What do I need to know about coronavirus?

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doctalaughs said:
I have no idea what you are trying to say or your point.
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you're demonizing the president using some hypothetical phone call example

I thought my point was obvious...no?
 
Dr Mantis Toboggan said:
I suppose all those of us nearer to the heartland can do is prepare and look to the coasts to see what might happen where we live and work. Might be nice to have a thread that focuses on pure medicine, operational strategies, and what people are actually seeing, with less discussion on politics/media etc.
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This is SDN... not gonna happen...
 
bravotwozero said:
My memory of biostatistics is a bit hazy. Forgive me for asking, but R0 is the asymptomatic period? Does a higher R0 mean a disease is deadlier?
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sph.umich.edu

R0: How Scientists Quantify the Intensity of an Outbreak Like Coronavirus and Its Pandemic Potential | The Pursuit | University of Michigan School of Public Health | Coronavirus | Pandemic

R0 is the number of cases, on average, an infected person will cause during their infectious period. Michigan Public Health professor of Epidemiology, Joe Eisenberg, explains how scientists quantify the intensity of outbreaks like the coronavirus.
sph.umich.edu sph.umich.edu
 
Birdstrike said:
Since we can’t test asymptomatic & subclinical cases we don’t know the denominator of the equation (death rate = infection deaths/infection deaths + infection survivors). If the denominator is falsely low, the death rate is falsely high. I’ve already posted this numerous times on this thread and it’s obvious, it should be common sense to anyone paying attention or with a background in healthcare and statistics, like all physicians should have. It’s the last time I’m typing it out.

Since we don’t have tearing fully online, US Covid-19 death rates are currently unreliable and will change, since they are false until testing is widely available.

Regardless, I’ll take your bait. If a virus with a lower “death rate” kills 18,000 and the one with the higher death rate kills 40, I sure as hell wouldn’t want the one that kills 18,000 in my population regardless of how much you like the “death rate.” Even if the US Covid-19 problem gets 10 times worse (400 deaths) or 100 times worse (4,000) deaths, it’s still less severe than past outbreaks that didn’t “collapse our health system,” “turn us into Italy,” of fulfill any of the other preposterous predictions or hysteria you and others are so irresponsibly spreading to your patients, families, general public and yourself.
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Except that is our very job.

Everyone else in the healthcare system focuses on what is "most likely." It is our job to focus on "worst case scenario."

Sure most cases of chest pain turn out to be GERD, or shoulder pain, or costochondritis, but we still think first of MI.

That sixty year old smoker with back pain probably has just back pain, but we think about dissection.

I believe you are doing pain medicine, I don't know if it is purely interventional, but I bet if a 60 year old woman who is on 30 mg of oxycodone and 2mg of Xanax you aren't keeping her on that, despite the fact she has been stable on that for 20 years.

It is the job of the EM physician to always focus on the "worst case" scenario and have his mind working on how to address that, be it in the case of a specific patient, or the hospital/system as a whole. If you are an EM physician you had better be focused on the worst case scenario and be working out in your mind how you will handle it. It ins't likely, but that is the whole point of the specialty.

About twenty years ago we were hit with a string of tornadoes. Had dermatologists in the ED. Guess what? We had thought of that exact scenario six months earlier. There hadn't been a tornado in the city for fifty years, but guess whose job it was to think that it might happen?
 
WilcoWorld said:
As a Board Certified Emergency Physician, I'll say that I don't think being a BCEP makes me more expert than a resident [any field] on the epidemiology of a viral pandemic or on what the public policy response should be - with the possible exception of the application of that policy to my particular ED.
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This.

Until just recently, most physicians had very little reliable epidemiology to make proclamations about this pandemic. Yet, there are some attendings here screaming about the falling sky and others saying it's nothing more than a mild seasonal viral infection. Both of these require a lot of hubris.

One of the most attractive aspects of the EM community, to me, is the humble nature that we must assume as acute care generalists. Yet, in this thread there are multiple posts expressing their beliefs with authority or an implied sense of expertise. I highly doubt, as great as this sub-forum is, that we have multiple EM attendings who are also epidemiologists, biostaticians, or ID docs.

I believe we must accept what the experts have to say and apply this to our local hospitals/ED in collaboration with local public health officials.

I don't mean to sound like a sanctimonious d!ck here, but some of this politicized back-and-forth is embarrassing.

