What do I need to know about coronavirus?

[Birdstrike]

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Just to reemphasize the weirdness of this thing, not a single neonate has been killed or even seriously sickened by coronavirus, and to the best of my knowledge its not clear that being immunodeficient is a risk factor for poor outcomes.

If anyone can make sense of that you will probably get the MacArthur award.

Not only no US neonates dead or in the ICU, no one even under age 20, with nearing 10,000 cases (see my above CDC post) in US. It's directly correlated with age and even more so, code status (85+). Note, the deaths correlate with age, yet admissions and hospitalizations drop off over a certain age, I suspect because many of those are likely DNR patients who die in the nursing home because their DNR orders prevent aggessive care, admission and/or intubation

 

[TwoHighways]

Not only no US neonates dead or in the ICU, no one under age 20, with nearing 10,000 cases (see my above CDC post) in US. It's directly correlated with age and code status.

I wonder if chronic inflammation has a hand in this. Would be interesting to see fibrinogen and C-reactive protein levels at baseline of those that ended up with poor outcomes. Would make sense given the link to those with heart disease succumbing at disproportionate rates relative to others. All the more reason why anyone interested in real public health should be on the minimizing insulin area under the curve approach to health and longevity.

 

[Birdstrike]

I wonder if chronic inflammation has a hand in this. Would be interesting to see fibrinogen and C-reactive protein levels at baseline of those that ended up with poor outcomes. Would make sense given the link to those with heart disease succumbing at disproportionate rates relative to others.

Good question. Because the first thought is that the age correlation is due to lung status, which does worsen with age. But there's also enough of that at the other extreme of the age spectrum you'd think we'd see some severe cases in those kids by now, and we haven't. What correlates only with age, but not pulmonary function? If inflammation, why not in kids with pediatric rhematologic disease, JRA, etc?

 

[Birdstrike]

CNN has its own breakdown and has listed the actual ages, of the known deaths (below). I don't see a single one under 50 of those who's ages are known, on this list. The CDC graph I posted 3 posts above does allude to what looks like 1 person in the 20-44 age group (0.1-0.2% CFR of 705 cases, which comes out to a range of 0.1-1.4 people, so obviously, 1 person). It will go higher, but that's one so far age 44 or under, in a country of 331,000,000 people. If you include the CDCs 3 deaths in the 45-54 age group (429 cases x 0.005-0.008 [CFR of 0.5-0.8] = 3 people). So, that's 4 people 54 and under (will go higher), that have died so far, after over 11,000 infections (likely at least 6x's more untested and increasing) in a country of 331,000,000 people. It's too many of any age group, obviously, and many more are ill and requiring care and stressing the system, but that's the numbers so far in the age groups here in the States, per CDC.






"Death toll state by state
CALIFORNIA: 14
- A patient in Placer County who had underlying health conditions was the first coronavirus-related death in the state.
The person, described as elderly, was likely exposed while traveling February 11-21 on a Princess cruise ship that was going from San Francisco to Mexico, according to Placer County Public Health. The patient had been in isolation at Kaiser Permanente Roseville Medical Center.
- An "older adult" woman who was hospitalized for a respiratory illness died March 9 in Santa Clara County.
- A woman in her 60s died in Santa Clara County. The woman was hospitalized for several weeks and is believed to have contracted the virus through community transmission, the county's health department said.
- A resident of Sacramento County who had underlying health conditions and was in an assisted living facility, the county public health department said. A county official told CNN the resident was in their 90s.
- A woman in her 60s who was visiting friends died in Los Angeles County. She had a history of extensive travel, including a long layover in South Korea, according to Barbara Ferrer, director of public health for Los Angeles County.
- A person was reported dead in San Mateo County on March 15.
- A Sacramento County resident who was older than 70 and suffered from underlying health conditions.
- A person in Santa Clara County.
- A person in Santa Clara County.
- A person in Riverside County.
- A person in Riverside County.
- A person in Riverside County.
- A man in his 60s died in San Benito County on March 16. He had traveled to Thailand and had an underlying health condition.
- A man in his 50s who was hospitalized died on March 17.

