What do I need to know about coronavirus?

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Recession was bound to happen, this just happens to be the background music.
erdoc00 said:
We can address the virus and implement reasonable precautions such as social distancing without causing widespread irrational panic and economic collapse.
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It was never realistic to test everyone like we do influenza. I don't see that capability happening in the US for a few weeks realistically (or even longer). With the potential shortage of the reagents and swabs, it just further underscores this.

Regarding the mortality rate, it is falsely elevated at this point. We don't have a true sense of the denominator. Ohio estimates they have 100,000 cases.

In my state, there are only ~700 confirmed cases. That number is realistically at least an order of magnitude higher.

At this point, we need to slow the spread just so the health system can react in order to minimize morbidity and mortality. We will be dealing with this well into summer.

The initial public panic is going to be replaced by general apathy as well. There is only so long the American public can shelter in place and be hypervigilant.

This is going to be a long couple of months coupled with a painful recession.
 
anonperson said:
It was never realistic to test everyone like we do influenza. I don't see that capability happening in the US for a few weeks realistically (or even longer). With the potential shortage of the reagents and swabs, it just further underscores this.

Regarding the mortality rate, it is falsely elevated at this point. We don't have a true sense of the denominator. Ohio estimates they have 100,000 cases.

In my state, there are only ~700 confirmed cases. That number is realistically at least an order of magnitude higher.

At this point, we need to slow the spread just so the health system can react in order to minimize morbidity and mortality. We will be dealing with this well into summer.

The initial public panic is going to be replaced by general apathy as well. There is only so long the American public can shelter in place and be hypervigilant.

This is going to be a long couple of months coupled with a painful recession.
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There is a good NY Times article on this too, that people can shelter only for so long. Hopefully you can read it:

Opinion | The Single Most Important Lesson From the 1918 Influenza
 
thegenius said:
There is a good NY Times article on this too, that people can shelter only for so long. Hopefully you can read it:

Opinion | The Single Most Important Lesson From the 1918 Influenza
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Can't read the whole thing due to a pay-wall, but the first paragraph has some inaccurate, or exaggerated statements:

"But it is far more lethal than 2009’s H1N1 (swine flu) pandemic, and the coronavirus does not resemble SARS, MERS or Ebola, all of which can be easily contained."

I think it's doubtful and yet-to-be-determined that it's more "lethal" than the H1N1 which could have had up to 579,000 deaths. So far we area long way from that number of deaths worldwide. It would have to ramp up significantly in China, the US and Europe to even approach that number. Although this could be the typical journalistic practice of using words like "lethal" as a way of juicing up their story.
 
You guys seeing drug shortages yet? I got an email yesterday that we are running very low on fentanyl at my hospice.
 
TheSingularity said:
What do you guys plan on doing if PPE supplies run out? Honestly, I don't think I will come to work.

Sent from my Pixel 3 using SDN mobile
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Well given that I'm under 70 with no pre-existing lung conditions I'm not going to worry. Despite the anecdotal evidence, the stats show the risk of critical illness or death is low. Maybe a good opportunity for my over-60 colleagues to leave the profession.....
 
thegenius said:
I think that news actually came out days ago? Didn't two of them become critically ill?
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I'm pretty sure they're different. The two that are critical are the guys in Wash and NJ who seem to have gotten it from patients, whereas the five are suspected to have gotten it at a conference. There was a recent update on the guy in NJ who they're saying is, "Critical but stable," and apparently stable enough to consent to "share his name and condition so it may encourage others to come forward and get tested." Maybe someone can fact check us on that.

Regardless, it's probably moot at this point since, despite the fact that I will take precautions as if I'm never going to get it or spread it, it likely we all probably are going to get this at some point, if not at work, through community spread. Preventing us from all getting it at once is a worthy goal, I suppose.
 
