What do I need to know about coronavirus?

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The Las Vegas strip has been shut down for the first time ever. Casinos are closing today, and the largest operator, MGM resorts is shutting down everything as of tomorrow.

This is unprecedented.

So far we we have ~ 30 cases in the entire county (2 million people). We are now testing everyone walking through the door with even the mildest sniffle and it's getting worse. So far we really aren't seeing a lot of bad elderly respiratory cases. What will really break our system is having to do an EMTALA-mandated screening on the walking-worried who demand testing.

I wish we could just put a "GTFO nurse" to sit up front. She'd screen them and tell them to "GTFO".
I've changed my thinking on this. Those early and aggressive actions by the current administration and health care providers like you and I have saved 1,599,929 lives (1.6 million predicted potential deaths - 71 deaths). It is the greatest epidemiological success and most lives saved in our country's history. Keep doing what you're doing. It's working. It makes no sense to view it any other way. Start thinking this and start telling people this, immediately.
 
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You're looking at this all wrong. Those early and aggressive actions by the current administration and health care providers like you and I have saved 1,599,929 lives (1.6 million predicted potential deaths - 71 deaths). It is the greatest epidemiological success and most lives saved in our country's history. Keep doing what you're doing. It's working. It makes no sense to view it any other way. Start thinking this and start telling people this, immediately.

oh gawd

LOL

This thread is disintegrating
 
All kidding around if this turns out to not be as bad as people are speculating it to be, who gets the credit?? Is it the same guy that everybody is trying to throw under the bus at the top ?
 
oh gawd

LOL

This thread is disintegrating
I’m not joking. You think I am but I’m not. If the 1.6 million potential American deaths was taken seriously enough to trigger the current nationwide reaction, it should be taken seriously enough to count any number less than that as a success, and lives saved by all involved, including those that ordered the response, and those that carried it out. I’m 100% on board with this now. We need to keep doing what we’re doing because we’ve saved up to 1,599,929 lives so far. Let’s keep that number as high as possible. I’m dead serious. This is how I view it now. It makes no sense to view it any other way, including the way I was framing it earlier on in this thread.
 
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All kidding around if this turns out to not be as bad as people are speculating it to be, who gets the credit?? Is it the same guy that everybody is trying to throw under the bus at the top ?
I’m not joking even a little bit. The credit will go to those that ordered the response, all the way up to the top, and those who carried it out, including us health care workers and even the American people who complied. It’s the greatest success that we may ever have the chance to be a part of in our lifetimes. It makes no sense to view it any other way. The yardstick was set at “healthcare systems collapsing in 10 days like Italy” (which would be this Friday) and up to 1.6 million deaths. I no longer reject those estimates. I accept them whole heartedly and can’t prove they wouldn’t have happened without action. Therefore anything short if that is a success, by you, me, our healthcare workers, compliant citizens and those that ordered the response. By far, there is much more to be gained by viewing it this way, than any other. And I realize now, why those in charge framed it this way. From now on I’m counting the successes not the failures.

1,599,929 potential American lives saved, to date.
 
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This virus is different. It has the potential for great desolation, both economically and medically.

The figures regarding mortality rates being used in the media are not the right numbers in my opinion. Total infected includes those that have just been infected, but haven’t completed the course of illness. Many of these will die. More telling are the numbers of killed over patients with an outcome (killed plus recovered). These numbers are jaw dropping. look at the website worldometers.info/coronovirus

Coronavirus Update (Live): 181,310 Cases and 7,128 Deaths from COVID-19 Virus Outbreak - Worldometer

Looking at the numbers on Worldometers above, this number shows the mortality of 7.9 percent for those whose illness has completed its course (whether dead or survived). The total number infected and death graphs for the world are chilling.


total deaths world wide.png



That, my friends is wicked exponential growth. We also don’t know about morbidity, long-term lung damage, renal failure, etc. The mortality number very well may go up in the next year with lungs permanently damaged suffer from COPD, Fibrosis, and complications of chronic lung disease.

