Covid19 - clinical / epidemiological thread

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our public hospitals will be cancelling elective surgery soon enough, but are actually ramping up to get urgent electives done before the pandemic hits.
our private hospitals at present are continuing unchanged at present - but soon enough they'll have no choice but to stop surgery. I expect the public system will pay to use their facilities to help with the pandemic.

all employees of course get paid sick leave, which will be important in getting people to self isolate
 
hankbb02 said:
This is a very important issue that isn't being discussed at all. The only solution I see is if the federal government steps in to fiscally support the hospitals.
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Our hospital keeps at least 150 days of expenses on hand...there are some with a lot more, including many of the large non profit chains. That should keep them making good on their obligations for a while. Meanwhile all capital expenditures will be delayed.
Our PP partner group will tighten belts and rely on savings. Our employees get paid first, that is what being a partner means.
It does massively suck though, we will likely need a loan to make payroll.
 
Looking at this from the personal viewpoint, not the practice viewpoint...

I typically do not keep a significant amount of cash in the bank. I prefer to have my money either spent, or doing work for me. Being said, a combination of market conditions, recent locums work, a larger than expected tax return (thanks Trump), and money saved for first quarter estimated taxes, leave me with around 3 to 4 months wages worth of cash right now.

I maintain 1/3 of my home value in a HELOC, specifically for emergencies like this. Access to that is as simple as walking in and making a withdrawal. If you have some equity built up in your home, this is a great time to look into securing a HELOC. Rates are insanely low.

I am planning to significantly reduce my estimated quartely tax payments for April and June, and pay whatever penalties I need to next year. My income is always significantly higher in the last few months of the year, so I already make massively asymmetric estimated payments anyway.

If you haven't looked into the mechanism and penalties for tapping into your 401K/IRA, now is the time to do it. It's the last place you want to be pulling funds from, but for many of us it is the largest account we have.

I suspect the Gov is going to suspend or reduce penalties for reduced quarterly estimated tax payments and 401K/IRA disbursements, but obviously there is no way of knowing for sure.

I also maintain 6 months of wages worth of available credit card space. I never carry a balance on them, but I could tap into that in an emergency.

Any other ideas for emergency funds?
 
What are people’s thoughts on domestic travel at this point? Nervous to fly?
 
I'm headed to Maui on Tuesday. My biggest fear is getting quarantined there for 2 weeks, then quarantined here for 2 weeks, making it 6 weeks of no work.

I'll be paying close attention to the reports out of Hawaii this weekend, and may bail.
 
periopdoc said:
I'm headed to Maui on Tuesday. My biggest fear is getting quarantined there for 2 weeks, then quarantined here for 2 weeks, making it 6 weeks of no work.

I'll be paying close attention to the reports out of Hawaii this weekend, and may bail.
Click to expand...

Ya have a trip planned next weekend to Colorado. Im not nervous to travel per se but man this country is going crazy right now and i wouldnt be surprised if we are on full lockdown by next week.
 
kmurp said:
We are likely going to have to go the line of credit way by next month. Don't know what we do after that's tapped out. I imagine our CRNAs will want to get paid. Our hospital is already on the edge so that could also be an issue.
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Aren't a lot of options for something like this.

-Mandate people take vacation or unpaid leave. May violate employment law or your contracts.
-Use A/Rs to make payroll for the employees.
-Borrow on a line of credit.
-Fire employees.
-Default.
-Go to the hospital and ask for financial relief or they won't have anesthesia when crisis is done. (chortle)
-One of the times in life where it may be better to be an employee than an owner.
 
www.linkedin.com

Notes from UCSF Expert panel - March 10

University of California, San Francisco BioHub Panel on COVID-19 March 10, 2020 Panelists Joe DeRisi: UCSF’s top infectious disease researcher. Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford).
www.linkedin.com www.linkedin.com
Notes from University of California, San Francisco BioHub Panel on COVID-19

