What do I need to know about coronavirus?

[Matthew9Thirtyfive]

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Developed symptoms in Florida. Had been to a conference, Disney, two airports and on a flight. Then died. https://www.google.com/amp/s/amp.miamiherald.com/news/coronavirus/article241348121.html

He was there the same time I was there with my family.

 

[thegenius]

Governor Gavin Newsome asked all Californians to stay at home. 40 million. He was told that
Gov. Newsom tells residents to stay home after projecting 56% will be infected with coronavirus in eight weeks.

There are 40 million Californians. Pick any CFR you like. A low number would be 0.1%. A normal number might be 1%. A high number might be 5%.

Pick any one you want.

40 Million x 56% infected x (0.1% - 5%) death rate gives

22,400 - 1,120,000 dead in California

(over a span of about 6-12 months perhaps)


Boy oh boy.

People aren't freaking out? There is no freak out? Of course they are and for good reason!

 

[TwoHighways]

Governor Gavin Newsome asked all Californians to stay at home. 40 million. He was told that
Gov. Newsom tells residents to stay home after projecting 56% will be infected with coronavirus in eight weeks.

There are 40 million Californians. Pick any CFR you like. A low number would be 0.1%. A normal number might be 1%. A high number might be 5%.

Pick any one you want.

40 Million x 56% infected x (0.1% - 5%) death rate gives

22,400 - 1,120,000 dead in California

(over a span of about 3 months)


Boy oh boy.

People aren't freaking out? There is no freak out? Of course they are and for good reason!

how many motorists die on California highways each year? How many die from garden variety flu or cold? How many die from heart disease? How many from cancer? Stroke? Neurodegenerative disease?

 

[dadaddadaBATMAN]

how many motorists die on California highways each year? How many die from garden variety flu or cold? How many die from heart disease? How many from cancer? Stroke? Neurodegenerative disease?

typically there are about 732 deaths per 100,000 people in the USA as of 2016. We would expect about 310,000 deaths annually in a population of 40,000,000

this is between a ten percent increase and a 400% increase over that in a few months time.

Obviously there is a heavy degree of uncertainty, but no on finds the idea of a million potentially preventable deaths tenable.

even assuming that the more conservative rates are correct, the increased utilization of hospital resources would also increase the mortality for strokes, car accidents, cancer and everything else you mentioned.

 

[thegenius]

how many motorists die on California highways each year? How many die from garden variety flu or cold? How many die from heart disease? How many from cancer? Stroke? Neurodegenerative disease?

I think I know what you are getting at. The main difference between a one time virus that sweeps through a population and killing a small percentage of it and these other killers you mention above is we are not at steady state with the SARS-COV-2 virus. We are at equilibrium with heart disease, traffic deaths, etc. We live with those risks, are aware they exist, have treatment for them, have options for avoiding them, and businesses and culture and politics and society carry on normally with those conditions.

 

[GeneralVeers]

I'm not really sure it's all that preventable at this point, but I'm sure others will disagree. You have a potentially airborne virus that could be around for 18 months. It's not possible to shut down the economy for that long so.......

 

[TwoHighways]

I think an uptick in death association from covid 19 will be somewhat offset by reduction of death from other causes as this virus clearly affects the comorbid at a disproportionate rate.

 

[turkeyjerky]

I think the cruise ship data was interesting. On the quarantined cruise ship, we can pretty much gaurantee that all 3000+ people on board were exposed to the virus at very high levels given the close proximity and density of people. Of those ~ 700 got sick, and 7 died. That 1% mortality is probably way skewed high due to the extreme advanced age, and very low health of the average cruiser. It would suggest that approximately 30% of people in the country will get infected with this, and < 1% will die.

Problem is that a 30% attack rate would quickly overwhelm our healthcare system. Without ICU beds and ventilators, the case fatality rate will be much higher.

The sad truth is that even with relatively favorable assumptions, this thing looks really bad...