Birdstrike said:
Preventing us from all getting it at once is a worthy goal, I suppose.
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I sometimes wonder if we should just put our hands up in the air and “give up”, allow people to move around freely and let the virus do what it’s gonna do. It’s going to infect us all as you said.

I guess we can’t because it will overwhelm our hospital system like it did in Italy, causing even more deaths.

Boy o boy what a decision
 
d2305 said:
As far as economic stimulus is concerned, the Austrian School has the right philosophy. Everything the government does is wrong.
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It doesn’t matter unfortunately. The academics think they can save us from market forces. The problem is systemic. Perpetual debt isn’t sustainable.
 
what else do you need to know: if you dont have the ability to perform outpatient testing (most hospitals in america will fall into this basket) EVERY SINGLE CONSULTANT will send you everyone with a fever for covid testing. testing you cant do because they dont need to be admitted. and then they will go back to their outpatient providers because you'll tell them thats the only way* to get outpatient testing and they'll caugh their plague all over the waiting room there twice.

* this is changing. Counties are starting to make places for the public to get mass-tested. and thats whats going to break the scary cycle of PCPs refusing to perform the swab and hospitals not allowing us to perform it on non-admitted patients.
 
DocEspana said:
what else do you need to know: if you dont have the ability to perform outpatient testing (most hospitals in america will fall into this basket) EVERY SINGLE CONSULTANT will send you everyone with a fever for covid testing. testing you cant do because they dont need to be admitted. and then they will go back to their outpatient providers because you'll tell them thats the only way* to get outpatient testing and they'll caugh their plague all over the waiting room there twice.

* this is changing. Counties are starting to make places for the public to get mass-tested. and thats whats going to break the scary cycle of PCPs refusing to perform the swab and hospitals not allowing us to perform it on non-admitted patients.
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In my group, PCPs have started swabbing and sending to LabCorp bypassing the state labs. But we're screening prior to arrival (on their scheduling phone call if able) and if they need a test they're not allowed in the waiting room. They're sent around to a back door where we've designated a room way in the back by the door, for only that. When done, they go back out the back door and never go through he main lobby or hallways. Everyone else here for any other reason, gets a temp at the front door as a screen. We have community spread here (*pause to blow nose*) with confirmed cases less than a mile away, so I'm assuming I'm already exposed.
 
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I didn't know we even had these. Should help

"Trump Deploying Navy Hospital Ship To NYC As Virus Surges
By Jeff Overley
(March 18, 2020, 11:58 AM EDT) -- New York Gov. Andrew Cuomo on Wednesday announced that President Donald Trump has agreed to immediately dispatch a Navy hospital ship to New York City as it wrestles with a surging number of coronavirus infections.

"It's an extraordinary step, obviously," Cuomo said at a Wednesday morning news conference. "It's literally a floating hospital, which will add capacity, and the president said that he would dispatch that immediately."

The ship, which will dock in New York Harbor, is called the USNS Comfort and has about 1,000 rooms, the governor said. As of Tuesday afternoon, the city had confirmed about 815 coronavirus cases — roughly 15% of the estimated national tally."
 
Birdstrike said:
In my group, PCPs have started swabbing and sending to LabCorp bypassing the state labs. But we're screening prior to arrival (on their scheduling phone call if able) and if they need a test they're not allowed in the waiting room. They're sent around to a back door where we've designated a room way in the back by the door, for only that. When done, they go back out the back door and never go through he main lobby or hallways. Everyone else here for any other reason, gets a temp at the front door as a screen. We have community spread here (*pause to blow nose*) with confirmed cases less than a mile away, so I'm assuming I'm already exposed.
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yeah Im single-handedly responsible for multiple + cases in my county and probably numerous others who i quarantined.
 