COLORADO: 2
- A woman in her 80s who lived in El Paso County.
FLORIDA: 6
- A patient died in Santa Rosa County following an international trip.
- A person in their 70s who tested presumptive positive in Lee County following an international trip.
- Three people who lived at assisted living facilities died in Fort Lauderdale. The deaths happened at separate facilities and each of them had different levels of symptoms.
- A 77-year-old man linked to an assisted living facility in Broward County died. He had "significant" underlying medical problems, health officials said.

GEORGIA: 1
- A 67-year-old man who was hospitalized at WellStar Kennestone Hospital in Marietta since he tested positive for coronavirus on March 7.
ILLINOIS: 1
- A woman in her 60s with an underlying condition who lived in Chicago. She had contact with an infected person.
INDIANA: 2
- A person over the age of 60 died. The patient's significant other was also infected and they could only see each other through a video call.
- A person in their 60s died in Marion County.
KANSAS: 1
- A man in his 70s who lived in a long-term care facility in Wyandotte County died.

KENTUCKY: 1
- A 66-year-old man in Bourbon County died.
LOUISIANA: 4
- A 58-year-old who lived in Orleans Parish died. The patient, who had an underlying medical condition, was hospitalized at Touro Infirmary Hospital and Medical Center.
- A 53-year-old who lived in Orleans Parish died. The patient was hospitalized at Touro Infirmary Hospital and Medical Center.
- A woman in her 80s who lived at Lambeth House nursing home died.
- A person who lived in Orleans Parish died.
NEVADA: 1
- A man in his 60s who lived in Clark County died. He had been hospitalized and suffered an underlying medical condition.
NEW JERSEY: 3
- A 69-year-old man from Bergen County who was treated at Hackensack University Medical Center died March 10. He had a history of diabetes, hypertension, atrial fibrillation, gastrointestinal bleeding and emphysema, said Judith Persichilli, the state's health commissioner.
The man, who traveled regularly to New York City, had a heart attack a day before he died and was revived. He died after having a second heart attack.
- A woman in her 50s died after being hospitalized at Centra State Medical Center.
- A man in his 90s died after being hospitalized at Hackensack University Medical Center.

NEW YORK: 15
- An 82-year-old woman with emphysema died in a New York City hospital.
- A 79-year-old woman had been suffering from heart failure and lung disease before contracting the virus. She died in a New York City hospital.
- A 78-year-old man with multiple pre-existing conditions died in a New York City hospital.
- A 56-year-old man with diabetes died in a New York City hospital.
- A 53-year-old woman with diabetes and heart disease died in a New York City hospital.
- A patient died in a New York City hospital.
- A patient died in a New York City hospital.
- A 64-year-old person died in Rockland County on March 12. The patient had other "significant" health problems.
- A man in his 80s who had been in isolation at St. Catherine's Hospital in Suffolk County died.
- A man in his 90s who had been isolation at Huntington Hospital died.
OREGON: 2
SOUTH CAROLINA: 1
SOUTH DAKOTA: 1
- A man in his 60s with underlying medical conditions died, according to Kim Malsam-Rysdon, South Dakota's secretary of health.
TEXAS: 1
- A man in his 90s who lived in Matagorda County died.
VIRGINIA: 2
- A man in his 70s died from respiratory failure.
- A man in his 70s died in the state's Peninsula region.

