Covid19 - clinical / epidemiological thread

Started by deleted59964
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I posted this over in the critical care forum (along with some other links) but given this thread is much larger, thought it might be of interest to the group here as well. Moderators please feel free to delete if it's considered a violation of cross posting and my apologies in that case. Also if someone already posted it in this thread. For everyone not familiar, medRxiv is not peer reviewed so this along with all other articles there, are first drafts people are submitting to journals. It often has a lot of very new, very relevant research.

Epidemiological, Clinical Characteristics and Outcome of Medical Staff Infected with COVID-19 in Wuhan, China: A Retrospective Case Series Analysis
www.medrxiv.org

Epidemiological, Clinical Characteristics and Outcome of Medical Staff Infected with COVID-19 in Wuhan, China: A Retrospective Case Series Analysis

Backgrounds Since December 2019, a novel coronavirus epidemic has emerged in Wuhan city, China and then rapidly spread to other areas. As of 20 Feb 2020, a total of 2,055 medical staff confirmed with coronavirus disease 2019 (COVID-19) caused by SARS-Cov-2 in China had been reported. We sought...
www.medrxiv.org www.medrxiv.org
 
FFP said:
A factor of 1.2-1.3x/day. Will get higher when we start testing. That's about 4000x or more in a month.

Damn those idiots who can't keep their butts at home!
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Bars in Chicago and NYC were reportedly crowded/packed last night.

It's like watching the beginning of a horror movie, with the usual start involving kids drinking and fooling around... except that this happens to be real life.
 
67552931811 said:
Well, that isn't terrifying...
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I say that we are actually much worse than the Italians. If you were to assume that our population density is much less
than the Italians and we don’t kiss/hug as much socially, our number should be much less. So, if this virus goes exponential it’s going to be bad.
 
Going off on my previous post, our population density and geographic vastness did help us isolate the very first person to carry Covid 19. Based on the genomic analysis done in Washington state, it was said to be 6 weeks before community spread, that meant the first virus in order to spread had to overcome how spread out people were and that took six weeks. We had an opportunity to contain this bad boy if we had earlier testing and strict quarantine of those who have contracted it.
 
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I’m am skeptical of the assertion that the severity of illness in Italy is due to aged Italian smokers, and that this is somehow reassuring in the context of the vibrant health of the average American. I mean, they may be old, probably smoked, and the air quality in Milan is crap, but the risk factors for severe disease reads like the problem list of at least 50% of my patients.
 
Beach bum said:
At a minimum there are filters that should be used.
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Sure, but it's something I hadn't thought about yet. I have looked around and found information for the Ambu KingFlex2 circuits that we use at my place which come with the filters. Here's the data for anyone that might be interested. Of course they won't have the data for COVID-19 but I think for anyone that uses these same circuits you can feel fairly comfortable.

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DocVapor said:
Sure, but it's something I hadn't thought about yet. I have looked around and found information for the Ambu KingFlex2 circuits that we use at my place which come with the filters. Here's the data for anyone that might be interested. Of course they won't have the data for COVID-19 but I think for anyone that uses these same circuits you can feel fairly comfortable.

View attachment 298640
Click to expand...

We have the covidien puritan bennett 980 serious ventilators in the ICUs.

I have confirmed that the filter size is 0.3 microns @ 30L/min of flow, which is the same size as the N95 mask if worn properly.

Many sources consider intubation and mechanical vent with ventilator source control. Just make sure the filter is working properly.
 
SurfingDoctor said:
‎Pediatrica intensiva: Italian COVID19 experience on Apple Podcasts

Experience of two ICU physicians out of Italy. Sorry there is a slight pediatric slant, but considering they turned the whole hospital into an isolation unit...

I mean, they have infectious disease physicians managing non-invasive ventilation due to staffing.
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Excellent podcast.

Holy crap, it's a war zone! And they did point out that it's one of the richest areas in Italy/Europe, with excellent healthcare.
 
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any plans for what to do when PPE N95 masks run out for intubation?
someone posted that has happened already in Italy.

there are N95 industrial respirators used in industries like spray painting ... but since they’re not disposable you need to think through how you’d use one.
 
kmurp said:
It’s concerning that ORs are positive pressure. How do staff caring for ICU patients in ORs protect themselves?
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We have a policy already that any patient requiring a negative pressure room (TB, and now this) are to be intubated in our negative pressure rooms in pre-op or PACU or the ICU then transferred to the OR with an ambu bag and the appropriate virus filter on the oETT.