March 10, 2020

  • Panelists
  • Joe DeRisi: UCSF’s top infectious disease researcher. Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford). Co-inventor of the chip used in SARS epidemic.
  • Emily Crawford: COVID task force director. Focused on diagnostics
  • Cristina Tato: Rapid Response Director. Immunologist.
  • Patrick Ayescue: Leading outbreak response and surveillance. Epidemiologist.
  • Chaz Langelier: UCSF Infectious Disease doc

  • Top takeaways
  • At this point, we are past containment. Containment is basically futile. Our containment efforts won’t reduce the number who get infected in the US.
  • Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed.
  • How many in the community already have the virus? No one knows.
  • We are moving from containment to care.
  • We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different.
  • 40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.
  • [We used their numbers to work out a guesstimate of deaths— indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flu’s average of 50K Americans per year. Assume 50% of US population, that’s 160M people infected. With 1% mortality rate that's 1.6M Americans die over the next 12-18 months.]
  • The fatality rate is in the range of 10X flu.
  • This assumes no drug is found effective and made available.
  • The death rate varies hugely by age. Over age 80 the mortality rate could be 10-15%. [See chart by age Signe found online, attached at bottom.]
  • Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did
  • I can only tell you two things definitively. Definitively it’s going to get worse before it gets better. And we'll be dealing with this for the next year at least. Our lives are going to look different for the next year.
  • What should we do now? What are you doing for your family?
  • Appears one can be infectious before being symptomatic. We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).
  • ...................
 
hankbb02 said:
This is a very important issue that isn't being discussed at all. The only solution I see is if the federal government steps in to fiscally support the hospitals.
Click to expand...

state governments will have a role in supporting hospitals in their state. It isn't just a federal issue.
 
Has there been any explanation as to why US government refused the WHO testing kits? Why did we insist on creating our own?

Are your hospitals/clinics ramping up testing yet? It seems like things are slowly picking up here, but got another update that one lab said it could take up to 6 days for results :/
 
AMEHigh said:
Has there been any explanation as to why US government refused the WHO testing kits? Why did we insist on creating our own?
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Why do we do everything different than the rest of the world (think miles vs meters), even disrespect world organizations, and are proud of it? Why did we elect a president who emphasized that?
 
FFP said:
Why do we do everything different than the rest of the world (think miles vs meters), even disrespect world organizations, and are proud of it? Why did we elect a president who emphasized that?
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You're correct. Not sure why I was looking for a logical answer :/ especially since he called this a hoax and being made political 2 weeks ago.
 
This is just a deep state conspiracy to eliminate all our excess Boomers.
 
AMEHigh said:
Has there been any explanation as to why US government refused the WHO testing kits? Why did we insist on creating our own?

Are your hospitals/clinics ramping up testing yet? It seems like things are slowly picking up here, but got another update that one lab said it could take up to 6 days for results :/
Click to expand...

Because we are the best!

CDC early PCR primers can dimerize and form hairpins. Great, everyone is negative.


Sent from my iPhone using Tapatalk
 
narcotics999 said:
Except that the majority of the rich and powerful are boomers.

Why would they do it?


Sent from my iPhone using Tapatalk
Click to expand...

Because they’ve already self isolated on their private tropical islands with stockpiles of remdesivir.

Now if you’ll please excuse me, I need to go add another layer to my tinfoil hat.
 
periopdoc said:
How do we know its a 12%/3% rate? They won't even start doing anything resembling adequate screening until next week. We simply have no denominator for this disease.,
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We can extrapolate from 145k who have been infected worldwide. We don’t need to wait another week and let it spread exponentially.
 
Not sure Trump wants to lose 200,000 Boomer votes. Maybe they can mail in their votes early.... (tactless)
marr65 said:
We can extrapolate from 145k who have been infected worldwide. We don’t need to wait another week and let it spread exponentially.
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or extrapolate from Italian data: 10k infected/roughly 1k mortality . Italian experience is more deadly for unclear reasons .
 