WASHINGTON: 54
- A man in his 50s who was hospitalized at the EvergreenHealth Medical Center in Kirkland.
- A man in his 70s died February 29. He was hospitalized at EvergreenHealth and had underlying health conditions.
- A woman in her 80s died March 1. She had been in critical condition at EvergreenHealth.
- A woman in her 90s died March 3. She had been hospitalized at EvergreenHealth.
- A man in his 60s who visited Life Care Center died March 5.
- A person died in Snohomish County, said Heather Thomas, a spokeswoman with the Snohomish Health District.
- A person in Grant County.
- A woman in her 80s who lived at the Issaquah Nursing and Rehabilitation Center in Issaquah died March 8. She had been hospitalized at Swedish Hospital in Issaquah.
- A man in his 80s who lived at Ida Culver House, a retirement community in Seattle, died March 9. He was hospitalized at the University of Washington Medical Center.
- A man in his 80s who was "connected" to Josephine Caring Community, an assisted living facility in Snohomish County.
- A woman in her 90s who lived at the Redmond Care and Rehabilitation Center nursing home died March 10 after being hospitalized at EvergreenHealth.
- A person in Snohomish County.
- A man in his 80s died March 11. He was hospitalized at EvergreenHealth.
- A man in his 70s died March 9. He was hospitalized at Overlake Medical Center in Bellevue.
- A man in his 80s died March 11 at Swedish Hospital in Issaquah.
- A person died in Snohomish County.
- A person died in King County.
- A person died in King County.
- A person died in King County.
- A man in his 80s died March 15.
- A woman in her 70s died March 15.
- A man in his 80s died March 11.
- A woman in her 50s died March 8 at Harborview Medical Center.
- A woman in her 70s died March 14 at Northwest Hospital.
- A woman in her 90s died March 12. She lived at Redmond Care and Rehabilitation Center nursing home.
- Two people died in Clark County March 16, health officials from the county's health department said.
Life Care Center nursing home residents:
- A woman in her 70s died March 2. She was hospitalized at EvergreenHealth Medical Center.
- A man in his 70s died March 1 at EvergreenHealth and had underlying health conditions.
- A woman in her 70s died March 1 at EvergreenHealth. She had underlying health conditions.
- A woman in her 80s who was never hospitalized died at her family home February 26.
- A man in his 50s died February 26 after being hospitalized at Harborview Medical Center.
- A woman in her 90s died March 3 after being hospitalized at EvergreenHealth.
- A man in his 70s died March 2 after being hospitalized at EvergreenHealth.
- A woman in her 80s died March 5. She was hospitalized at Harborview Medical Center.
- A woman in her 70s died March 5. She was hospitalized at EvergreenHealth.
- A woman in her 80s died March 6. She was hospitalized at EvergreenHealth.
- A woman in her 80s died March 6. She was hospitalized at EvergreenHealth.
- A man in his 90s died March 5. He was hospitalized at Harborview Medical Center.
- A woman in her 80s died March 4. She was hospitalized at EvergreenHealth.
- A woman in her 90s died March 8. She was hospitalized at Harborview Medical Center.
- A woman in her 70s died March 8. She was hospitalized at EvergreenHealth.
- A woman in her 90s died March 3.
- A man in his 90s died March 5. He was hospitalized at EvergreenHealth.
- A woman in her 60s died March 9. She was hospitalized at EvergreenHealth.
- A woman in her 90s died March 6.
- A woman in her 90s died March 6.
- A woman in her 80s died March 4.
- A woman in her 60s died March 14. She was hospitalized at Franciscan Medical.
- A woman in her 70s died March 12."

 

[TwoHighways]

Good question. Because the first thought is that the age correlation is due to lung status, which does worsen with age. But there's also enough of that at the other extreme of the age spectrum you'd think we'd see some severe cases in those kids by now, and we haven't. What correlates only with age, but not pulmonary function? If inflammation, why not in kids with pediatric rhematologic disease, JRA, etc?

There’s certainly an immune component at hand. I don’t have the data, but my hunch is that the immune response to the virus is killing people more than the virus itself.

 

[deleted65604]

Just to reemphasize the weirdness of this thing, not a single neonate has been killed or even seriously sickened by coronavirus, and to the best of my knowledge its not clear that being immunodeficient is a risk factor for poor outcomes.

If anyone can make sense of that you will probably get the MacArthur award.

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.

 

[turkeyjerky]

I think it's far too early to make accurate conclusions about age-stratified death/hospitalization rates. With the limited testing so far available, we just don't know the actual number of cases yet. It'll be a more days or a week until it settles out a little better and we can draw conclusions.

