What do I need to know about coronavirus?

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Some evidence against the anecdotal narratives being pushed constantly without any data being reported that ICUs are "full of people in there 20s, 30s, 40s, etc and they're dying in droves!".


YsDYz6V.png
 
GeneralVeers said:
Interesting. With 60+ doctors and hundreds of nurses, I don't know of anyone at work getting seriously ill, much less admitted to the ICU.
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Obviously very location dependent.
Hopefully your town/city stays safe.
Unfortunately not really the case here, things seem to be going as predicted with more and more people being hospitalized.
 
This is from The NY Times yesterday (bold my emphasis):

While China on Thursday reported zero new locally transmitted infections for the first time, users on Chinese social media the next day circulated photographs of notices from certain Wuhan neighborhoods which appeared to announce newly detected cases.

The outcry and confusion were such that the Wuhan government released a statement on its official social media account on Sunday to rebut the assertions that the authorities were hiding new cases. Some of the cases cited in the photos had already been counted and reported earlier, the government said. Another patient who had tested positive was asymptomatic, and so would be monitored but not count as a confirmed case until he showed symptoms, the statement said.

Chinese officials count only patients with both symptoms and a positive test in their official tally of confirmed cases. The approach is at odds with the World Health Organization’s guidance that all people who test positive should be considered confirmed cases regardless of whether they show symptoms.
 
Rekt said:
Some evidence against the anecdotal narratives being pushed constantly without any data being reported that ICUs are "full of people in there 20s, 30s, 40s, etc and they're dying in droves!".


YsDYz6V.png
Click to expand...

This says nothing at all about ICU usage.

It’s just a graph of fatality rate and age.
 
Rekt said:
People are saying they're dying. Because they "heard so". Words are tough, but I do believe death = fatality.
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Articles are reporting on high rates of young people using ICUs. People are inappropriately extrapolating that to suggest that they are dying in high numbers. I agree with you that young people are not dying in droves, but they are using up a significant proportion of ICU resources. If the point of your graph was only to refute the fatality rate, then OK, but you made it seem like 'young people are requiring ICU level care' was on a similar level of incredulity, which is not the case.
 
evilbooyaa said:
Articles are reporting on high rates of young people using ICUs. People are inappropriately extrapolating that to suggest that they are dying in high numbers. I agree with you that young people are not dying in droves, but they are using up a significant proportion of ICU resources. If the point of your graph was only to refute the fatality rate, then OK, but you made it seem like 'young people are requiring ICU level care' was on a similar level of incredulity, which is not the case.
Click to expand...

Sure, but literally no one is producing this data so everyone is going on mass hysteria and facebook posts and "my freind's sisters cousin in a resident in NYC and they have twenty-seven floors of 20 year olds on vents!". Even Cuomo was playing with the numbers. "70% of hospitalized pateints are over 70 years old and the the ones under 70 had significant comorbidities". Why'd he start at 70? how much higher would the perecent be if it was 60? 55? Why not just actually give the numbers?

Give us the data
 
While I agree there is hysteria among our own profession, the use of nebulizer treatments should be limited -- but not forbidden. Nebulizers can aerosolize coronavirus up to 1 meter and was responsible for infection of several paramedics during the Toronto SARS outbreak. However, we do nebulize albuterol for even confirmed COVID patients. The difference is they must be on airborne (not droplet) precautions and the room has to wait 2 hours after use before it can be cleaned.

Paramedics, however, are not allowed to give nebulizer treatments for PUI's.

Keep in mind that Georgia has a significant number of cases and limited testing capability. We are not testing healthy people who are discharged home.
 
Birdstrike said:
This is bizarre. Can anyone that's seen COVID-19, confirm this:


"Care home nurse tells of terrifying and sudden ways coronavirus struck her patients

The veteran registered nurse started her own mental checklist: cough, rapid breathing and the red eyes -- all the sickest patients seemed to have the red eyes.
For Chelsey Earnest it was the eyes that became the single most important sign as she and other staff at the Life Care Center in Kirkland, Washington, struggled with the new coronavirus that was sweeping the nursing home even before it became feared across the country.