This is an interesting virus. The explanations of the numbers, don’t fit any model that I have heard described by epidemiologists. In China, there was clearly exponential growth, followed by brief linear, then a transition to logarithmic growth curve with a ceiling and a drastic reduction in new cases.

Total deaths china.png


Everywhere else is currently in exponential growth phase.

Daily new cases, Italy.png




The outcome statistic from Italy is very chilling: Cases which had an outcome: 4,144; Deaths:1,809 (44%)

That is a Death rate of 44 percent!

The number of serious cases is also sobering.

Why in the world is Italy getting hit harder than Iran? Northern Italy is one of the richest areas in all the world. Their medical care is equivalent to our medical care in technology. Hygiene and living conditions are much better in the North in my imperfect understanding.

The USA is in exponential growth phase. In cases which have an outcome, we have a death rate of 44%

We are in exponential growth phase.
Daily new cases US.png



Iran seems to be transitioning to a linear growth phase, likely to plateau like China did. The outcome for closed cases in Iran is only 16% compared to more modern countries. If the transmissibility of this virus were dependent on hygiene and the mortality were linked to the sophistication of the medical system, why is Iran lagging behind in growth of the disease and mortality, compared to Italy?

Why would a virus have an exponential growth phase and then transition to a logarithmic growth phase before infecting the entire nation?

Why would kids have a low prevalence and zero percent mortality?

Why are there sex differences with more men getting the virus and more of them dying from the illness?

This outbreak is breaking many of the rules of other viruses.


“The disease's death rate is highest among more elderly groups. The study this data comes from did not report any deaths in children younger than 10, who represented less than 1% of the patients studied.”

Some say that this virus is like Chicken Pox or Hepatitis A, which infects kids but doesn’t give them severe illness. This could be true, but those diseases tend to have very high prevalence in the population of children compared to adults. That isn’t the case with COVID-19. The kids are getting infected at relatively low rates. Not a single kid has died! That is unprecedented for most diseases! Although I think MERS and SARS had similar trends due to the fact that they are also Coronaviruses.

I have a theory. I openly admit I could be wrong. I theorize that kids are partially immune to this coronavirus. Why? Children are exposed to numerous colds every year. There are over ten different viruses that get swapped around by them every year. Let's say the average kid gets 7 URIs per year. On average, they are getting ill with a coronavirus every year or other year until the age of 10, when they stop eating boogers, and kind of figure out hygiene. As a result, the younger the kid, the more immunity they have to the coronavirus family. People who interact with lots of kids probably have similar immunity. This would explain why Northern Italy has terrible spread and outcomes. There are no kids. The more prosperous a nation, the fewer kids they have. The better the nation’s hygiene, the less coronaviruses they are exposed to every year. Could it be that the most prosperous cities on the planet will get devastated by a virus because they aren’t taking care of kids, children who are sharing their yearly colds? Could the exponential growth found in China have dropped off because only those adults that didn’t have exposure to children and children’s diseases were affected? The remaining population harbored a herd immunity? Could the relatively low prevalence in China have been caused by higher prevalences in the past of Coronavirus infections (SARS, MERS) that the population had been exposed to previously? This theory would explain the difference in sex distribution between men and women. Women are much more exposed to the diseases of childhood, due to the fact that they are more likely to interact with children, suspend careers while children are young and are often more likely involved in careers with pediatric exposure (nursing, elementary education). Could it be interacting with children gives us immunity?

Economically, this is the death knell for the stock market, which requires perpetual growth for solvency. Some would define a financial scheme that requires perpetual growth in order to not collapse a pyramid scheme. Basing the financial future of a country on a pyramid scheme was a bad idea.
 

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You think this virus is mutating to a less deadly form now? All the peeps who got the bad strain are dead, less deadly strain selected for to increase infection rate while decreasing death rate. Nature selects for this.
 
This virus is different. It has the potential for great desolation, both economically and medically.

The figures regarding mortality are not the right ones in my opinion. Total infected includes those that have just been infected, but haven’t completed the course of illness. Many of these will die. More importantly are the numbers of killed over killed plus recovered. These numbers are jaw dropping.