 

[GeneralVeers]

Can you post a link?

Here's what we know about the 100 people who've died in the US from coronavirus | CNN

Dozens of people from their 50s to their 90s have died in the United States after contracting the novel coronavirus and the death toll continues rising.

www.cnn.com

Their stats are from 2-3 days ago so obviously could have changed.

 

[Birdstrike]

Here's what we know about the 100 people who've died in the US from coronavirus | CNN

Dozens of people from their 50s to their 90s have died in the United States after contracting the novel coronavirus and the death toll continues rising.

www.cnn.com

Their stats are from 2-3 days ago so obviously could have changed.

The CDC numbers I posted above were released today 3/18 (cases through 3/16) so it's the most current information available. It's 4 US deaths 54 and under, 1 death 44 and under, and zero under 20.

 

[NJWxMan]

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.

This is genius. Look up all of the newspaper articles of asymptomatic teachers.

 

[Birdstrike]

BREAKING: Reported COVID-19 deaths in Italy now have surpassed China

ArcGIS Dashboards

ArcGIS Dashboards

gisanddata.maps.arcgis.com

 

[bravotwozero]

That makes sense, since new infections have essentially halted in China (if you believe them), and Italy is far from that point.

 

[GeneralVeers]

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.

 

[TwoHighways]

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.

If this pans out (which I suspect is likely), this has been one heck of a public health fiasco, right up there with the demonization of saturated fat.

 

[Birdstrike]

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.

How much "less than" 1%? Because 30% of our population (331,000,000) is 99,300,000, and 1% of that is 993,000. 0.1% of that is 99,300 and 0.01% of that is 9,930. Between 0.1% and 1% would be a once in a century plauge, and 0.01%-0.1% would be anywhere from a very mild to horrendous flu season.

 

[evilbooyaa]

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.

If this pans out (which I suspect is likely), this has been one heck of a public health fiasco, right up there with the demonization of saturated fat.

Lot of assumptions, lot of judgement. Lots of cherry picking facts/assumptions to back your predisposed notions.

This thread will be interesting to read in a few months when we can play the 'i told you so' game. I hope I'm the one who is being told 'I told you so'.

 

[Birdstrike]

If this pans out (which I suspect is likely), this has been one heck of a public health fiasco, right up there with the demonization of saturated fat.

I think we're way to early to be looking back, and blaming since we have way too much looking forward and infection fighting still to do. But I suppose it'll all come down to how it's framed. With 2.2 million US deaths predicted by the UK group and 1.6 million US deaths predicted by another reputable group, if it turns out to be much less than that (hoping), it could just as easily be considered the greatest public health success and number of lives saved in U.S history, or so the politicians will claim. Again, it's way, way too early for any this, but these things always come down to the Expectations minus reality, equation, followed by persuasion and framing.

Either way, I hope this burns out ASAP so we can take off our PPE, don't have to bury our parents and can get back to arguing about pointless petty nonsense, like usual.

 

[TwoHighways]

Lot of assumptions, lot of judgement. Lots of cherry picking facts/assumptions to back your predisposed notions.

This thread will be interesting to read in a few months when we can play the 'i told you so' game. I hope I'm the one who is being told 'I told you so'.

I'd argue that those pumping doom and gloom are also cherry picking data points to back their predisposed notions. It will be interesting indeed. I won't be one to gloat, however. I am biased, of that I have doubt. My natural tendency is to zig and the overwhelming majority are zagging.

 

[TwoHighways]

I think we're way to early to be looking back, and blaming since we have way too much looking forward and infection fighting still to do. But I suppose it'll all come down to how it's framed. With 2.2 million US deaths predicted by the UK group and 1.6 million US deaths predicted by another reputable group, much less than that could just as easily be considered the greatest public health success and number of lives saved in U.S history. Again, it's way, WAY too early for any this, but these things always come down to the Expectations minus reality, equation, followed by persuasion and framing.

Either way, I hope this burns out ASAP so we can take off our PPE, don't have to bury our parents and can get back to arguing about pointless petty nonsense, like usual.