Chelsey Earnest says she has never experienced anything like the outbreak in Kirkland in 20 years as a registered nurse.
"It's something that I witnessed in all of them (the patients). They have, like ... allergy eyes. The white part of the eye is not red. It's more like they have red eye shadow on the outside of their eyes," Earnest said."

www.cnn.com

Inside the first coronavirus outbreak in the US

A nurse from the Life Care Center in Kirkland, Washington, tells of the war-like struggle as it became the epicenter of the first coronavirus outbreak inside the US. "There's lots of casualties and ... you can't see the enemy," Chelsey Earnest said.
www.cnn.com www.cnn.com
Click to expand...

I've seen more than 10 confirmed cases and another 50+ suspected cases, and I have not seen a single one with "red eyes." That's usually adenovirus that causes viral conjunctivitis. However, perhaps significant coughing can cause conjunctival hemorrhages that can present as "red eyes."
 
TwoHighways said:
I would actually love to see ICU admits secondary to corona virus stratified in age classes if such data exists.
Click to expand...
I did a deep dive on this and posted the US age group data from the CDC on this thread on Thursday. See posts 752 & 754, above.
 
Birdstrike said:
I did a deep dive on this and posted the US age group data from the CDC on this thread on Thursday. See posts 752 & 754, above.
Click to expand...

How did they choose their age stratification? A 20 year old and a 44 year old are in two vastly different places. Regardless, it looks like 85-90% of ICU admits are over the age of 50
 
Maybe we should just lockdown NYC. It appears the majority of the disease is there. Everywhere else can 1) stay home if you are sick, and 2) social distance 6 ft apart while at work or play.
 
thegenius said:
Maybe we should just lockdown NYC. It appears the majority of the disease is there. Everywhere else can 1) stay home if you are sick, and 2) social distance 6 ft apart while at work or play.
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Lock down Louisiana while we’re at it.
 
How many people are dying or admitted to ICU because we can't give nebulizers now? My RTs will literally refuse to give nebs on anyone these days.

Also every intubation is now a "COVID rule-out patient" but I haven't really seen a statistical increase in intubations. I'm still doing one every other shift which hasn't changed. Many of thise "COVID rule-outs" are run of the mill COPD, CHF, or pneumonia which would have come in anyway.
 
evilbooyaa said:
Articles are reporting on high rates of young people using ICUs. People are inappropriately extrapolating that to suggest that they are dying in high numbers. I agree with you that young people are not dying in droves, but they are using up a significant proportion of ICU resources. If the point of your graph was only to refute the fatality rate, then OK, but you made it seem like 'young people are requiring ICU level care' was on a similar level of incredulity, which is not the case.
Click to expand...

I’m not convinced that his graph supports a hypothesis that mortality in young adults is low. Look at what is happening in Italy to the 30-49 year olds - mortality is 0.4-0.6%. That is 4-6X the mortality of seasonal flu for all age groups.

Considering 25% of people age 30-49 could get it if we choose not to isolate, a 0.4-0.6% mortality would be devastating.
 
GeneralVeers said:
How many people are dying or admitted to ICU because we can't give nebulizers now?
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There shouldn't be any, and if nothing else good comes out of this I hope that at a minimum everyone's RT department can learn that MDIs with spacers work just as well as nebulizers if you give an equivalent dose. We could cut down on an enormous number of nonsense ED and office visits if we could just convince everyone that the MDI they have in their pocket works just as well as the nebulizer they get after waiting for a physician.

Children's hospitals have been working to get rid of inpatient nebulizers since before I have started training for exactly that reason, and they have largely succeeded. A significant number of children's hospitals only keep nebulizers for CF patients who need nebulized hypertonic saline. Everyone else gets an MDI.
 
Interesting article in the Financial Times. In the UK they are going to start antibody assays from a random population sample to see what percentage of people have already been infected. This is exactly the kind of data we need so we can figure out what stage of the epidemic we are currently in.

Client Challenge

www.ft.com
 
Perrotfish said:
Not a single one, and if nothing else good comes out of this I hope that at a minimum everyone's RT department can learn that MDIs with spacers work just as well as nebulizers if you give an equivalent dose. We could cut down on an enormous number of nonsense ED and office visits if we could just convince everyone that the MDI they have in their pocket works just as well as the nebulizer they get after waiting for a physician.

Children's hospitals have been working to get rid of inpatient nebulizers since before I have started training for exactly that reason, and they have largely succeeded. A significant number of children's hospitals only keep nebulizers for CF patients who need nebulized hypertonic saline. Everyone else gets an MDI.
Click to expand...