Update on PPE shortage:

"Trump to invoke Defense Production Act to expand production of hospital masks and more
https://www.cnn.com/profiles/maegan-vazquez
By Maegan Vazquez, CNN

Updated 12:19 PM ET, Wed March 18, 2020

(CNN) President Donald Trump said during Wednesday's White House press briefing that he will be invoking the Defense Production Act.
'Right after we finish this conference, I'll be signing it and it's prepared to go,' Trump said.
CNN reported last month that the Trump administration was considering using the 1950 wartime law to expand the production of masks and protective gear to prevent the spread of the virus.
This story is breaking and will be updated."
 
thegenius said:
I sometimes wonder if we should just put our hands up in the air and “give up”, allow people to move around freely and let the virus do what it’s gonna do. It’s going to infect us all as you said.

I guess we can’t because it will overwhelm our hospital system like it did in Italy, causing even more deaths.

Boy o boy what a decision
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Seems a bit early to get fatalistic about this. We are still acting in darkness, but we get more data every day. At some point it may become clear that our interventions are not going to work, or that they're too costly to warrant continuing. WE ARE NOT THERE YET.

For now, I favor the Golden Mean - take the actions that seem likely to help (slowing spread to prevent overwhelming out systems) with the understanding that they will come at a cost (inconvenience, lost money).

I want to remind everyone that, though this is VERY serious, things are still pretty good. Think about the following:

1 - I'm still able to get on SDN and argue with @Birdstrike and today I'm gonna watch a classic movie with my kids on Netflix. It's amazing to me how convenient it is to shelter in place.
2 - At the moment I type this post the stock market is up 9% from where it was 5 years ago. Noone on this forum is going to become homeless because of COVID 19.
3 - If we, as a society, manage to keep calm and work together, we'll make it through this and hopefully learn some valuable lessons.
 
New York is reporting over 2,000 cases including over 500 who have been hospitalized.
 
We will not go quarantine for more than 8 weeks nope not worth it.

The “cure” is worse than the disease we would be better off isolating 70/80 year olds and mass produce p100 masks and ramp up testing which would be far more feasible and less costly than quarantine
 
Brigade4Radiant said:
We will not go quarantine for more than 8 weeks nope not worth it.

The “cure” is worse than the disease we would be better off isolating 70/80 year olds and mass produce p100 masks and ramp up testing which would be far more feasible and less costly than quarantine
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This is essentially what Denmark has done. Will be interesting to see the comparative results.
 
Brigade4Radiant said:
We will not go quarantine for more than 8 weeks nope not worth it.

The “cure” is worse than the disease we would be better off isolating 70/80 year olds and mass produce p100 masks and ramp up testing which would be far more feasible and less costly than quarantine
Click to expand...

I agree completely. Complete, mass quarantine can't go on longer than 2 weeks. At that point without salary, jobs, entertainment, or booze people will start to rebel. An advanced economy can't survive near total shutdown for months at a time and still be advanced afterward.

CNN had a story yesterday where they revealed details of EVERY death in the country. Essentially no one under 50 has died, and the vast, vast majority of them were over 70 with pre-existing conditions. I maintain again that our focus should be on quarantining and isolating the sub-section of the population who are actually vulnerable to this disease, rather than destroying our economy and ruining the lives of every American.
 
What's the real level of isolation we need? It sounds like the current guideline most hospitals are putting out, "droplet for everyone except airborne precautions for critical/aerosol producing procedures" is wrong. If there's airborne transmission when I intubate, there's airborne transmission when the patient coughs, sneezes, or breathes, right?

What makes surgical/procedure masks appropriate all in this situation?
 
Interesting if you look at the infection rates in China, Italy, and South Korea who are all a few weeks ahead of us in the course of this disease, it's a similar story. About 2 weeks of rapidly increasing infection rates (as testing ramps up), followed by a brief peak, and rapid decline. It's about a 30-day cycle for them all. Based on the current graphs, we should have a massive increases in cases this week, followed by a steep decline the following week.
 