HH
 
WilcoWorld said:
As a Board Certified Emergency Physician, I'll say that I don't think being a BCEP makes me more expert than a resident [any field] on the epidemiology of a viral pandemic or on what the public policy response should be - with the possible exception of the application of that policy to my particular ED.
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After treating thousands of flu and virus patients it certainly does. I don't think someone in residency training has a similar grasp of our public health systems, hospital administration, and national health policy.
 
ShockIndex said:
sph.umich.edu

R0: How Scientists Quantify the Intensity of an Outbreak Like Coronavirus and Its Pandemic Potential | The Pursuit | University of Michigan School of Public Health | Coronavirus | Pandemic

R0 is the number of cases, on average, an infected person will cause during their infectious period. Michigan Public Health professor of Epidemiology, Joe Eisenberg, explains how scientists quantify the intensity of outbreaks like the coronavirus.
sph.umich.edu sph.umich.edu
Click to expand...

That was very informative, and I thank you posting the link. However, that article states the R0 for COVID can range from 1.4-4.08! That's quite the range, making it not possible to get a real grasp on mortality predictions....
 
doctalaughs said:
No one claims Trump or Pence knows what a primer is.

However, it would have helped if at that time of this CDC decision - Trump wasn’t telling everyone publicly that this was a hoax, that we have the situation under great control and that he’s already done a great job at containment.



It’s still mind boggling to me that a country 1/6 our size and power how now ramped up today to producing several million accurate tests per day (supplying many other countries) for the cost of 20 dollars a kit; We are still dicking around trying to get a thousand tests a day run without errors at 250 a kit. Incompetent at all levels.
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The bolded part never happened. Trump never referred to the virus as a hoax. That lie came from Mike Bloomberg during an 60 Minutes interview and was immediately corrected by Scott Pelley.

www.factcheck.org

Trump and the 'New Hoax' - FactCheck.org

President Donald Trump accused the Democrats of "politicizing" the new coronavirus, calling it "their new hoax." Even after Trump explained his remarks, some Democrats -- including Mike Bloomberg -- continued to wrongly accuse Trump of describing the coronavirus as a "hoax."
www.factcheck.org www.factcheck.org

I’m no Trump fan; didn’t vote for him and wish that we had more competent leadership in the Oval Office. However, a big part of the problem is people repeating bull**** on the internet and then accusing people of being incompetent - ironic.

I spent 17 years working for the federal government - military and DOJ. From my perspective, the mobilization of national will over the last 6 weeks is simply staggering. For a little perspective, it took until 10/7 for the first combat troops to start putting boot to ass after 9/11...
 
Vandalia said:
Except that is our very job.

Everyone else in the healthcare system focuses on what is "most likely." It is our job to focus on "worst case scenario."

Sure most cases of chest pain turn out to be GERD, or shoulder pain, or costochondritis, but we still think first of MI.

That sixty year old smoker with back pain probably has just back pain, but we think about dissection.

I believe you are doing pain medicine, I don't know if it is purely interventional, but I bet if a 60 year old woman who is on 30 mg of oxycodone and 2mg of Xanax you aren't keeping her on that, despite the fact she has been stable on that for 20 years.

It is the job of the EM physician to always focus on the "worst case" scenario and have his mind working on how to address that, be it in the case of a specific patient, or the hospital/system as a whole. If you are an EM physician you had better be focused on the worst case scenario and be working out in your mind how you will handle it. It ins't likely, but that is the whole point of the specialty.

About twenty years ago we were hit with a string of tornadoes. Had dermatologists in the ED. Guess what? We had thought of that exact scenario six months earlier. There hadn't been a tornado in the city for fifty years, but guess whose job it was to think that it might happen?
Click to expand...
We consider the "Worst Case Scenario" but always do a likelihood assessment. We don't admit every pediatric rash because the "worst case scenario" is early meningococcemia with no likelihood assessment. We don't call the CDC every time we see the flu and say, "I saw a lot of flu this year. The worst case scenario is that this is the beginning of the next 50 million death Spanish flu epidemic." Because I can alway think of a more severe, very unlikely worst case scenario. Even though 1.5 million Americans dying from COVID-19 is a once in a century disaster, it's not the worst case scenario. 1.5 million dying from COVID-19 then having our current flu season blossom into a Spanish flu at the same time where an additional 1/3 of the US population dies, would be worse, however unlikely. Although that's an exceedingly unlikely but really possibility, we're not going to take drastic action because our risk benefit assessment tells us we shouldn't.
 
Hamhock said:
I don't mean to sound like a sanctimonious d!ck
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Are you sure about that?

Hamhock said:
Until just recently, most physicians had very little reliable epidemiology to make proclamations about this pandemic. Yet, there are some attendings here screaming about the falling sky and others saying it's nothing more than a mild seasonal viral infection. Both of these require a lot of hubris.