Framing this as a public health success instead of failure of epidemiology based on shotty data is absolutely disgusting in my view, but it's undoubtedly what will happen. I just hope the public is more vigilant of this going forward and doesn't fall into government and media induced paranoia.

 

[Birdstrike]

Framing this as a public health success instead of failure of epidemiology based on shotty data is absolutely disgusting in my view, but it's undoubtedly what will happen.

Yes, you're right. Politicians are disgusting. They are happy to take tragedy and use it to further their agendas and careers. As physicians, there's no place in our brains for that. We don't understand it, it's foreign and mind boggling. But for politicians its basic currency. It's the air they breathe. And they do it, because see the fact that they were elected as evidence of its success. They're masters of persuasion and are all lying, all the time.

 

[Money-Moniker]

Framing this as a public health success instead of failure of epidemiology based on shotty data is absolutely disgusting in my view, but it's undoubtedly what will happen. I just hope the public is more vigilant of this going forward and doesn't fall into government and media induced paranoia.

What is it that you're saying, exactly? It almost sounds like you're saying that when the world's drastic action to contain this pandemic allows us to avoid the worst case scenario of death and morbidity, you will argue that it was all an overreaction because the worst case scenario did not come to pass! Please tell me you're not engaging in this kind of fallacy.

 

[TwoHighways]

What is it that you're saying, exactly? It almost sounds like you're saying that when the world's drastic action to contain this pandemic allows us to avoid the worst case scenario of death and morbidity, you will argue that it was all an overreaction because the worst case scenario did not come to pass! Please tell me you're not engaging in this kind of fallacy.

The quarantining of people with no underlying health problems and media/government induced panic was worse for society than the virus itself is my argument. We'll likely never know the real rate of infected within the population because asymptomatic people won't be tested. If asymptomatic people were tested, the mortality rates would be much lower than currently reported. This hoopla was essentially over a novel cold virus. The people that ended up dying from this would have been just as susceptible of death from any other respiratory virus that we don't mass quarantine for.

 

[Freeded]

At some point the r/b of sheltering in place would need to be looked at.

However much of the point of sheltering in place NOW is so we can buy time to understand what we are dealing with. What actually effectively reduces transmission? What treatments prevent morbidity mortality? Why does it bounce off of the young and to some extent women - exposure to other coronavirus / receptor changes or differences in lungs?

 

[Painted]

The quarantining of people with no underlying health problems and media/government induced panic was worse for society than the virus itself is my argument. We'll likely never know the real rate of infected within the population because asymptomatic people won't be tested. If asymptomatic people were tested, the mortality rates would be much lower than currently reported. This hoopla was essentially over a novel cold virus. The people that ended up dying from this would have been just as susceptible of death from any other respiratory virus that we don't mass quarantine for.

No way you are a physician.

 

[bravotwozero]

The russians seem to have a very low incidence and mortality rate. Thoughts?

 

[Money-Moniker]

The quarantining of people with no underlying health problems and media/government induced panic was worse for society than the virus itself is my argument. We'll likely never know the real rate of infected within the population because asymptomatic people won't be tested. If asymptomatic people were tested, the mortality rates would be much lower than currently reported. This hoopla was essentially over a novel cold virus. The people that ended up dying from this would have been just as susceptible of death from any other respiratory virus that we don't mass quarantine for.

lmao, so a novel cold virus is overwhelming health systems across the world and causing crematoriums in Italy to run 24/7 and still not keep up with the demand. Bro, you're high af.

 

[IMGASMD]

The russians seem to have a very low incidence and mortality rate. Thoughts?

There is a joke that is going around the internet.

North Korea had one and only one case. He was ordered to self quarantine. He didn’t. Went to a Sauna and got caught.

They took him out and shot him on the spot. Later that day Kim declares total defeat of the virus.

So. Russia has no cases? Maybe they’ve achieved total defeat of the virus too?

 

[Money-Moniker]

The russians seem to have a very low incidence and mortality rate. Thoughts?

