t live in the US, I’m very glad they’re not living in dorms in college.  It never even occurred to me before this that dorms could be closed and students sent “home.” Sometimes there’s not a home to go to.

[Pen]

3 minutes ago, Acadie said:

A friend who is a family physician posted on FB this summary from an infectious disease conference in California on 3/8/20. The most helpful part to me was #1, the description of the common presentation of symptoms.

For docs...
#COVID19

An ID doc with consensus info from an ID conference in California. Covid19

3/8/2020

Notes from the front lines:

I attended the Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7. In attendance were physicians from Santa Clara, San Francisco and Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence hospitals, who has 2 affected Seattle hospitals under his jurisdiction. Erin Epson, CDPH director of Hospital Acquired Infections, was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.

1. The most common presentation was one week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.

2. Co-infection rate with other respiratory viruses like Influenza or RSV is <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China.

3. So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.

4. Patients with underlying cardiopulmonary disease seem to progress with variable rates to ARDS and acute respiratory failure requiring BiPAP then intubation. There may be a component of cardiomyopathy from direct viral infection as well. Intubation is considered “source control” equal to patient wearing a mask, greatly diminishing transmission risk. BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs.

5. To date, patients with severe disease are most all (excepting those whose families didn’t sign consent) getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5 vs 10 days of Remdesivir) or the NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, but didn’t seem to be much benefit.

6. If our local lab ran out of test kits we could use Quest labs to test. Their test is 24-48 hour turn-around-time. Both Quest and ordering physician would be required to notify Public Health immediately with any positive results. Ordering physician would be responsible for coordinating with the Health Department regarding isolation.

7. At facilities that had significant numbers of exposed healthcare workers they did allow those with low and moderate risk exposures to return to work well before 14 days. Only HCW with highest risk exposures were excluded for almost the full 14 days (I think 9 days). After return to work, all wore surgical masks while at work until the 14 days period expired. All had temperature check and interview with employee health prior to start of work, also only until the end of the 14 days. Obviously, only asymptomatic individuals were allowed back.

8. Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort.

9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart.

10. All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines.

11. Some larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments.

12. Health Departments state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in the area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.

Feel free to share. All PUIs in the county so far have been negative.

Martha.

Martha L. Blum, MD, PhD

 

 

That’s good thanks.

also keep in mind that some cases seem to be having acute rapid onset 

and some present with different symptoms 

at lest in other countries 

usa wont test unless travel fits protocols or unless known contact or unless symptoms fit the expectation ... so we get a circular situation of not knowing if we too have cases with different onset or symptoms because they aren’t tested.  

It is very dangerous for health care workers imo.

[Sneezyone]

5 minutes ago, prairiewindmomma said:

 

https://www.nbcnews.com/business/business-news/educators-scramble-bring-classes-cloud-coronavirus-shuts-schools-n1154636

“Whether administered by the school or a private company, online lessons are only effective if you can access them. According to the most recent government data, only 61 percent of children ages 3 to 18 had internet access at home.

 

 

This is, in part (cost reduction was a mother major factor) why I worked so freaking hard to get K-12 Arkansas public schools/students connected to ARE-ON. Profits>people. It's so frustrating!

[mlktwins]

I'm on a FB crafting group and one of the ladies on there lives in Rome.  Her nonna tested positive and is in the hospital and her family is in isolation.  I can't even imagine, but like @SeaConquest said above, I also think we are not far behind Italy at all.  Many of us will be facing these same conditions :-(.

 

[prairiewindmomma]

Two school districts ago (move-wise, for us), every kid was issued a laptop or iPad--depending on age--, and if you didn't have access to the internet, they would issue a hotspot. It was pretty much 100% connectivity.

In our current district, they don't even have enough chrome books for the kids in the classroom to use.  They moved to internet based science texts, but they have to share 3 kids/chromebook.  Could they make it work? Yes, but I think they'd have to end up doing a dual approach like shoreline.  They don't have enough imagination or will to make it happen.