To transfer from AMBU to ventilator, give breath, clamp oETT, transfer, unclamp tube.

ICU patients may (and I've done this before on bad ARDS patients) be brought down with the ICU ventilator and kept on it while running a TIVA.
 
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JobsFan said:
any plans for what to do when PPE N95 masks run out for intubation?
someone posted that has happened already in Italy.

there are N95 industrial respirators used in industries like spray painting ... but since they’re not disposable you need to think through how you’d use one.
Click to expand...

Just ordered 200+ overseas. Plan to wear it under regular mask to avoid hospital backslash.


Sent from my iPhone using Tapatalk
 
vector2 said:
To get back on topic, we currently have 2 confirmed in our MICU:

One is age 60+. Other is 40+. Both had obesity, DM, HTN. Presented with low WBC ct and lymphocytopenia, mildly bumped LFTs. Rapidly progressive hypoxemia. ARDS picture on CXR. Deteriorated quickly and were intubated. Both proned, 100% Fi, high PEEP, paralysis, and requiring vasopressors. One is getting marginally better and is now supine. Other is still requiring proning trials. We currently are not using any experimental therapies.
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Any steroid use?
 
This is a nasty critter.

“more than 50% of people infected with SARS-CoV-2 have the virus in their stool; some patients have vomiting and diarrhea; and some test positive for virus in stool even after respiratory samples test negative for the pathogen.”

 
Looking at the data from the ill-fated cruise ship, 705 positive results out of 3511 passengers so 20% - and that’s on the confines of a Petri dish that is a cruise ship. Extrapolating out to the US population would mean 66 million infected which is hopefully worst case given current social distancing measures and the fact we don’t all live on the same boat.

While I think current precautions are warranted - I remain cautiously optimistic.
 
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What are people doing about self-quarantine? This time of year I am almost guaranteed to have a minor sore throat or slight cough that lasts a day or so...especially with a toddler at home. At what point do I self-quarantine? Is a fever the threshold or should I be more cautious? If my toddler develops a cough or fever, do I self-quarantine as well?
 
GravelRider said:
What are people doing about self-quarantine? This time of year I am almost guaranteed to have a minor sore throat or slight cough that lasts a day or so...especially with a toddler at home. At what point do I self-quarantine? Is a fever the threshold or should I be more cautious? If my toddler develops a cough or fever, do I self-quarantine as well?
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Your toddler will not have serious symptoms from coronavirus, most likely. So it's not a bad idea to spend less time with the kid in this period, especially if the kid is sick.

If I had symptoms, I would stay at home until I am not symptomatic anymore (separate room, dishes +/- bathroom), then get tested before going back to work. It's better to isolate now, while the sky is blue, then work while sick, makes other sick, too, and then the hurricane arrives.

Think about your patients. Above age 50, 60% of intubated Covid patients die. Unless one is a pediatric anesthesiologist, or one lacks a conscience, one shouldn't be cavalier about the potential risks of passing on Covid.
 
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SaltyDog said:
Looking at the data from the ill-fated cruise ship, 705 positive results out of 3511 passengers so 20% - and that’s on the confines of a Petri dish that is a cruise ship. Extrapolating out to the US population would mean 66 million infected which is hopefully worst case given current social distancing measures and the fact we don’t all live on the same boat.

While I think current precautions are warranted - I remain cautiously optimistic.
Click to expand...
Well, one upside to being on a cruise ship is that you can get off. Which is what happened to the people on the Diamond Princess, after a relatively short period of time. I have little doubt that if they'd stayed longer it'd have been 100%. We can't really disembark from the USA, we're here till COVID-19 says it's done.


My mother was on a cruise ship until yesterday, doing a 4 month around-the-world cruise. A month ago I told her I would get off, unless the only place I could get off was into a Chinese prison camp, because being 80 and confined on a ship full of old people out in the middle of the ocean, stopping off in port after port where 1000s of people of 50 or so nationalities got on and off, with the buffet being prepped by workers living 17 to a cabin in the nasty bowels of the ship, was a terrible place to be during an event like this. She was concerned but kept on keeping on, after all, this was early or mid February when we had the conversation. They cancelled a bunch of port calls (eight?) between India, Hong Kong, Singapore, etc on their way to Australia. She told me how pissed some of the other passengers were that they weren't stopping.

Yesterday the line abruptly threw everyone off the ship in Australia and offered them rooms in a hotel and plane tickets back to London. Can't make this stuff up.
 
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