Just to make things a little bit harder:

48.5% of COVID-19 patient will present with a chief complaint of GI symptoms (often anorexia, diarrhea) and 3% (7 out of 204) may have GI symptoms but no respiratory symptoms. GI symptoms appear to be a marker for more severe disease.

“Results: In the present study, 204 patients with COVID-19 and full laboratory, imaging, and historical data were analyzed. The average age was 54.9 years (SD +15.4), including 107 men and 97 women. We found that 99 patients (48.5%) presented to the hospital with digestive symptoms as their chief complaint. Patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms (9.0 days vs. 7.3 days). Patients with digestive symptoms had a variety of manifestations, such as anorexia (83 [83.8%] cases), diarrhea (29 [29.3%] cases), vomiting (8 [0.8%] cases), and abdominal pain (4 [0.4%] cases). In 7 cases there were digestive symptoms but no respiratory symptoms. As the severity of the disease increased, digestive symptoms became more pronounced. Patients without digestive symptoms were more likely to be cured and discharged than patients with digestive symptoms (60% vs. 34.3%). Laboratory data revealed no significant liver injury in this case series.

Conclusion: We found that digestive symptoms are common in patients with
COVID-19. Moreover, these patients have a longer time from onset to admission and their prognosis is worse than patients without digestive symptoms. Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge. However, further large sample studies are needed to confirm these findings.

https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf

.

This is interesting. I had a young guy 2 days ago come in w/ abd pain and diarrhea. I noticed he was a little hypoxic (and he endorsed a cough on ROS) and he had a mild infiltrate in his RLL. Had some scattered crackles on lung exam too. I put him on abx and sent him home w/ covid precautions. Will be interesting to see if his swab comes back positive (but I'll probably never hear back from the health dept).

 

[thegenius]

I think the cruise ship data was interesting. On the quarantined cruise ship, we can pretty much gaurantee that all 3000+ people on board were exposed to the virus at very high levels given the close proximity and density of people. Of those ~ 700 got sick, and 7 died. That 1% mortality is probably way skewed high due to the extreme advanced age, and very low health of the average cruiser. It would suggest that approximately 30% of people in the country will get infected with this, and < 1% will die.

This would obviously be over a span of 12-18 months.....

350M people x 30% infection rate x 0.5% CFR = 525,000 deaths
simply go to 1% and you get a million deaths.


There is something telling me not that many Americans will die...I'm predicting 45,000 dead in the US due to SARS-COV-2 by the end of 2021 (20 months from now)



Imagine if this thing hits India. India has like 200 cases right now. That densely populated nation of close to a billion people. Boy oh boy!!!!

 

[y123]

NYT has a great calculator for mortality

Could Coronavirus Cause as Many Deaths as Cancer in the U.S.? Putting Estimates in Context

 

[anonperson]

Governor Gavin Newsome asked all Californians to stay at home. 40 million. He was told that
Gov. Newsom tells residents to stay home after projecting 56% will be infected with coronavirus in eight weeks.

There are 40 million Californians. Pick any CFR you like. A low number would be 0.1%. A normal number might be 1%. A high number might be 5%.

Pick any one you want.

40 Million x 56% infected x (0.1% - 5%) death rate gives

22,400 - 1,120,000 dead in California

(over a span of about 3 months)


Boy oh boy.

People aren't freaking out? There is no freak out? Of course they are and for good reason!

I just read the 56% estimate.

I don't even know what to say. Seems hopeless because how long can people keep up being locked down? A virus in which 80٪ are asymptomatic or mildly symptomatic with not even enough tests.

We tested a pregnant patient on 3/16 and sent it off to quest. As of today, Quest indicated they hadn't even run tests from 3/13. So probably won't know for another week. Already did her c section today.

This is comical at this point.

 

[doctalaughs]

I just read the 56% estimate.

I don't even know what to say. Seems hopeless because how long can people keep up being locked down? A virus in which 80٪ are asymptomatic or mildly symptomatic with not even enough tests.