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Backpack234 said:
What's the real level of isolation we need? It sounds like the current guideline most hospitals are putting out, "droplet for everyone except airborne precautions for critical/aerosol producing procedures" is wrong. If there's airborne transmission when I intubate, there's airborne transmission when the patient coughs, sneezes, or breathes, right?

What makes surgical/procedure masks appropriate all in this situation?
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Due to a severe shortage of even surgical masks, a critical access hospital I work at was refusing to give nurses even surgical masks. Doctors had to bring our own N-95s and we have to do the nasal swabs (since there was no PPE for nurses).
 
Why is testing so important? What does a positive test change at this point?
 
TooMuchResearch said:
We're arranging to do telehealth from within our department if needed.
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We were just talking about this, literally minutes ago at my outpatient shop. Our group is setting up group facebook messenger accounts we can all use and we're going to Telehealth that way. Providers also given the option to use face-time if they want patients to have their cell # (Lol, what could go wrong!)
 
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GeneralVeers said:
Interesting if you look at the infection rates in China, Italy, and South Korea who are all a few weeks ahead of us in the course of this disease, it's a similar story. About 2 weeks of rapidly increasing infection rates (as testing ramps up), followed by a brief peak, and rapid decline. It's about a 30-day cycle for them all. Based on the current graphs, we should have a massive increases in cases this week, followed by a steep decline the following week.
Click to expand...

That's because each of those 3 countries took huge quarantining efforts, like locking down the whole region (China), locking down the whole country (Italy), or doing mass testing and quarantining anyone with a positive result (South Korea).

We are not doing any one of those 3 things. We are taking some steps to minimize interaction with social distancing, yes, but it is to be determined if that will result in the same change in the incidence curve as what has been seen in those other 3 countries. It certainly could, as we started distancing at an earlier timepoint than those 3 countries, but we'll have to see what the daily infection rate is before we make any judgements.

You only see the steep decline in the curve a few days after drastic measures are taken.
 
evilbooyaa said:
That's because each of those 3 countries took huge quarantining efforts, like locking down the whole region (China), locking down the whole country (Italy), or doing mass testing and quarantining anyone with a positive result (South Korea).


You only see the steep decline in the curve a few days after drastic measures are taken.
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That's to be determined. Is the steep decline because of drastic measures, or because the infection burns itself out? We shall see in about 1.5 weeks what the curve looks like.
 
GeneralVeers said:
That's to be determined. Is the steep decline because of drastic measures, or because the infection burns itself out? We shall see in about 1.5 weeks what the curve looks like.
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There's got to be a limit to how much drastic social distancing and quarantines help once the whole environment's coated in the ****. With it turning out that the virus lives on surfaces 6 days and in air for hours, it's got to be from it burning out and herd immunity developing.

And for your entertainment, we've already had several a$slords here lie about travel history and expose entire hospital wards while threatening to sign out AMA before they crumped and went into multi-organ system failure. Also, just had a pcp come into my office and tell me how "short of breath and chilled" she feels after having sent a post-cruise, coughing, febrile, hypoxic patient to the ED. Why she tryna kill me
 
TwoHighways said:
It doesn’t matter unfortunately. The academics think they can save us from market forces. The problem is systemic. Perpetual debt isn’t sustainable.
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That is true. Our impressive growth recently due to, in large part, massive purchasing (or acquisition) of debt.
 
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Brigade4Radiant said:
We will not go quarantine for more than 8 weeks nope not worth it.

The “cure” is worse than the disease we would be better off isolating 70/80 year olds and mass produce p100 masks and ramp up testing which would be far more feasible and less costly than quarantine
Click to expand...

That is the Vulcan way of looking at it and Star Trek has taught us over and over that humans are not logical!!!

Picard should be the president of the country right now. **** would get done and we would all rally with confidence under our fearless leader.
 
evilbooyaa said:
That's because each of those 3 countries took huge quarantining efforts, like locking down the whole region (China), locking down the whole country (Italy), or doing mass testing and quarantining anyone with a positive result (South Korea).