Coronavirus Update (Live): 181,310 Cases and 7,128 Deaths from COVID-19 Virus Outbreak - Worldometer

Looking at the numbers on Worldometers above, this number shows the mortality of 7.9 percent for those whose illness has completed its course (whether dead or survived). The total number infected and dead graphs for the world are chilling.


View attachment 298724


That, my friends is wicked exponential growth. We also don’t know about morbidity, long-term lung damage, renal failure, etc. The mortality number very well may go up in the next year as those whose lungs were permanently damaged suffer from COPD, Fibrosis, and complications of chronic lung disease.

Economically, this is the death knell for the stock market, which requires perpetual growth for solvency. Some would define a financial scheme that requires perpetual growth in order to not collapse a pyramid scheme. Basing the financial future of a country on a pyramid scheme was a bad idea.

This is an interesting virus. The explanations of the numbers, don’t fit any model that I have heard described by epidemiologists. In China, there was clearly exponential growth, followed by brief linear, then a transition to logarithmic growth curve with a ceiling, above which, infections seem to fail to exceed.

View attachment 298726

Everywhere else is currently in exponential growth phase.

View attachment 298727



The outcome statistic from Italy is very chilling: Cases which had an outcome: 4,144; Deaths:1,809 (44%)

That is a Death rate of 44 percent!

Why in the world is Italy getting hit harder than Iran? Northern Italy is one of the richest areas in all the world. By comparison, Southern Italy is poorer. Their medical care is equivalent to our medical care in technology. Hygiene and living conditions are much better in the North in my imperfect understanding.

The USA is in exponential growth phase. In cases which have an outcome, we have a death rate of 44%

We are in exponential growth phase.
View attachment 298728


Iran seems to be transitioning to a linear growth phase, likely to plateau like China did. The outcome for Closed cases in Iran is only 16% compared to more modern countries. If the transmissibility of this virus were dependent on hygiene and the mortality were linked to the sophistication of the medical system, why is Iran lagging behind in growth of the disease and mortality, compared to Italy?

Why would a virus have an exponential growth phase and then transition to a logarithmic growth phase before infecting the entire nation?

Why would kids have a low prevalence and zero percent mortality?

Why are there sex differences with more men getting the virus and more of them dying from the illness?

This outbreak is breaking many of the rules of other viruses.


“The disease's death rate is highest among more elderly groups. The study this data comes from did not report any deaths in children younger than 10, who represented less than 1% of the patients studied.”

Some say that this virus is like Chicken Pox or Hepatitis A, which infects kids but doesn’t give them severe illness. This could be true, but those diseases tend to have very high prevalence in the population of children compared to adults. That isn’t the case with COVID 19. The kids are getting infected at relatively low rates. Not a single kid has died! That is unprecedented for most diseases! Although I think MERS and SARS had similar trends due to the fact that they are also Coronaviruses.

I have a theory that I openly admit could be wrong. I theorize that kids are exposed to numerous colds every year. There are over ten different viruses that get swapped around by them every year. The average kid gets 7 URIs per year. On average, they are getting a Coronavirus every year or other year until the age of 10, when they stop eating boogers, and kind of figure out hygiene. As a result, the younger the kid, the more immunity they have to the coronavirus family. This would explain why Northern Italy has terrible spread and outcomes, there are no kids. The more prosperous a nation, the fewer kids they have. The better the nation’s hygiene, the less coronaviruses they are exposed to every year. Could it be that the most prosperous cities on the planet will get devastated by a virus because they aren’t taking care of kids who are feeding them yearly colds? Could the exponential growth found in China have dropped off because those adults that didn’t have exposure to children and children’s diseases were affected and the remaining population harbored a herd immunity? Could the relatively low prevalence in China have been caused by higher prevalences in the past of Coronavirus infections (SARS, MERS) that the population had been exposed to previously? This theory would explain the difference in sex distribution between men and women. Women are much more exposed to the diseases of childhood, due to the fact that they are more likely to suspend their careers while their children are young and they go into careers that are much more likely to have pediatric exposure (nursing, elementary education).
Agree
 
You think this virus is mutating to a less deadly form now? All the peeps who got the bad strain are dead, less deadly strain selected for to increase infection rate while decreasing death rate. Nature selects for this.
I think our aggressive action plan is decreasing the death rate.
 