We tested a pregnant patient on 3/16 and sent it off to quest. As of today, Quest indicated they hadn't even run tests from 3/13. So probably won't know for another week. Already did her c section today.

This is comical at this point.

comical as in why can’t we get our act together? S Korea had a 30 minute test over a month ago widely deployed. Many other countries aren’t having near the problem of Ppe shortage that we do.

Not sure it’s total lack of preparation/ foresight for years - or active incompetence from day 1 of the outbreak?

 

[HoosierdaddyO]

Correct me if I am wrong here... but as more people get infected and then heal... in theory we would be getting closer to herd immunity no?? Granted the question is the mortality and what that looks like all the while herd immunity is being built‍♂!!!

 

[thegenius]

Correct me if I am wrong here... but as more people get infected and then heal... in theory we would be getting closer to herd immunity no?? Granted the question is the mortality and what that looks like all the while herd immunity is being built‍♂!!!

Yes, I think you get to herd immunity when 50-65% of the population is immune.

 

[doctalaughs]

Yes, I think you get to herd immunity when 50-65% of the population is immune.

Unless immunity from infection with SARS-cov2 is not reliable. Everyone is assuming infected people are immune but it would be a huge disaster if that wasn’t the case or this virus can mutate and remain pathogenic as easily as influenza.

There are several reports of people testing positive, recovering then negative for several weeks then getting sick and positive again like a month later. No one knows if it’s due to problems with false negatives or false positives vs actual Re-infection. There are studies to show antibody levels for the virus that causes SARS (which is the closest virus we know to the one causing covid19) last only 2 years then essentially disappear. Of course antibody levels aren’t a reliable marker for immunity for every disease but it’s a little scary.

 

[anonperson]

comical as in why can’t we get our act together? S Korea had a 30 minute test over a month ago widely deployed. Many other countries aren’t having near the problem of Ppe shortage that we do.

Not sure it’s total lack of preparation/ foresight for years - or active incompetence from day 1 of the outbreak?

Yes.
Slow testing. Not enough testing.
Ppe issues.

You'd think we didn't have a head start on this situation.

 

[TheSingularity]

how many motorists die on California highways each year? How many die from garden variety flu or cold? How many die from heart disease? How many from cancer? Stroke? Neurodegenerative disease?

Can you ****ing stop it.

 

[Birdstrike]

Correct me if I am wrong here... but as more people get infected and then heal... in theory we would be getting closer to herd immunity no??

Yes

 

[cyanide12345678]

comical as in why can’t we get our act together? S Korea had a 30 minute test over a month ago widely deployed. Many other countries aren’t having near the problem of Ppe shortage that we do.

Not sure it’s total lack of preparation/ foresight for years - or active incompetence from day 1 of the outbreak?

Our hospital policy got even worse. We are only testing people who are being admitted -_- no outpatient tests, just tell them to stay home basically.

 

[d2305]

With less traffic, fewer will die on the crazy freeways out there. I survived SR 94. I don't see many staying at home for too long.

 

[Birdstrike]

Our hospital policy got even worse. We are only testing people who are being admitted -_- no outpatient tests, just tell them to stay home basically.

"You have a 3% chance of dying from, and killing your relatives with, a once in a century plague that will kill 2,200,000 Americans, but you don't need to know if you have it."

 

[takeurmeds02]

Did you guys bring your bandanas and scarves on shift? CDC said you could....

 

[Dr Mantis Toboggan]

Does anyone here have easy access to testing, as in, you can test whoever you want without thinking about swab or reagent shortages, it comes back reasonably fast etc?

Anyone on this entire board?

"You have a 3% chance of dying from, and killing your relatives with, a once in a century plague that will kill 2,200,000 Americans, but you don't need to know if you have it."

 

[Fox800]

I'd encourage each of you to purchase a reusable respirator on eBay, at a hardware store like Lowe's or Home Depot, a paint supply store, or an industrial safety supply store along with multiple pairs of filters. N95 or P95 rating or better. I'm having my friends and colleagues do the same.