One of the most attractive aspects of the EM community, to me, is the humble nature that we must assume as acute care generalists. Yet, in this thread there are multiple posts expressing their beliefs with authority or an implied sense of expertise. I highly doubt, as great as this sub-forum is, that we have multiple EM attendings who are also epidemiologists, biostaticians, or ID docs.
Click to expand...
I'll tell you how I was almost immediately and easily able to tell that predictions of, "1.5 million Americans dying this year from COVID-19" and people predicting (on March 10th) "In 10 days the American health system will collapse like Italy," were false, without having any experience in epidemiology, biostatistics or infectious disease, aside from my medical education and life experience. In fact, I was better able to assess the situation than the experts in those fields that made those predictions. I was able to do so because:

1) Social media panic, 2) Experts being bad at predicting the future, and 3) Media exaggerations for ratings and profit are exceedingly common, whereas, 4) Things that happen once in a century (super-plagues that shut down the American health system due to once-in-a-century deaths counts) are exceedingly uncommon.

It's that simple. I could see immediately see that those three very common sources of exceedingly bad information were driving this, and trying to convince me that #4, which I know to be true beyond a shadow of a doubt, was false. It was easy. Why other people couldn't see it, I don't know. But we'll know in another 7 days if I was right on the second prediction (America falling apart likely Italy). The first prediction, COVID-19 deaths per year, is going to take another 10 months to assess, but two months in we're at 50 American COVID-19 deaths, and the garbage information sources are 1,499,950 short of being correct.
 
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I just fear the economic fallout will be so much worse than this virus. People will start to lose their jobs, housing, and savings as job sites close. I fear a bigger public health impact from this.
 
To all fellow doctors, nurses, and health workers across the globe - this is an extremely serious pandemic which will last at least 6-24 months. You are all the front line of defense. Please remember to take care of yourself as best you can. (No, the warmer weather will do nothing to prevent the spread of the virus, that is an absolute myth)

All healthcare systems will begin to collapse over the next few months. The US healthcare system is definitely not any better than Italy's, the latter having one of the best healthcare systems in the world. Most medications and medical supplies are manufactured in China - resupply may not occur for months.

It is time for everyone to stop thinking that they are infallible, that the crisis isn't serious, and that it is just another flu. It isn't. And no, your medical system won't cope. Current predictions say that 480,000 Americans may die from this virus, with 90,000,000 infected, and 48,000,000 hospitalised (Source: CIDRAP)

I think that the only thing we can do now, is to act re-actively until herd immunity is reached.
 
lifeisamystery said:
To all fellow doctors, nurses, and health workers across the globe - this is an extremely serious pandemic which will last at least 6-24 months. You are all the front line of defense. Please remember to take care of yourself as best you can. (No, the warmer weather will do nothing to prevent the spread of the virus, that is an absolute myth)

All healthcare systems will begin to collapse over the next few months. The US healthcare system is definitely not any better than Italy's, the latter having one of the best healthcare systems in the world. Most medications and medical supplies are manufactured in China - resupply may not occur for months.

It is time for everyone to stop thinking that they are infallible, that the crisis isn't serious, and that it is just another flu. It isn't. And no, your medical system won't cope. Current predictions say that 480,000 Americans may die from this virus, with 90,000,000 infected, and 48,000,000 hospitalised (Source: CIDRAP)

I think that the only thing we can do now, is to act re-actively until herd immunity is reached.
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Thank you for your concerns. We’re aware of what’s happening around the world and at home and we’re taking precautions.
 
calvnandhobbs68 said:
Half of all ICU cases in France right now are <50yo. I suspect this is influenced by the fact that they all smoke like chimneys in France but still.
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Edit: Double post deleted
 
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pollyspockets said:
I just fear the economic fallout will be so much worse than this virus. People will start to lose their jobs, housing, and savings as job sites close. I fear a bigger public health impact from this.
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I’m right there with you.
 
Confucius say...
The “fear” of something.... is usually much worse than the actual thing you’re fearing!!
 
Birdstrike said:
Thank you for your concerns. We’re aware of what’s happening around the world and at home and we’re taking precautions.
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Unless you have anything beneficial to add, it would be better for you to stop posting and allow people to provide the information they have.

Your sarcasm and arrogance aren't appreciated.
 
lifeisamystery said:
Wow. I didn't realise this forum was so full of arrogant ****wits - great qualities to have in fighting this virus.
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the second time you call someone arrogant in a grand total of 4 posts
 
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lifeisamystery said:
Unless you have anything beneficial to add, it would be better for you to stop posting and allow people to provide the information they have.