It’s win-win for Trump at this point. If the virus is contained and the effects are minimal then he looks like a hero. If the virus spreads and we lose control of it then he “postpones” the election.
 
10KHertz said:
or extrapolate from Italian data: 10k infected/roughly 1k mortality . Italian experience is more deadly for unclear reasons .
Click to expand...

They have the same problem with establishing prevalence, the denominator, as we do. Not as big of a problem, but a problem nonetheless.

Unless this thing becomes a persistent bug, ala influenza, we will likely never know the true mortality rate.

In all likelihood, the prevalence last month was at least 10 times as high as the official, contemporaneous estimates.
 
periopdoc said:
They have the same problem with establishing prevalence, the denominator, as we do. Not as big of a problem, but a problem nonetheless.

Unless this thing becomes a persistent bug, ala influenza, we will likely never know the true mortality rate.

In all likelihood, the prevalence last month was at least 10 times as high as the official, contemporaneous estimates.
Click to expand...
Ohio estimates 100k undiagnosed cases, Russia has 45(Ukraine 3!). Italy is probably the truest prevalence data thus far.

Like I said before the communist know how to create viruses and cure them at the same time...
 
10KHertz said:
Like I said before the communist know how to create viruses and cure them at the same time...
Click to expand...
That's because the communists lie, according to their PR needs, Who does that remind me of...?

tl;dr: I wouldn't believe any number coming out of China, not until the trend is confirmed by a democracy.
 
I (unfortunately) listened to trump's speech today. He went on and on about how google is about to roll out a website where anyone can go to find out if they should be tested and then will be able to go get tested. He literally said it'd be up and running faster than any website in the past...whatever that means. Well apparently that is not true and google is very confused by his HUGELY announcement.
This is just horrific....and embarrassing and scary. Thankfully I don't know any vocal trump supporters, but if I did I would seriously cut them out of my life because voting for him is not ok.

www.wired.com

Trump Surprised Google With a Bogus Coronavirus Site Claim

Google's not making a nationwide coronavirus testing website. And the company had no idea the president would say it was.
www.wired.com www.wired.com
 
FFP said:
This is the coronavirus math that has experts so worried: Running out of ventilators, hospital beds
Click to expand...

exactly

this is the problem - I'm sure I'm not telling you something you don't understand

the BEST data is the South Korea data - CFR is going to end up being lower than 3%

too many people are running around thinking about only their personal risk and missing the whole ****ing point

the problem is obviously, if anyone cares to do some math and apply the statistics to an unprotected population - even the "small percentage" equals a LARGE relative to resources absolute number of people sick people. Too many people who need a hospital or ICU at any given time based on everyone being sick at the relatively SAME time - we lack the magic trees that these beds, and ventilators, and nurses, and RT's, and intensivists grow on to match the demand - where I work we are THOUSANDS of beds short PER MONTH assuming unrestricted spread.

this is sobering

The Italians, good bless them, are fighting the ****ing Alamo right now
 
I apologize if this isn't the best place for this question

Has there been any data on how this affects asthmatics? I haven't been able to find any. I'm just a lowly premed applying to med school in June, but I've been reading about this virus a lot. I'm in my mid 20's with mild asthma that's well controlled by symbicort. I live at 9,000 feet and work at 12,000 feet (I'm a ski patroller) so I'm in good health.

On the other hand my mom is in her late 50's, BMI ~45, with severe asthma problems (was just in the ICU a month ago). Im guessing it wouldn't be good if she got it.
 
Maybedoc1 said:
I apologize if this isn't the best place for this question

Has there been any data on how this affects asthmatics? I haven't been able to find any. I'm just a lowly premed applying to med school in June, but I've been reading about this virus a lot. I'm in my mid 20's with mild asthma that's well controlled by symbicort. I live at 9,000 feet and work at 12,000 feet (I'm a ski patroller) so I'm in good health.

On the other hand my mom is in her late 50's, BMI ~45, with severe asthma problems (was just in the ICU a month ago). Im guessing it wouldn't be good if she got it.
Click to expand...