Video laryngoscopes ought to be standard equipment in every emergency room. No need to get your face down in there for a view of the vocal cords when you can visualize them on a larger screen.

I am not sure you should have your face "down in there" with DL, either.

Joking aside, the best view with both DL and VL is often obtained with your eyes farther away from the patient's mouth then most learners of DL think. It's a trick that would be very beneficial to know when intubating contagious patients.

HH
 
I am not sure you should have your face "down in there" with DL, either.

Joking aside, the best view with both DL and VL is often obtained with your eyes farther away from the patient's mouth then most learners of DL think. It's a trick that would be very beneficial to know when intubating contagious patients.

HH
I was under the impression that this is a myth--driven by older people having changes in their refraction (similar to them needing reading glasses).
 
Also, could someone please show me the guidline where EMTALA requires that an MSE includes testing for CoV?

If you don't think we have sustained and widespread community spread in this country, you have your head in the sand. We need to get away from the idea of ED's a public health testing center, and quickly. That obviously begins with the government opening outside testing centers, but we need to act using the knowledge that viral testing is a epidemiological tool, not a clinical one.
 
I can only hope that the greybeard sellouts who surrendered the medical profession to corporate for a quick buck were heavy equities before this drop. May be the only good thing to come out of this pandemic.
 
I am not sure you should have your face "down in there" with DL, either.

Joking aside, the best view with both DL and VL is often obtained with your eyes farther away from the patient's mouth then most learners of DL think. It's a trick that would be very beneficial to know when intubating contagious patients.

HH

Yes...you should be this close when intubating...

endotracheal-intubation-procedure.jpg


This is probably too close

doctor-performing-tracheal-intubation-operating-room-51097485.jpg
 
50% of the ICU patients with COVID-19 in France are under 60.
 
what about in America? how many icu patients with covid 19 are under 60?

Do we know if infection and subsequent recovery with COVID-19 confers immunity?
 
I am not sure you should have your face "down in there" with DL, either.

Joking aside, the best view with both DL and VL is often obtained with your eyes farther away from the patient's mouth then most learners of DL think. It's a trick that would be very beneficial to know when intubating contagious patients.

HH

Use a glide, be 1.5-2 feet away from the mouth -_-
 
what about in America? how many icu patients with covid 19 are under 60?

Do we know if infection and subsequent recovery with COVID-19 confers immunity?

Unknown in the US. Similar stats in Italy.
They think so...not sure...RNA viruses mutate quickly.
 
Great, they cancelled SNL. Who's going to make toilet paper jokes now? Anyone catch their airport skit with 'profiled Asian'? that was gold.
 
I have a theory. I openly admit I could be wrong. I theorize that kids are partially immune to this coronavirus. Why? Children are exposed to numerous colds every year. There are over ten different viruses that get swapped around by them every year. Let's say the average kid gets 7 URIs per year. On average, they are getting ill with a coronavirus every year or other year until the age of 10, when they stop eating boogers, and kind of figure out hygiene. As a result, the younger the kid, the more immunity they have to the coronavirus family. People who interact with lots of kids probably have similar immunity. This would explain why Northern Italy has terrible spread and outcomes. There are no kids. The more prosperous a nation, the fewer kids they have. The better the nation’s hygiene, the less coronaviruses they are exposed to every year. Could it be that the most prosperous cities on the planet will get devastated by a virus because they aren’t taking care of kids, children who are sharing their yearly colds? Could the exponential growth found in China have dropped off because only those adults that didn’t have exposure to children and children’s diseases were affected? The remaining population harbored a herd immunity? Could the relatively low prevalence in China have been caused by higher prevalences in the past of Coronavirus infections (SARS, MERS) that the population had been exposed to previously? This theory would explain the difference in sex distribution between men and women. Women are much more exposed to the diseases of childhood, due to the fact that they are more likely to interact with children, suspend careers while children are young and are often more likely involved in careers with pediatric exposure (nursing, elementary education). Could it be interacting with children gives us immunity?