Your sarcasm and arrogance aren't appreciated.
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I wasn’t being sarcastic. I honestly thought you were trying to be helpful and I meant what I said.
 
Listen2Savage said:
Image result for white guy blinking gif
right, Aussi lol whatever
220 × 153
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Hahahaha you are hilarious. You are arrogant and intellectually challenged - what an unfortunate combination.

Kiwis are from New Zealand you genius - perhaps didn't pass geography in primary school, but you have access to the internet right?

And yes, I've used "arrogant" three times.
 
Birdstrike said:
I wasn’t being sarcastic. I honestly thought you were trying to be helpful and I meant what I said.
Click to expand...

Others can't post their observations of the virus from other countries as you believe you have it under control. I see.
 
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bravotwozero said:
That was very informative, and I thank you posting the link. However, that article states the R0 for COVID can range from 1.4-4.08! That's quite the range, making it not possible to get a real grasp on mortality predictions....
Click to expand...

That article was published over a month ago and the R0 estimates for COVID-19 were largely derived from data just from China in January. I provided it simply because it is a good explanation of R0.

The updated R0 estimates for COVID using Chinese, European, and S. Korean data are settling around 2.3 prior to extreme social isolation precautions. More importantly, we can bend that R0 down to 1.1-1.3.

 
Kiwi premed SDN trolling check list

1) call someone "arrogant" whenever possible
2) misinterpret what people say, and then attack them for it!!!

check......and......check
 
thegenius said:
I can't tell anymore who is arguing against whom in this thread.

SDN for ya!

I'm trying to decide whether to buy a house or not right now. Anyone want to go over to the other thread and weigh in?

SDN - https://forums.studentdoctor.net/threads/real-estate-and-coronavirus-recession
Click to expand...

Heck yeah you should! Especially if you had enough to at least put 20% down, and planning on living there for a long time with a stable nearby job.


Sent from my iPhone using Tapatalk
 
www.sciencedirect.com

Investigating the impact of influenza on excess mortality in all ages in Italy during recent seasons (2013/14–2016/17 seasons)

In recent years, Italy has been registering peaks in death rates, particularly among the elderly during the winter season. Influenza epidemics have be…
www.sciencedirect.com www.sciencedirect.com


•
In the winter seasons from 2013/14 to 2016/17, an estimated average of 5,290,000 ILI cases occurred in Italy, corresponding to an incidence of 9%.

•
More than 68,000 deaths attributable to flu epidemics were estimated in the study period.

•
Italy showed a higher influenza attributable excess mortality compared to other European countries. especially in the elderly.


68,000 over 4 flu seasons is 17,000 per year in a population of 60 million (1/6th of the US). In the US, we would have to have 100,000 flu deaths a year for it to be equally deadly here. So, respiratory virus related deaths are just more severe there for whatever the reason may be.
 
calvnandhobbs68 said:
I screenshotted it bc I know NYT has a paywall but they post pretty frequent updates that have good info.

View attachment 298582
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Can you find confirmation of this "half under 50" stat? Because that would be an outlier from every other country in the world reporting data. Everyone else is reporting that severity, as measured by death, is proportional to advanced age. Why would France have a completely different age distribution that the rest of the world? No one is reporting anything like "half under 50, half over 50." I read the full article (incognito mode to bypass paywall) and they list no source at all. No WHO, France's equivalent of CDC, or anything to confirm where they got the information. I did my own search and no one else that I can find is reporting that. I can't find an age breakdown for France anywhere. I did find this source stating 96% of their cases were "Mild." Sloppy, unsourced reporting and not credible until proven otherwise.
 
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Birdstrike said:
Can you find confirmation of this "half under 50" stat? Because that would be an outlier from every other country in the world reporting data. Everyone else is reporting that severity, as measured by death, is proportional to advanced age. Why would France have a completely different age distribution that the rest of the world? No one is reporting anything like "half under 50, half over 50." I read the full article (incognito mode to bypass paywall) and they list no source at all. No WHO, France's equivalent of CDC, or anything to confirm where they got the information. I did my own search and no one else that I can find is reporting that. I can't find an age breakdown for France anywhere. I did find this source stating 96% of their cases were "Mild." Sloppy, unsourced reporting and not credible until proven otherwise.
Click to expand...