Colleagues are being written up/disciplined for wearing respirators on shift despite the fact that OSHA and CDC regulations specify we should be wearing a respirator (not a surgical mask) for any patient with suspected COVID, and CDC/NIH data that it's present in infectious quantities in the air for at least 3 hours.

Last night my colleague asked for an N95 and was refused by a nurse because "you aren't intubating".

Administrators care more about the fact that we "look scary". Utterly insane. F them, protect yourself and your family. If they try to discipline you, threaten to quit on the spot. Get your disciplinary measures in writing so you can complain to OSHA and provide them to an employment attorney and for the local news.

Hospitals. Do. Not. Care. About. Us. At. All.

 

[Birdstrike]

Does anyone here have easy access to testing, as in, you can test whoever you want without thinking about swab or reagent shortages, it comes back reasonably fast etc?

Anyone on this entire board?

I'm in an outpatient office and the PCPs here have started bypassing the state health Dept and sending out swabs to Labcorp in the past couple of days. The turn around is 2-3 days. So far, no positives but there have only been a handful resulted. Despite the talk of testing shortages, we haven't gotten any blow back on that, yet, but it's super early. Labcorp seems happy and ready to pump them out. I'll update as we get into next week as far as any feedback on shortages, backlogs and results. I expect many positives to come since there are many documented cases around us.

 

[bravotwozero]

So we have in house testing that I can order, but whether that test gets run is decided by our county health department, which is going by criteria that is already outdated and designed as if we don't already have an endemic infection.

 

[deleted65604]

I said it in a previous post. I swear that I have the answer. Kids get corona virus every year which causes minor respiratory complaints. On our respiratory panel, 4 out of the 14 pathogens tested for are corona virus. On average, kids get 5-7 colds per year, giving them massive and personal herd immunity. This would explain the sex differences in males versus females. Females are more likely be around sick kids (stay at home moms, daycare workers, nursing).
This would explain why Italy is getting hit so hard in the heart of their most prosperous region (their birthrate is abysmal in that area and it is too expensive to afford housing for kids). Just like cow pox inoculation protected form small pox, the common cold is protecting them from this strain. This is why entire wings of the nursing homes are dying...no kid exposure for years.

That's not the answer. That answer would fit if we were seeing 6 year olds and Pediatricians being affected less than the elderly and Orthopedic surgeons, but it doesn't explain the lack of morbidity and mortality in infants and neonates who have never had any viruses at all. ESPECIALLY preterm neonates. There is no other serious infectious disease on the planet that isn't an absolute catastrophe for neonatologists. An outbreak of flu can but put half of a NICU in critical condition, and COVID has days of asymptomatic shedding that should make it impossible to keep out. If it was anything like a normal virus we should be seeing stories about entire NICUs where every baby suddenly goes on a vent. We haven't seen that happen once.

This is some interaction between the virus and the mature immune system. Or the mature cardiovascular system. Or the mature endocrine system. I have no idea, really, but probably one of those things. I did learn from google that both 'immunosenescence' and 'cardiac immunology' are academic specializations, so I imagine those guys are putting in some overtime right now.

6-year-olds ARE being affected less than the elderly. Much less. Not a single kid has died among 256,879 patients patients! It is wreaking havoc on nursing homes. We are talking 40 percent mortality rates, with 40 percent of the occupants getting it. Do we have data collected on Orthopedic surgeons and pediatricians? I'm not aware of it. Can you direct me to the data? Preterm infants are at pediatric hospitals predominantly, with staff who see sick kids all day. Herd immunity would be strong among the staff. The relatively young mothers and fathers would be more exposed the common cold corona viruses as they and their friends often have kids under 10. Twenty and Thirty year old immune systems remember their childhood immunity better than fifty-year-olds and sixty-year-olds. Many of these children are fed breast mild from their mothers, who have antibodies to corona virus. These kids are usually in isolation with positive pressure ventilation keeping them from being affected. By definition, they are in "isolettes."