No specific data I've seen on *asthmatics* - "chronic lung disease" (very loosely defined) are at increased risk mortality.

This is one of the frustrating things about the available data, it's needs to be wide open and out there, available for anyone to sift through, and while we cannot have high expectations that certain other countries will be willing or forthcoming on this, in our country we can and should have a database - pass a HIPAA amending protecting some identifiable health information but otherwise allowing clinicians to enter age, comorbidities, and notes not the case (vent, pressor, renal failure, etc)
 
dchz said:
I am from China, my parents were physicians in China. I lived inside the Court yard of a hospital until I was 11. Nothing over there is "advanced care". LOL

Wuhan, hubei isn't a very affluent province either. Wonder what the mortality rate is in Beijing or Shanghai? Their equipment/setup is more comparable to the US.



This part is scary.
Click to expand...


www.nytimes.com

Two Women Fell Sick From the Coronavirus. One Survived. (Published 2020)

The young medical professionals came down with fevers. Within weeks, they were both lying in hospital beds, hooked up to IVs or oxygen machines.
www.nytimes.com www.nytimes.com


Another account out of China. Rapid deterioration after some hopeful signs of improvement, cardiac arrest, ECMO, MOF, death.
 

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Maybedoc1 said:
I apologize if this isn't the best place for this question

Has there been any data on how this affects asthmatics? I haven't been able to find any. I'm just a lowly premed applying to med school in June, but I've been reading about this virus a lot. I'm in my mid 20's with mild asthma that's well controlled by symbicort. I live at 9,000 feet and work at 12,000 feet (I'm a ski patroller) so I'm in good health.

On the other hand my mom is in her late 50's, BMI ~45, with severe asthma problems (was just in the ICU a month ago). Im guessing it wouldn't be good if she got it.
Click to expand...
If I were to guess, you may end up hospitalized, she has a good chance of getting intubated and possibly dying.

It's essential that you both isolate. As far as we know, steroids (even inhalational) seem to worsen outcomes in this disease, hence the need for other bronchodilators once you test positive. Do contact your doctors for advice as soon as you suspect an infection with Covid-19. Neither of you is healthy as far as this disease is concerned.
 
FFP said:
It's coming. In less than a month.
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Yes. I have had a few anxiety dreams about it.

Grinds my gears when my neighbors act like this is all some big “Democrat conspiracy” to make the president look bad. What is wrong with people? This virus is going to effect everyone in a big way even though it likely won’t make most of them sicker than the usual cold if they get it.
 
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Beach bum said:
Why do you say ”no denominator”? Numerator is what is truly missing....
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(death rate) = dead / infected

Or to put it another way it's (death rate) = dead / (recovered + dead)

But that's retrospective math.


It's easy to count the dead. That's the numerator.

It's hard to count the number of infected. That's the deominator.

Because of things like
- number of people tested
- presumed but not lab-proven diagnoses
- non-transparent governments fudging the numbers
- mild cases that never have symptoms
it's essentially impossible to know for sure what the denominator really is.
 
pgg said:
It's easy to count the dead. That's the numerator.

It's hard to count the number of infected. That's the deominator.
Click to expand...

yep, that’s my thought too.
i’ll base my investment decisions based on declining death rates ... assuming i stay well
 
The declining death rate is nothing more than a statistical anomoly, at this point. The death rate is "declining" because we are testing more people and finding more infections than we realized. The denominator is expanding.

Even if we are losing against the virus over the next two weeks, the mortality rate will continue to drop due to expanded testing.

We probably can't make an accurate estimate of the US death rate for another 2 to 3 months.
 
Report today (country wide) is that we have 4 deaths: 1 70+ y/o 2 80+ and 1 90y/o
At the moment 24 patients are in the ICU and 22 on the vent.
Switzerland is shutting down it's ski area ( 😡 i was planning on going) they've had 7 deaths for 1000 proven cases.
France about 80 deaths for 3600 cases
Spain 136 deaths for 5753 cases
 
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