I understand some reasoning behind this theory but it doesn't explain the fact that there are probably tens of thousands of babies (<1yo) exposed to COVID in China and none of them got severely ill. It's likely some function of the immune system that becomes less effective as we get older...which is why we see a jump up in mortality around 50yo and then continues on a severely upward trend the older you get. Could also obviously be due to comorbidities but this offers a more consistent explanation for why basically no kids whatsoever have gotten seriously ill (even newborns!).

Regarding the stuff about China's growth curve...it's pretty easily explained? They literally locked down the whole region in a way that would never be possible in Western countries. If you have a fever, you go to a "fever clinic" where they come out to see you in full PPE, get a flu swab and CBC, if those are negative you immediately get a COVID test/CT scan, if that's positive you're put into quarantine and monitoring immediately (not home quarantine, like stay in the tent with other people with COVID quarantine). With that put in place for a few weeks, that cut down community transmission prettyyyyy quickly. We would have to ask ourselves, is that something we're willing to accept in America? I don't think it is (and personally, I'm not sure that's something I'd be willing to accept either except for the quick testing part...that would be great).
 
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anyone had any COVID airway disasters? two at my shop in the last week. tons of secretions, distorted landmarks. tough cases.
 
anyone had any COVID airway disasters? two at my shop in the last week. tons of secretions, distorted landmarks. tough cases.

Maybe it is time to retire. Or quit. Sigh. Palli is sounding good. @dchristismi ?
Anything but this. They haven't even suspended pt satisfaction bull**** at my job. Really? I may be out sooner than later.
 
Iran seems to be transitioning to a linear growth phase, likely to plateau like China did. The outcome for closed cases in Iran is only 16% compared to more modern countries. If the transmissibility of this virus were dependent on hygiene and the mortality were linked to the sophistication of the medical system, why is Iran lagging behind in growth of the disease and mortality, compared to Italy?

Dude... There are satellite photos of mass graves which the Iranians were digging the day they announced the first two deaths in Qom. Their numbers have no relations to reality.

Nor do the Chinese numbers, for that matter. At least the early ones.
 
anyone had any COVID airway disasters? two at my shop in the last week. tons of secretions, distorted landmarks. tough cases.

Tough secretions are surprising to me.

Landmarks distorted seems unlikely for COVID19.

Tough cases? Hell yes, I expect them...mostly because ARDS in the elderly is a bitch.

PEEP on my colleagues,

HH
 
What do you all know about private testing?

Our hospital is sending everything to the state lab and as we have limited testing kits, we are being advised to follow very strict guidelines before testing someone first.

Today I had a healthy, young dude come in looking like a peach with a cough and fevers at home. He didn’t meet criteria for testing. He said he was fine with it, but upon discharge raised hell (this has been my experience... most patients act nonchalant and like they didn’t even think of COVID-19, smile and nod and say the understand when I tell them why we are not testing, and then tell the nurse they need to speak with me because they want the test...after I’ve discharged them). I called our infection control specialist and she said the patient didn’t meet criteria. So after a long chat with the dude, he brought up LabCorp’s website as they just a few days ago started doing private COVID-19 testing and wanted to know why I wasn’t going that route. I didn’t know the answer so I left to do my research and during this time, the patient called his PCP who ordered the test. He then left the ER to go get swabbed in the parking lot by one of the PCP’s office staff...
 
People are free to go to labcorp on their own. ED staff have nothing to do with it. So if someone is getting pissy because they’re not getting tested, tell them to go to labcorp if they insist.


Sent from my iPhone using Tapatalk
 
We dont even test in the ED.