You're right, it does look like that may have been a mistranslation? The source for this appears to have been a public statement by the head of the French public health authority, Jerome Salomon. However all the other sources I'm seeing for this say 300 ICU cases so far, half under 60 (not 50). Still a decently younger skewing population based on what's been seen so far, but definitely not as drastic as under 50.

www.france24.com

Lockdown: France orders closure of restaurants and all 'non-essential' commerce to stem coronavirus

France has gone on lockdown after French Prime Minister Edouard Philippe ordered the closure of restaurants, cafés and all other "non-essential" commerce beginning at midnight on Saturday. Groceries,…
www.france24.com www.france24.com
www.reuters.com

France closes shops, restaurants, tells people to stay home

France will shut shops, restaurants and entertainment facilities from Sunday with its 67 million people told to stay home to help fight the rapid acceleration of the coronavirus in a country where the number of cases has doubled in 72 hours.
www.reuters.com www.reuters.com

So it looks like it's 300 ICU patients, half of which are under 60.
 
Birdstrike said:
Can you find confirmation of this "half under 50" stat? Because that would be an outlier from every other country in the world reporting data. Everyone else is reporting that severity, as measured by death, is proportional to advanced age. Why would France have a completely different age distribution that the rest of the world? No one is reporting anything like "half under 50, half over 50." I read the full article (incognito mode to bypass paywall) and they list no source at all. No WHO, France's equivalent of CDC, or anything to confirm where they got the information. I did my own search and no one else that I can find is reporting that. I can't find an age breakdown for France anywhere. I did find this source stating 96% of their cases were "Mild." Sloppy, unsourced reporting and not credible until proven otherwise.
Click to expand...
Death gets worse with age but that could easily mean that a lot of younger people are ending up the ICU but get better while the older folks don't.

the lack of any specific clinical information on all this is really starting to bug me
 
Large companies are using this as an excuse to lay off workers. For example, in Las Vegas MGM has been trying to drastically downsize its workforce despite healthy profits every quarter. They've had resistance from the Culinary union, but this virus gives them just the excuse to "temporarily lay off" workers as they close down restaurants, nightclubs, and concerts. Many of my friends who work in the industry are not going to be re-hired.

In the end the panic-induced economic damage will likely vastly exceed healthcare costs, or other direct harm from the virus.
 
Birdstrike said:
Can you find confirmation of this "half under 50" stat? Because that would be an outlier from every other country in the world reporting data. Everyone else is reporting that severity, as measured by death, is proportional to advanced age. Why would France have a completely different age distribution that the rest of the world? No one is reporting anything like "half under 50, half over 50." I read the full article (incognito mode to bypass paywall) and they list no source at all. No WHO, France's equivalent of CDC, or anything to confirm where they got the information. I did my own search and no one else that I can find is reporting that. I can't find an age breakdown for France anywhere. I did find this source stating 96% of their cases were "Mild." Sloppy, unsourced reporting and not credible until proven otherwise.
Click to expand...

Very typical for the New York Slimes.
 
GeneralVeers said:
Large companies are using this as an excuse to lay off workers. For example, in Las Vegas MGM has been trying to drastically downsize its workforce despite healthy profits every quarter. They've had resistance from the Culinary union, but this virus gives them just the excuse to "temporarily lay off" workers as they close down restaurants, nightclubs, and concerts. Many of my friends who work in the industry are not going to be re-hired.

In the end the panic-induced economic damage will likely vastly exceed healthcare costs, or other direct harm from the virus.
Click to expand...

The flip side is that this might be a good opportunity for ED attendings to push hospital admin to declare a moratorium on patient satisfaction surveys. The government has declared a state of emergency, hospital systems are starting to get saturated, we need to focus on appropriate utilization of resources, instead of directing them towards achieving 'patient satisfaction'.....
 
bravotwozero said:
The flip side is that this might be a good opportunity for ED attendings to push hospital admin to declare a moratorium on patient satisfaction surveys. The government has declared a state of emergency, hospital systems are starting to get saturated, we need to focus on appropriate utilization of resources, instead of directing them towards achieving 'patient satisfaction'.....
Click to expand...

HAAAAH ha ha ha ha!

For this to work, you have to assume admins care about anything other than their own greed.
 
yeah, but no satisfaction surveys mean no reimbursement/bonus cuts for the c suite. This might be in our mutual interest.
 
bravotwozero said:
The flip side is that this might be a good opportunity for ED attendings to push hospital admin to declare a moratorium on patient satisfaction surveys. The government has declared a state of emergency, hospital systems are starting to get saturated, we need to focus on appropriate utilization of resources, instead of directing them towards achieving 'patient satisfaction'.....
Click to expand...

I think this is something we can all unite behind.
 
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