[Pen]

17 minutes ago, prairiewindmomma said:

This......but I saw last night that Shoreline(?) school district in WA had opened up childcare facilities for school children and meal pickups for those in this situation while allowing those with the resources to care for their own children to keep them safe and educated at home.  It seemed like a balanced and nouanced approach. 

 

Good.  

I wish more places would start adopting this.

I hope Oregon is getting prepared to, not just crossing fingers that it will go away by itself.

[gardenmom5]

19 minutes ago, Acadie said:

A friend who is a family physician posted on FB this summary from an infectious disease symposium on 3/8/20 with doctors who have cared for COVID-19 patients in California. I was especially interested in #1, the description of the most common presentation of symptoms they've seen in their patients.

For docs...
#COVID19

An ID doc with consensus info from an ID conference in California. Covid19

3/8/2020

Notes from the front lines:

I attended the Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7. In attendance were physicians from Santa Clara, San Francisco and Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence hospitals, who has 2 affected Seattle hospitals under his jurisdiction. Erin Epson, CDPH director of Hospital Acquired Infections, was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.

1. The most common presentation was one week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.

2. Co-infection rate with other respiratory viruses like Influenza or RSV is <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China.

3. So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.

4. Patients with underlying cardiopulmonary disease seem to progress with variable rates to ARDS and acute respiratory failure requiring BiPAP then intubation. There may be a component of cardiomyopathy from direct viral infection as well. Intubation is considered “source control” equal to patient wearing a mask, greatly diminishing transmission risk. BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs.

5. To date, patients with severe disease are most all (excepting those whose families didn’t sign consent) getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5 vs 10 days of Remdesivir) or the NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, but didn’t seem to be much benefit.

6. If our local lab ran out of test kits we could use Quest labs to test. Their test is 24-48 hour turn-around-time. Both Quest and ordering physician would be required to notify Public Health immediately with any positive results. Ordering physician would be responsible for coordinating with the Health Department regarding isolation.

7. At facilities that had significant numbers of exposed healthcare workers they did allow those with low and moderate risk exposures to return to work well before 14 days. Only HCW with highest risk exposures were excluded for almost the full 14 days (I think 9 days). After return to work, all wore surgical masks while at work until the 14 days period expired. All had temperature check and interview with employee health prior to start of work, also only until the end of the 14 days. Obviously, only asymptomatic individuals were allowed back.

8. Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort.

9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart.

10. All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines.

11. Some larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments.

12. Health Departments state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in the area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.

Feel free to share. All PUIs in the county so far have been negative.

Martha.

Martha L. Blum, MD, PhD

 

we had a local dr treating nursing home patients. - he's scared.  he said it wasn't unusual for a patient to be healthy - and within AN HOUR, to develop acute symptoms and require hospitalization. 

I've also seen a published plea by one dr treating patients begging people to take this seriously.  he has a 40 year old patient with NO underlying health problems in ICU right now.   

[YaelAldrich]

FINALLY, my husband's university is going online as of tomorrow.  All of the major colleges and unis in Boston/MA have gone online.  We surmise it was because Northeastern has a very high number of international students.  NEU is NOT making students leave the dorms.

 

[Sneezyone]

7 minutes ago, prairiewindmomma said:

Two school districts ago (move-wise, for us), every kid was issued a laptop or iPad--depending on age--, and if you didn't have access to the internet, they would issue a hotspot. It was pretty much 100% connectivity.

In our current district, they don't even have enough chrome books for the kids in the classroom to use.  They moved to internet based science texts, but they have to share 3 kids/chromebook.  Could they make it work? Yes, but I think they'd have to end up doing a dual approach like shoreline.  They don't have enough imagination or will to make it happen.

 

Our current district is preparing for 1-1 devices but the capacity to do this sort of thing is why we moved here. I don't think this is commonly available and it will be a problem. In China, kids in the cities started online classes over a month ago. In the last week, rural students began getting access.