They closed their borders with China very early on, I think in January even. Also taking draconian measures to enforce quarantines of people returning from abroad, with years in prison for anyone who breaks quarantine. In other words, ounces of prevention to avoid the pounds of cure.

 

[erdoc00]

The russians seem to have a very low incidence and mortality rate. Thoughts?

Russians are tough as **** and have to deal with actual problems in life. Plus they basically have a steady stream of vodka in their blood. In soviet Russia, people kill coronavirus.

 

[bravotwozero]

Regarding Chloroquine, this is an in vivo, live patient study, different from the paper I posted 2 days ago. Granted it's very small, needs to be repeated and confirmed but, "A renowned research professor in France has reported successful results from a new treatment for Covid-19, with early tests suggesting it can stop the virus from being contagious in just six days." If you know French, here's his lecture video and slides. Which is promising, because, "Bayer preps massive U.S. donation of chloroquine to help in COVID-19 fight." Will human ingenuity, people coming together, making progress, allow us to beat the worst-case-scenario predictions by a lot? Hopefully. Whether it'll be enough to increase production of toilet paper to a level to ease the anxiety of American hoarders, I'm not so hopeful.

I wonder what led researchers to consider investigating chloroquine as a potential treatment in the first place?

 

[dadaddadaBATMAN]

The russians seem to have a very low incidence and mortality rate. Thoughts?

maybe I’m alone, but I don’t trust the Russian or Chinese governments/media as a reliable source of information. I don’t really trust our media either, but at least their foolishness is generally without malice.

I have zero doubt that China’s government/elite would accept 3% mortality over loss of economic growth any day. Especially of its more elderly and less productive citizens.

 

[20gauge]

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)

 

[Backpack234]

any tips for wearing the n95 for an extended time? There’s barely any supply left so the preferred way of wear it when you’re in the room then discard it is gone. But wearing it for 2 hours and your face gets itchy. You need a drink. Whatever.

Any tricks to wearing it for 6-12 hours?

 

[Birdstrike]

I wonder what led researchers to consider investigating chloroquine as a potential treatment in the first place?

Because it showed promise for SARS Coronavirus.

 

[Birdstrike]

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)

Yeah. I just saw that. I wasn’t too happy about it either.

 

[Birdstrike]

maybe I’m alone, but I don’t trust the Russian or Chinese governments/media as a reliable source of information. I don’t really trust our media either, but at least their foolishness is generally without malice.

I have zero doubt that China’s government/elite would accept 3% mortality over loss of economic growth any day. Especially of its more elderly and less productive citizens.

Given their human rights track record, I wouldn't be surprised if they considered it a welcome culling of the herd.

 

[Perrotfish]

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.

 

[thegenius]

Just get a bidet man


Sent from my iPhone using Tapatalk

My friend installed one. Costs 40 bucks and goes right in your toilet. It’s called Luxe Bidet. Apparently they are on back order on Amazon.

 

[erdoc00]

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)

I just published some new guidelines too:

1. All potentially exposed personnel should be in full PPE to protect against possibility of aerosolized spread.

2. If sufficient PPE is unavailable, hospital administrators will don scarves and bandanas and provide direct patient care under the remote video guidance of physicians using facetime

 

[dadaddadaBATMAN]

I just published some new guidelines too:

1. All potentially exposed personnel should be in full PPE to protect against possibility of aerosolized spread.

2. If sufficient PPE is unavailable, hospital administrators will don scarves and bandanas and provide direct patient care under the remote video guidance of physicians using facetime

3.) if hospital administrators are providing care for patients, they must do so with queens “another one bites the dust” as a background theme.

 

[Dr Mantis Toboggan]

I was asked to research reuse of N95’s. This is what I came up with, please comment/correct provide alternative ideas. If anyone is in an austere environment without PPE and has practical advice we’d welcome it.

Disclaimer: I am not a materials scientist or public health expert or ID doc. I’m just trying to do the best I can in an international pandemic.