We don't have MDIs at my hospital. They never used to carry them as they would always do nebs. Our hospital has now ordered them, but they are backordered indefinitely. So essentially at this point in time, no albuterol treatments for anyone.
 
GeneralVeers said:
We don't have MDIs at my hospital. They never used to carry them as they would always do nebs. Our hospital has now ordered them, but they are backordered indefinitely. So essentially at this point in time, no albuterol treatments for anyone.
Click to expand...
Ok that is a legitimately bad situation. I guess its terbutaline for everyone until they stock up on MDIs? Or IM epi if they're out of terbutaline?
 
GeneralVeers said:
Interesting article in the Financial Times. In the UK they are going to start antibody assays from a random population sample to see what percentage of people have already been infected. This is exactly the kind of data we need so we can figure out what stage of the epidemic we are currently in.

Client Challenge

www.ft.com
Click to expand...

Behind a paywall. Post it if you can
 
Perrotfish said:
Ok that is a legitimately bad situation. I guess its terbutaline for everyone until they stock up on MDIs? Or IM epi if they're out of terbutaline?
Click to expand...

Actually Epi is what has been recommended. Of course it certainly won't exacerbate the CHF/A-fib/CAD co-morbidities that all my CHFers have.
 
GeneralVeers said:
How many people are dying or admitted to ICU because we can't give nebulizers now? My RTs will literally refuse to give nebs on anyone these days.

Also every intubation is now a "COVID rule-out patient" but I haven't really seen a statistical increase in intubations. I'm still doing one every other shift which hasn't changed. Many of thise "COVID rule-outs" are run of the mill COPD, CHF, or pneumonia which would have come in anyway.
Click to expand...

Do your RTs know how to use an MDI with spacer?
 
ShockIndex said:
I’m not convinced that his graph supports a hypothesis that mortality in young adults is low. Look at what is happening in Italy to the 30-49 year olds - mortality is 0.4-0.6%. That is 4-6X the mortality of seasonal flu for all age groups.

Considering 25% of people age 30-49 could get it if we choose not to isolate, a 0.4-0.6% mortality would be devastating.
Click to expand...

Eh, I imagine the argument will be that the number of reported cases in that age group is a fraction (maybe 6:1 as Birdstrike keeps saying) of the total #o f cases.
 
evilbooyaa said:
Eh, I imagine the argument will be that the number of reported cases in that age group is a fraction (maybe 6:1 as Birdstrike keeps saying) of the total #o f cases.
Click to expand...

And the number of reported influenza cases in that age group is a fraction of the total number, which is why the graph use CFR (number of deaths/reported cases). Now, people can argue that the CFR for a pandemic infection is not accurate in the early phases of the pandemic, and I’m sympathetic to that fact. However, doing so would mean that we need to stop citing mortality stats and go with anecdotal evidence at this early stage. That anecdotal evidence is that COVID-19 kills the elderly and is a major kick in the nuts to plenty of young adults too...
 
GeneralVeers said:
How many people are dying or admitted to ICU because we can't give nebulizers now? My RTs will literally refuse to give nebs on anyone these days.

Also every intubation is now a "COVID rule-out patient" but I haven't really seen a statistical increase in intubations. I'm still doing one every other shift which hasn't changed. Many of thise "COVID rule-outs" are run of the mill COPD, CHF, or pneumonia which would have come in anyway.
Click to expand...
Nationally, only 15%, or about 1 in 7 patients swabbed patients is coming back positive for COVID-19. About 6 out 7 of those suspected are actually coming back negative.

Www.covidtracking.com
 
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Birdstrike said:
Nationally, only 15%, or about 1 in 7 patients swabbed patients is coming back positive for COVID-19. About 6 out 7 of those suspected are actually coming back negative.

Www.covidtracking.com
Click to expand...

That's surprising because we are generally only swabbing people who we think are high risk of being positive.

Maybe the test sucks

Maybe we are blowing this thing way out of proportion.

(both can be right...)
 
Italy has had several days in a row of new cases and new deaths falling. Good news. I hope it continues.

0DAF9BD9-39BB-431B-A25D-496233BE8010.jpeg
531E607C-99AC-41E5-9410-544C036D5D4B.jpeg

www.worldometers.info

Italy COVID - Coronavirus Statistics - Worldometer

Italy Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.
www.worldometers.info www.worldometers.info
 
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thegenius said:
That's surprising because we are generally only swabbing people who we think are high risk of being positive.