Also if you intubate someone from now on give atropine so you can decrease secretions
 
One of my collegues got chewed out because some “COVID hotline” told them that their daughter should get tested. Our ID folks said no. They threatened lawyers and such.

People don’t realize, even at a large institution, we don’t have the capability to test everyone. Trust me, I wish we could.
 
One of my collegues got chewed out because some “COVID hotline” told them that their daughter should get tested. Our ID folks said no. They threatened lawyers and such.

People don’t realize, even at a large institution, we don’t have the capability to test everyone. Trust me, I wish we could.

And this is why we will never have a working healthcare system in this country.

Americans simply cannot handle being told no.
 
What do you all know about private testing?

Our hospital is sending everything to the state lab and as we have limited testing kits, we are being advised to follow very strict guidelines before testing someone first.

Today I had a healthy, young dude come in looking like a peach with a cough and fevers at home. He didn’t meet criteria for testing. He said he was fine with it, but upon discharge raised hell (this has been my experience... most patients act nonchalant and like they didn’t even think of COVID-19, smile and nod and say the understand when I tell them why we are not testing, and then tell the nurse they need to speak with me because they want the test...after I’ve discharged them). I called our infection control specialist and she said the patient didn’t meet criteria. So after a long chat with the dude, he brought up LabCorp’s website as they just a few days ago started doing private COVID-19 testing and wanted to know why I wasn’t going that route. I didn’t know the answer so I left to do my research and during this time, the patient called his PCP who ordered the test. He then left the ER to go get swabbed in the parking lot by one of the PCP’s office staff...
Either they can call a private lab like Labcorp that offers the test and go there, make payment and get swabbed. Or if you're an outpatient office like the one I work in (multi-specialty) you probably have an arrangement where a company like Labcorp comes to your office daily to pick up samples you've collected. Interestingly, even though Labcorp comes to our office daily for pickups and has the COVID-19 test, our state health department is telling our PCPs not to order them, instead to call the Health Department so they can track the patients. Then when you do call them, they only want to test a small minority of patients, claiming it's because of a testing shortage which they created by preventing private ordering.
 
Either they can call a private lab like Labcorp that offers the test and go there, make payment and get swabbed. Or if you're an outpatient office like the one I work in (multi-specialty) you probably have an arrangement where a company like Labcorp comes to your office daily to pick up samples you've collected. Interestingly, even though Labcorp comes to our office daily for pickups and has the COVID-19 test, our state health department is telling our PCPs not to order them, instead to call the Health Department so they can track the patients. Then when you do call them, they only want to test a small minority of patients, claiming it's because of a testing shortage which they created by preventing private ordering.

******* ridiculous. And hence, the statistics can’t be trusted.
 
One of my collegues got chewed out because some “COVID hotline” told them that their daughter should get tested. Our ID folks said no. They threatened lawyers and such.

People don’t realize, even at a large institution, we don’t have the capability to test everyone. Trust me, I wish we could.

Would it not make sense that when a national emergency is declared for a Pandemic, Emergency Physicians should have lawsuit immunity for the duration of that state of emergency??
 
Would it not make sense that when a national emergency is declared for a Pandemic, Emergency Physicians should have lawsuit immunity for the duration of that state of emergency??
Hahah how about just overall tort reform in general... maybe after this dust all settles it’s a good time to restart that conversation lol... but you might be on to some ideas about state of emergency situations.
 
Yeah I’m done with the state. Had several concerning bilateral interstitial pneumonia patients yesterday. None had their ridiculous travel or known contact requirement so I just sent the LabCorp test and admitted them on precautions (all old and sick). I guess in 5 days I’ll know if they had it.

Either they can call a private lab like Labcorp that offers the test and go there, make payment and get swabbed. Or if you're an outpatient office like the one I work in (multi-specialty) you probably have an arrangement where a company like Labcorp comes to your office daily to pick up samples you've collected. Interestingly, even though Labcorp comes to our office daily for pickups and has the COVID-19 test, our state health department is telling our PCPs not to order them, instead to call the Health Department so they can track the patients. Then when you do call them, they only want to test a small minority of patients, claiming it's because of a testing shortage which they created by preventing private ordering.
 