This was my email response:


“I have found nothing reputable on reusing N95 masks for an extended period of time. The CDC did put this out, not tremendously helpful.


CDC - Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings - NIOSH Workplace Safety and Health Topic


For quick and dirty. I think UV sterilization might be the way to go. I have ordered a sterilizer. It should kill coronavirus easily (it did influenza). There is a risk the UV light can break down the polymers but this is a well designed article:

Effects of Ultraviolet Germicidal Irradiation (UVGI) on N95 Respirator Filtration Performance and Structural Integrity

Basically they took masks and exposed them to various levels of UV light. They found that the filtration capacity remained intact even at high levels. However, the mask becomes more fragile and tears easier with higher doses. This is good because if your mask tears or is visibly worn you know it’s done.

‘Two studies of UVGI disinfection of respirators exposed to droplets and aerosols containing influenza virus found that a 1.8 J/cm2 dose was sufficient to reduce the amount of viable influenza virus by a factor of >104 (>4-log reduction).(6,8) This suggests that, for influenza virus, dozens of UVGI disinfection cycles could be performed on respirators without the UVGI affecting their performance.

Another promising option is ethylene oxide. Can sterile supply do this?

Evaluation of Five Decontamination Methods for Filtering Facepiece Respirators

Bleach is not terrible, just the masks tend to smell afterwards, can cause respiratory irritation etc. Autoclave and alcohol based cleaning destroys the filtration, so they’re out.”

I just published some new guidelines too:

1. All potentially exposed personnel should be in full PPE to protect against possibility of aerosolized spread.

2. If sufficient PPE is unavailable, hospital administrators will don scarves and bandanas and provide direct patient care under the remote video guidance of physicians using facetime

 

[Birdstrike]

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

.

 

[Matthew9Thirtyfive]

I don't see a single one under 50 of those who's ages are known, on this list. The CDC graph I posted 3 posts above does allude to what looks like 1 person in the 20-44 age group (0.1-0.2% CFR of 705 cases, which comes out to a range of 0.1-1.4 people, so obviously, 1 person).

If it’s the same person, a 34-yo male just died from it. He had asthma though and interestingly had testicular cancer in 2016.

 

[Birdstrike]

An ER doc working shifts in Madrid contracted CV-19 and has been live tweeting his illness, symptoms and imaging.

Twitter handle:‪ @yaletung ‬

 

[GeneralVeers]

If it’s the same person, a 34-yo male just died from it. He had asthma though and interestingly had testicular cancer in 2016.

Asthma would definitely pre-dispose you from death due to this virus.

 

[TwoHighways]

Asthma would definitely pre-dispose you from death due to this virus.

I think cancer would as well.

 

[Birdstrike]

If it’s the same person, a 34-yo male just died from it. He had asthma though and interestingly had testicular cancer in 2016.

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

 

[HoosierdaddyO]

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

.

So I have taken care of 5 covid positive patients thus far... and 2 of them came in with N/V/D and mild abdominal complaints. This patient did not have any fevers or chill or chest pain or shortness of breath. I got blood work on this patient that showed a white count of 5 and a very very mild transaminitis with a normal CT!!! Sent this patient home with a covid test bc something didn’t sound right but was otherwise feeling well.

Patient 2 and older male with the same presentation and workup. Doing some chart reviews on my covid patients and where surprised that these actually popped up positive.

Both patients didn’t have cough or fever or chest pain or SOB... thankfully I was paranoid due to the other 3 covids I came into contact that were purely respiratory... but just some food for thought!!!

 

[NurWollen]

If GI symptoms are a indicator of a worse prognosis, but they don't develop respiratory symptoms, how do they progress? What do they get sick with?

Sent from my SM-G930V using SDN mobile

 

[Birdstrike]

If GI symptoms are a indicator of a worse prognosis, but they don't develop respiratory symptoms, how do they progress? What do they get sick with?

Sent from my SM-G930V using SDN mobile

The paper focused on symptoms at presentation. So my assumption is that they eventually must have progressed to respiratory symptoms, but only after presentation.