I ask you, why is Italy getting hit harder than China? Why is the richer part of Italy being more affected than the poor areas of Italy? Why is Iran being hit less hard than Italy, with less prosperous hospitals? Why is the outbreak essentially over in China? Why are there sex differences with more men getting the virus and more of them dying from the illness? Why would a virus have an exponential growth phase and then transition to a logarithmic growth phase before infecting the entire nation?

Do you think that the common corona viruses wouldn't help develop immunity to COVID 19? If so, why? If Cow Pox grants immunity to Small Pox, why couldn't the same principle apply here? Do you think that herd immunity among youth and adults wouldn't give them less spread of the disease. If so why?

You mention that "This is some interaction between the virus and the mature immune system. Or the mature cardiovascular system. Or the mature endocrine system. I have no idea, really, but probably one of those things."

How does your theory fit better than mine? How would a mature cardiovascular system give massive differences between prevalence and mortality between Asian countries and Italy?

 

[bravotwozero]

I wouldn't be so sure Iran has less mortality than italy. Their government's response to the epidemic has been nothing short of disastrous, and I certainly wouldn't trust their figures, especially with satellite images of mass graves being dug in Qom. Everything else you said is on point though, excellent questions.

 

[evilbooyaa]

how many motorists die on California highways each year? How many die from garden variety flu or cold? How many die from heart disease? How many from cancer? Stroke? Neurodegenerative disease?

My goodness man, how can you even breathe with your head so far in the sand?

 

[Angry Birds]

 

[Birdstrike]

I heard someone claim today that almost two months after the China travel ban was implemented to fight COVID-19, and until just a few days ago, Joe Biden was still calling for open and unrestricted travel to and from Wuhan China and Italy. I was like, “No f—-info way. I mean, I know he’s, a little, you know...but, come on now. Let’s not make ridiculous exaggeration to make a point.” Then, I looked it up.

Almost two months ago, when none of us even cared a fart about COVID-19 and 3 days before anyone cared enough to even start this thread, on January 31 President Trump announces the China travel ban.

March 12, more than a month after the travel ban. two days after the March 10, “We’ll be Italy in 10 days!” warning calls, a mere 16 days ago, Joe Biden was still was apparently railing against any and all travel bans, proposing that people be able to fly back and forth from Wuhan China and Italy, to the United States and back, openly and freely without restriction.

.

 

[Angry Birds]

I heard someone claim today that almost two months after the China travel ban was implemented to fight COVID-19, and until just a few days ago, Joe Biden was still calling for open and unrestricted travel to and from Wuhan China and Italy. I was like, “No f—-info way. I mean, I know he’s, a little, you know...but, come on now. Let’s not make ridiculous exaggeration to make a point.” Then, I looked it up.

Almost two months ago, when none of us even cared a fart about COVID-19 and 3 days before anyone cared enough to even start this thread, on January 31 President Trump announces the China travel ban.

March 12, more than a month after the travel ban. two days after the March 10, “We’ll be Italy in 10 days!” warning calls, a mere 16 days ago, Joe Biden was still was apparently railing against any and all travel bans, proposing that people be able to fly back and forth from Wuhan China and Italy, to the United States and back, openly and freely without restriction.

.

Your boy loves travel bans so he got that part covered
But not to the UK of course cuz they be like proper Anglo-Saxon and all

 

[turkeyjerky]

Our hospital policy got even worse. We are only testing people who are being admitted -_- no outpatient tests, just tell them to stay home basically.

Why is this a bad thing??

Shortly before they got the outbreak under control in Wuhan, they changed the case definition and no longer required a positive test. (Symptoms + positive CT became the new case definition).

Once you have confirmed, endemic spread in the community, you should no longer be testing people when it won't make a difference in management.