One of my collegues got chewed out because some “COVID hotline” told them that their daughter should get tested. Our ID folks said no. They threatened lawyers and such.

People don’t realize, even at a large institution, we don’t have the capability to test everyone. Trust me, I wish we could.

Nice documented chart about lawsuit threats and ID conversation and your presumably non-COVID-test-indicating exam, redirect to community health guidelines in your locale, discharge. Take care now, bye bye then.

Ridiculous.
 
Is it just me that doesn't understand the current testing "guidelines" from all of our amazing health departments and ID groups? I mean, I kind of get the whole travel as a risk factor thing if this was a month ago, but we all know this is all over the community now. It seems to me that what makes the most sense is to be testing: 1) The sickest people 2) Healthcare workers with symptoms 3) People with symptoms exposed to known positive cases. But at my shop for the most part it's still "Hurrr, durrr, have they traveled to China or Europe in the last 14 days? No? Then no test, hurrpedy durrpedy".
Agree that testing is most beneficial for the sickest (to guide treatment) and people like health care and other workers not on shutdown who are exposed to the public (to prevent viral spread). Testing those with mild disease and high risk (travel, known exposure) is happening and people are going to demand it. But like you're saying as community exposure gets more widespread, as it is already many places including where I live, I'm not sure how testing is better than diagnosing them with COVID-19 clinically and telling them to take precautions and stay away from people especially the elderly and immunocompromised. Tracking is not helpful if your tracking over and over leads you to the same conclusion that, "Everyone's getting this everywhere."

Friday when I left the office, our office policy was, "Call health department and consider testing those only who have all three, 1) Fever, 2) Cough and, 3) Travel or known exposure to a positive. By Monday, that changed to, 1) Fever, 2) Cough and the dreaded, 3) "Use clinical judgement."

Friday it was, "Maybe we can contain this." By Monday (yesterday) there were positives popping up at each of the local hospitals, news reports of little old ladies testing positive after the senior center pot luck, old men testing positive after farting around at the country club, and multiple residents and attendings at the local teaching hospital being out on self isolation for symptoms and presumed exposure.

My states positives are in the 30's. But with community spread including positives patients running around at tennis clubs and pot lucks, combined with very limited testing being done, the true positives have got to be at least 10x, or probably 100 times the known positives. Currently, there's one death in a nursing home patient (likely DNR, but I don't know for sure) in the state out of 33 known positives. Hopefully it won't go higher, but it likely will. 1 out of 33 known positives gives a case fatality rate (CFR) of 3%. If you accept that there's likely 6.14x's more untested actual positives out there (factor of 6 estimated from Science article four posts below) due to the known dearth of testing here locally, your true CFR would be more likely somewhere around 0.49%. Again, estimates based on rapidly changing information and could all be wrong.

Thinking positively and assuming a predicted worst case scenario of 1.6 million potential US deaths, we're currently at 85, which gives a current US potential lives saved of 1,599,915. Keep doing what you're doing. It's working.
 
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Hahah how about just overall tort reform in general... maybe after this dust all settles it’s a good time to restart that conversation lol... but you might be on to some ideas about state of emergency situations.

I really don’t disagree. I wish tort reform would pass federally. I am lucky to now be in a tort reform state.
I just know it probably would never pass in my lifetime. Too many lawyers with big pockets engrained in D.C.

However I really do feel during states of emergency EPs really should have immunity... we are taking risk because of poor government preparation...
 
Yo southerndoc how much COVID are you guys seeing?

A lot. Can't comment more than that, but we've been in the news. Health system is really controlling amount of info given out and wants it to come from a central source to reduce misinformation.
 
What are yall doing about outside transfer?

I don't trust a third of the docs/providers I'm taking patients from.

"so and so got fever, and some kind of infiltrate." Doesn't meet our testing criteria. . blah blah blah.

I feel like when things get more interesting, the small hospitals are going to lie and BS transferring all suspected patients.
 