We are not doing any one of those 3 things. We are taking some steps to minimize interaction with social distancing, yes, but it is to be determined if that will result in the same change in the incidence curve as what has been seen in those other 3 countries. It certainly could, as we started distancing at an earlier timepoint than those 3 countries, but we'll have to see what the daily infection rate is before we make any judgements.

You only see the steep decline in the curve a few days after drastic measures are taken.
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Agreed...and the recent economic data out of China is abysmal right now.
 
Word on the street is that the death data out of Germany is not to be taken seriously. Apparently they are only counting a coronavirus death if the patient had no comorbidities. If 1000 people over there die of Covid but 990 of them had CVD, DM, etc, then the official number of deaths will be listed as 10.
 
thegenius said:
Agreed...and the recent economic data out of China is abysmal right now.
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I'm not arguing the economic angle. I'm trying to stay away from 'is it worth it' discussions although I know others would like to have them.

Just wanted to put some information down on a few posters ITT who have extreme confidence to say 'x must be so because of y, and I am stating my opinion as fact and therefore we shouldn't bother with this anymore because of a, b, c reasons'.
 
Money-Moniker said:
Word on the street is that the death data out of Germany is not to be taken seriously. Apparently they are only counting a coronavirus death if the patient had no comorbidities. If 1000 people over there die of Covid but 990 of them had CVD, DM, etc, then the official number of deaths will be listed as 10.
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Yea and China is not reporting any new cases or deaths. Is that believable?!?!?!
 
Money-Moniker said:
Word on the street is that the death data out of Germany is not to be taken seriously. Apparently they are only counting a coronavirus death if the patient had no comorbidities. If 1000 people over there die of Covid but 990 of them had CVD, DM, etc, then the official number of deaths will be listed as 10.
Click to expand...

You know, this is an interesting point. Are we only counting it a coronavirus death if the primary cause is the viral pneumonia? Is it still a coronavirus death if an 89 year old had a fever for 3 days due to coronavirus, comes to ED with chest pain, a STEMI and codes? In the latter case, you can't say the cause of death was the virus.
 
zurned said:
You know, this is an interesting point. Are we only counting it a coronavirus death if the primary cause is the viral pneumonia? Is it still a coronavirus death if an 89 year old had a fever for 3 days due to coronavirus, comes to ED with chest pain, a STEMI and codes? In the latter case, you can't say the cause of death was the virus.
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It ultimately comes down to the the clinical judgement of who fills out the death certificate and what cause of death they write down.
 
GeneralVeers said:
I agree completely. Complete, mass quarantine can't go on longer than 2 weeks. At that point without salary, jobs, entertainment, or booze people will start to rebel. An advanced economy can't survive near total shutdown for months at a time and still be advanced afterward.

CNN had a story yesterday where they revealed details of EVERY death in the country. Essentially no one under 50 has died, and the vast, vast majority of them were over 70 with pre-existing conditions. I maintain again that our focus should be on quarantining and isolating the sub-section of the population who are actually vulnerable to this disease, rather than destroying our economy and ruining the lives of every American.
Click to expand...

While I agree with the info posted here, the one unclear question that has a lot of us worried doesn’t have a clear answer - How many young, healthy adults with COVID-19 end up in the icu on a ventilator? Not die, but develop ARDS and respiratory failure. Based on the Italian/French/Spanish experience, this seems like a sizable number of people...


Sent from my iPhone using Tapatalk
 
GeneralVeers said:
Due to a severe shortage of even surgical masks, a critical access hospital I work at was refusing to give nurses even surgical masks. Doctors had to bring our own N-95s and we have to do the nasal swabs (since there was no PPE for nurses).
Click to expand...

I spent $150 yesterday to buy my own ppe. I'll have my own N95s and i even ordered one of the proper reusable masks with changeable filters in case the contagion gets significantly worse.
 
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