Maybe the test sucks

Maybe we are blowing this thing way out of proportion.

(both can be right...)
Click to expand...

I don’t think that we have a good handle on either the WHO or CDC RT-PCR test characteristics. EMRAP cited a small study that tested known positives over a couple weeks and 25% where intermittently returning negative results.
 
Birdstrike said:
For the “We’re Italy in ten days” people, are we still Italy in ten days?

And for the “Viruses follow ‘exponential growth’ forever, not logistic growth until we all die” people, what’s happening the past few days in Italy?

View attachment 299670View attachment 299671
www.worldometers.info

Italy COVID - Coronavirus Statistics - Worldometer

Italy Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.
www.worldometers.info www.worldometers.info
Click to expand...
Italy is starting to flatten the curve - through extreme social isolation that will put their economy in a deep recession. For the past 10 days, people have not been allowed out of their houses in Italy except in very limited circumstances. That is good news.

Also, I don’t recall you being called names. I do remember people criticizing you for seeming to equate this virus to seasonal influenza and suggesting that we didn’t need austere social distancing (i.e. a deep recession) to prevent widespread disease in America. I still think those criticisms were fair despite believing that you are an intelligent, competent, and caring physician.
 
Last edited:
Birdstrike said:
Nationally, only 15%, or about 1 in 7 patients swabbed patients is coming back positive for COVID-19. About 6 out 7 of those suspected are actually coming back negative.

Www.covidtracking.com
Click to expand...

In other areas it is even lower.

Los Angeles Department of health has indicated under 10% of tests are actually coming back positive.
 
ShockIndex said:
Italy is starting to flatten the curve - through extreme social isolation. For the past 10 days, people have not been allowed out of their houses in Italy except in very limited circumstances. That is good news.
Click to expand...

Or, have all the old people who are going to die pretty much done so?
 
Spain is gonna be the new Italy, and New York, this early on, could be the new Spain. Or is NY going to make a quick flat line and be below Emilia Romagna?

New York is looking awfully pointy upwards.

California is doing great! California is doing better than S. Korea! So take that!!!!!

NewYork Madrid.jpg
 
Dr Mantis Toboggan said:
Hope they got you guys some PAPRs. As the elective joint volume has dried up here we appropriated some from the OR.
Click to expand...

Your orthopedists wear PAPRs to put in prosthetic joints? Thinking it will somehow prevent septic hips? I think they have something backwards there.
 
Interesting read:

apnews.com

'Cacophony of coughing': Inside NYC's virus-besieged ERs

NEW YORK (AP) — A “cacophony of coughing” in packed emergency rooms. Beds squeezed in wherever there is space.
apnews.com apnews.com

There are roughly 3000 ICU beds in the state of NY. They’ve filled 500 of them with COVID cases over the past 2 days.
 
ShockIndex said:
Interesting read:

apnews.com

'Cacophony of coughing': Inside NYC's virus-besieged ERs

NEW YORK (AP) — A “cacophony of coughing” in packed emergency rooms. Beds squeezed in wherever there is space.
apnews.com apnews.com

There are roughly 3000 ICU beds in the state of NY. They’ve filled 500 of them with COVID cases over the past 2 days.
Click to expand...

I work at a hospital outside of NYC and about 3/4 of the ED visits are COVID related. No extreme surges but our hospital is steadily filling with COVID cases. Sustainable for another 2 weeks? Sure. Sustainable for a month? Unlikely. I have co-workers that tested positive and attempted to push through it at home and ended up admitted.I'm beginning to suspect that Italy has a mutated strain, which may have been transmitted to NYC during that Friday rush back to the US. Thousands of people in the airports crowded together.
 
NJWxMan said:
I work at a hospital outside of NYC and about 3/4 of the ED visits are COVID related. No extreme surges but our hospital is steadily filling with COVID cases. Sustainable for another 2 weeks? Sure. Sustainable for a month? Unlikely. I have co-workers that tested positive and attempted to push through it at home and ended up admitted.I'm beginning to suspect that Italy has a mutated strain, which may have been transmitted to NYC during that Friday rush back to the US. Thousands of people in the airports crowded together.
Click to expand...

Oh. No. We are all going to die.
 
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