Not only does not testing the worried well decrease resource allocation (time in the ER, limited viral testing media, staff effort), it makes management of these dip****s far easier. Instead of making 15 calls to the county and having your nurses spend 2 hours collecting specimens, you just tell them they can't be tested and they should proceed as if they have it (home iso, etc). And it's less potential high risk exposure to us.

We need to turn the worried well around at the door. Do not pass go, Do not collect $200, Turn around and go home. GTFO, Now!

We need to conserve our resources (yes my time during a pandemic is a valuable resource). The gomers are coming and they will be sick.

 

[HoosierdaddyO]

Your boy loves travel bans so he got that part covered
But not to the UK of course cuz they be like proper Anglo-Saxon and all

Why is it racist to place a travel ban on the place where this most likely originated??? That’s kind of stupid to suggest that because he didn’t do it for UK at the same time then he’s racist. You’re better than that!!! The man did something right give him credit where credit is due!!!!

 

[evilbooyaa]

Why is this a bad thing??

Shortly before they got the outbreak under control in Wuhan, they changed the case definition and no longer required a positive test. (Symptoms + positive CT became the new case definition).

Once you have confirmed, endemic spread in the community, you should no longer be testing people when it won't make a difference in management.

Not only does not testing the worried well decrease resource allocation (time in the ER, limited viral testing media, staff effort), it makes management of these dip****s far easier. Instead of making 15 calls to the county and having your nurses spend 2 hours collecting specimens, you just tell them they can't be tested and they should proceed as if they have it (home iso, etc). And it's less potential high risk exposure to us.

We need to turn the worried well around at the door. Do not pass go, Do not collect $200, Turn around and go home. GTFO, Now!

We need to conserve our resources (yes my time during a pandemic is a valuable resource). The gomers are coming and they will be sick.

I agree with testing in the ED for patients requiring hospitalization only, but telling people who don't have confirmed diagnosis to go self isolate for 14 days is not going to be as productive as giving them an outlet to being tested on an outpatient basis. This affects psyche of the patient as well as those around them, as most patients with symptoms of COVID-19 don't actually have it.

If we could test for it on a larger scale we could then quarantine the people who are at risk of secondary transmission from the patient who doesn't need to be hospitalized, a la South Korea.

I do agree that in the case of shortage (which is sad that we as a country failed at this) that preference should be given to running the tests of those who are admitted, as ruling out COVID-19 in admitted patients is more important than those not sick enough to be hospitalized.

As a side note, if somebody comes in under suspicion of COVID-19, are you all CT scanning all of these patients? I'd be OK with Symptoms + positive CT replacing a true PCR testing if it lead to more diagnoses and more quarantining.

 

[turkeyjerky]

I agree with testing in the ED for patients requiring hospitalization only, but telling people who don't have confirmed diagnosis to go self isolate for 14 days is not going to be as productive as giving them an outlet to being tested on an outpatient basis. This affects psyche of the patient as well as those around them, as most patients with symptoms of COVID-19 don't actually have it.

If we could test for it on a larger scale we could then quarantine the people who are at risk of secondary transmission from the patient who doesn't need to be hospitalized, a la South Korea.

I do agree that in the case of shortage (which is sad that we as a country failed at this) that preference should be given to running the tests of those who are admitted, as ruling out COVID-19 in admitted patients is more important than those not sick enough to be hospitalized.

As a side note, if somebody comes in under suspicion of COVID-19, are you all CT scanning all of these patients? I'd be OK with Symptoms + positive CT replacing a true PCR testing if it lead to more diagnoses and more quarantining.

Dude have you not been following the news?

New York and California have state wide shelter at home orders in place. There's essentially a worldwide travel ban. We are rapidly running out of appropriate PPE. We're a few weeks away from running out of vents.

Containment has failed. Even if we still had a shot at it, relying on a test that takes 3-5 days to come back and is only 65-70% sensitive is not the answer.

Outpatient roadside testing centers? Sure--have at it. But allowing our EDs to become overwhelmed with people demanding surveillance screening? Count me out.