Journal of Science out yesterday:

Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus

"Estimation of the prevalence and contagiousness of undocumented novel coronavirus (SARS-CoV2) infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV2, including the fraction of undocumented infections and their contagiousness. We estimate 86% of all infections were undocumented (95% CI: [82%–90%]) prior to 23 January 2020 travel restrictions. Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%–62%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging."

If there were 86 (86/100) undocumented infections for every 14 documented ones (14/100), that would mean they had 6.1 x more patients (86/14) out there with the disease than known positives, at least in this population (China). That makes the case fatality rate 1/6 what's quoted, at least in the population they studied.
 
2,199,908 American lives are currently being saved by our actions and those of the current administration's action plan.

I have changed my American Lives Saved count based on a new estimate of American deaths from COVID-19. I had been using the 1.6 million deaths number by Fmr. CDC Director Tom Frieden. The latest estimate from Imperial College scientists in the U.K., as reported by the New York Times, is 2.2 million American deaths from COVID-19 peaking June 20.

Therefore, with 92 Americans confirmed dead from COVID-19 to date, the current American Lives Saved based on our actions and those of the current administration's response plan is, 2,199,908 American lives saved. So far, what we're doing is working. Let's keep that number as high as possible. Keep doing what you're doing.
 
...as far as growth, have you looked at the type of quarantine that has been instituted in Wuhan? Go google drone footage. It is eerie. Looks like a neutron bomb hit a major city and killed almost everyone while preserving the infrastructure. That’s what gets an exponential growth rate down.

Meanwhile, I would like to add something practical to the discussion.

What are you all reaching for in treating febrile patients? The NHS and French Health ministry have withdrawn recommendations to treat COVID19 patients with NSAIDs because of a supposed immunosuppressant effect.

Meanwhile, there is (I think) a 2016 study talking about the antiviral efficacy of Indomethacin at certain doses with respect to SARS.

Thoughts?
 
I’m not joking even a little bit. The credit will go to those that ordered the response, all the way up to the top, and those who carried it out, including us health care workers and even the American people who complied. It’s the greatest success that we may ever have the chance to be a part of in our lifetimes. It makes no sense to view it any other way. The yardstick was set at “healthcare systems collapsing in 10 days like Italy” (which would be this Friday) and up to 1.6 million deaths. I no longer reject those estimates. I accept them whole heartedly and can’t prove they wouldn’t have happened without action. Therefore anything short if that is a success, by you, me, our healthcare workers, compliant citizens and those that ordered the response. By far, there is much more to be gained by viewing it this way, than any other. And I realize now, why those in charge framed it this way. From now on I’m counting the successes not the failures.

1,599,929 potential American lives saved, to date.

If you’re going to take credit for saving lives...you need to be prepared to explain what you did to save them. Limited testing only hides a problem. You miss the people who had it and recovered...you also miss the people who had it and died.

Eventually, someone will have to come back and find the delta on all cause respiratory mortality this winter, spring, and summer for 2020 compared to the previous handful of years.

That will be the true disease burden for COVID19 and capture everyone who died as a result of it but was labeled with a different ICD10 code.
 
Good point on NSAIDS, @Old_Mil. They've turned out to be so much dirtier of drugs in so many more ways than we thought in the past.

Also, anyone who hasn't take a long run, walk, hike or done some yoga (at home) in the past 48 hours (where there's not a lot of people) needs to do it as soon as possible. It's much, much harder to be anxious when you're doing those things, compared to sitting at home watching infection reports which makes it easy. Me: 3 mile run today with 5 x 1/4 mile interval sprints. Nervous energy tank: Empty.

Too early to say if this will pan out, but potentially positive nonetheless:

"Chloroquine may be highly effective at treating coronavirus"
Presented by: James M. Todaro, MD (Columbia MD, [email protected]) and Gregory J. Rigano, Esq. ([email protected]) in consultation with Stanford University School of Medicine, UAB School of Medicine and National Academy of Sciences researchers. March 13, 2020

 
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