The fragile psyche of the worried well with the sniffles is not my concern.

 

[GeneralVeers]

We are told not to do CT scans on COVID rule-out patients. Unless they are critically ill, it won't add to the workup, and we have to terminally clean one of the scanners resulting in a massive backlog of studies.

 

[evilbooyaa]

Complete non-sequitur. Of course I've been following the news. Where is your source that the test has a 65-70% sensitivity? The issue with it was reportedly false positive rate, which is related to specificity.

I'm saying I agree with you that EDs should not become a testing ground, and if your argument is to not test patients coming to the ED, IN the ED, then OK.

But to say we shouldn't even bother at all with outpatient testing is defeatist. We can still do mitigation even if containment is out the window at this point.

But I think we agree that EDs are not the place to test folks that don't require hospitalization, but we should encourage outpatient testing centers.

 

[GeneralVeers]

The fragile psyche of the worried well with the sniffles is not my concern.

We were told the hospital system has waived our press-ganey scoring for the next few months. That means I can give these people a good dose of GTFO with hopefully no consequences.

 

[anonperson]

I agree with testing in the ED for patients requiring hospitalization only, but telling people who don't have confirmed diagnosis to go self isolate for 14 days is not going to be as productive as giving them an outlet to being tested on an outpatient basis. This affects psyche of the patient as well as those around them, as most patients with symptoms of COVID-19 don't actually have it.

If we could test for it on a larger scale we could then quarantine the people who are at risk of secondary transmission from the patient who doesn't need to be hospitalized, a la South Korea.

I do agree that in the case of shortage (which is sad that we as a country failed at this) that preference should be given to running the tests of those who are admitted, as ruling out COVID-19 in admitted patients is more important than those not sick enough to be hospitalized.

As a side note, if somebody comes in under suspicion of COVID-19, are you all CT scanning all of these patients? I'd be OK with Symptoms + positive CT replacing a true PCR testing if it lead to more diagnoses and more quarantining.

I don't see that amount of efficent testing being available in the US anytime soon. Maybe in 4 to 6 weeks but even that is optimistic.

 

[TooMuchResearch]

Pinnacle Biolabs has a rapid IgG/IgM test but I think it's EU/GB only.

My knowledge of this has rapidly evolved over the past 48-72 hours. I'm on shift now at Kaiser at night, thankfully it's very slow. I've been reading left and right and talking to other people and I felt like I had an "a-ha" moment a few days ago and I understand this so much more. At least the epidemiology part.

I really have no clue what nations plan on doing after they sequester and quarantine / isolate the first group of people who had the virus. We have to relax this sheltering-in-place.

The key is getting a rapid test ASAP. We absolutely need to have that. Then we can isolate people who have this virus instead of whole communities.

Even then, I can see the need for regional or local sheltering (or quarantining) if second and third waves of this virus sweep through large groups of people. Pulsed quarantining every few months. You get a wave of infections and if it reaches critical mass then you quarantine. That would be much preferable to locking down an entire country.

 

[TooMuchResearch]

I bought a pair of 6900s for our eventual need for PPE or just grocery shopping or even looting my neighbors houses. At least some of this post is serious though.

The n95s are through ebay. It's the only place they are available. Everywhere else they are sold out. But the folks who bought them all are now making a quick Buck by selling their loot on ebay. If you look for n95s there you will find plenty of options.

Similarly, i ordered a 7502 respirator with p100 2097 filters. It's obviously better than a n95, and that's the sort of equipment you see the Chinese healthcare professionals wear along with their bunny suits. Again, this was also ebay.

I'm buying these because i know April will be absolutely terrible. I think by May our supplies may get replenished as production will ramp up, but there is no way hospitals will have protective equipment during end of March and April. I have an 8 week old that i have to protect from myself in whatever way possible. It also doesn't help that my wife is going back to being a resident in 2 weeks from maternity leave and the both of us will expose our little one. The new data out of china is reflecting that very young infants, about 6 percent of them are getting severely sick.

 

[TooMuchResearch]

They start online school next week I think.

For those of you with kids in school, are your kids straight up missing school or are they doing daily online school work? The reason I ask is, after my kids missed an insane amount of school in the past couple of years due to hurricanes and flooding, up to stretches of 3 weeks at a time, they've finally set up continuation of school, but online, through this crisis so no make up days are needed. When I found this out, I was praising God, because when they miss that much time, then have to make it up on planned breaks or in the summer, it totally sucks. If your school district has kids out of school right now, and is not having kids do online school, you need to blow up your local school board's switchboard. Because this year, having them be able to log online, read the lessons, do the work, e-mail or video chat with their teach and get marked "present" each day so no make up days are required, is a huge improvement from passed missed-school debacles.

 

[TooMuchResearch]

The filters are good for 6 months once opened as long as you can breathe through them. But you probably have to seal the filters for a while after use to let the virus die.

Until it gets hard to breathe through it.

It should theoretically become a better filter as the pores clog up, but you won't be able to breathe so well.

I'm thinking of changing the filter every 1-2 months personally.

 

[GeneralVeers]

I think the key to saving PPE at this point in time would be to have one nurse (in PPE) screen the patients coming in with history and vitals. If there is any fever, respiratory or GI symptoms they get sent to a quarantine room. The physician or midlevel at that point should interview the patient securely through a glass or impermeable plastic partition without PPE. I don't think physical exam is warranted on anyone unless they are acutely ill, or will require intervention other than reassurance and discharge.

 

[TooMuchResearch]

"It's not PPE, but wear it if you have no other choice."

Anyone else catch the new CDC guidelines stating "bandanas and scarves" can be used when caring for COVID patients in the absence of facemasks?

Look at the end of the article under "HCP Use of Homemade Masks."

I wish I was making this **** up.

Source: Coronavirus Disease 2019 (COVID-19)

 

[Birdstrike]

I’ve hear of plenty of PPE shortages.

Can anyone report, or have they heard any colleagues say, their hospital system is collapsing?

Today was the day we were supposed to have hospital systems collapsing like Italy.

 

[cyanide12345678]

I think the key to saving PPE at this point in time would be to have one nurse (in PPE) screen the patients coming in with history and vitals. If there is any fever, respiratory or GI symptoms they get sent to a quarantine room. The physician or midlevel at that point should interview the patient securely through a glass or impermeable plastic partition without PPE. I don't think physical exam is warranted on anyone unless they are acutely ill, or will require intervention other than reassurance and discharge.

Or just stop these items from going to home Depot cvs and Walgreens where the general public buys them as soon as they hit the shelves.

Cvs, as per my pharmacist friend, is getting a batch of n95s soon. Why in this world do they need it?

Home Depot gets these honeywell respirators, every time the stock comes it, immediately sold out.

All supplies should funnel to hospitals, not to these stupid places that don't need them

 

[cyanide12345678]

I’ve hear of plenty of PPE shortages.

Can anyone report, or have they heard any colleagues say, their hospital system is collapsing?

Mine isn't yet. But this is ohio where our governor took impressive early steps. I get a daily n95 from work so far.

Though Cleveland clinic has official ordered doctors to not wear any PPE if they are seeing "other patients". Only when seeing Covid suspected or confirmed patients, ppe is provided. I think the patients that are asymmtomatic will end up infecting these physicians who will then spread the disease like wild fire.

Also the 200+ Cleveland clinic employees that came into contact with the first few positive covid patients before they were diagnosed are still required to come to work and are not being tested.

 

[bravotwozero]

I’ve hear of plenty of PPE shortages.

Can anyone report, or have they heard any colleagues say, their hospital system is collapsing?

Today was the day we were supposed to have hospital systems collapsing like Italy.

Well, the hardest hit areas in the country so far are urban centers in California, NY, and Washington State. Any docs working there want to chime in?