What do I need to know about coronavirus?

[GeneralVeers]

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

Question: How is the disease spread from asymptomatic patients who aren't producing droplets by coughing or sneezing? This is assuming rigourous hand gel/washing after every patient.

 

[turkeyjerky]

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

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

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

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

I apologize for the aggressive tone in my prior post. Here's a study displaying a high false negative rate:

Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases

Are the American tests more sensitive? I haven't seen data indicating this, but would appreciate it if you have. The Chinese algorithm was to perform 2 swabs, 12-24 hours apart, as well as chest CT on every single suspect case, before clearing them.

My feeling is that we, a country and a healthcare "system" are simply not equipped for this, at least at the current time. I agree that outpatient testing should be a part of a mitigation strategy. However, we're not there yet. PCPs don't want infectious patients in their offices (rightly so) and hence tell their patients to come to the ER for testing. Urgent care centers are a waste of space, and send patients to the ER for testing. Patients, for reasons I can't fathom, still think the ER is the place to get an MRI for their chronic knee pain and a side of coronavirus testing.

As a country, we have a toxic mix of complacency and panic. Which doesn't bode well when combined with a lack of public health infrastructure, poor planning and inadequate leadership.

 

[alpinism]

I'm working part time at one of the main academic hospitals in NYC right now.

We're seeing a steady increase in the number of serious COVID cases.

Gone from 1-2 per shift last week to 10-20 per shift this week.

 

[Frazier]

I'm working part time at one of the main academic hospitals in NYC right now.

We're seeing a steady increase in the number of serious COVID cases.

Gone from 1-2 per shift last week to 10-20 per shift this week.

What level care are they getting admitted to?

 

[TooMuchResearch]

ACEP says wear a mask at all times on shift. A few admin types told me it wasn't recommended, I told them our major college says differently and left it to them to discuss with anyone higher on the food chain than me. Medical directors have advised us to protect ourselves and they'll manage admin.

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

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

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

 

[thegenius]

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

Totally agree. critically ill patients with COVID consume massive resources and markedly increase the exposure potential. They end up on vents, get bronchs, get regularly suctioned by RT.

 

[thegenius]

As a country, we have a toxic mix of complacency and panic. Which doesn't bode well when combined with a lack of public health infrastructure, poor planning and inadequate leadership.

Well put.

 

[evilbooyaa]

I apologize for the aggressive tone in my prior post. Here's a study displaying a high false negative rate:

Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases

Are the American tests more sensitive? I haven't seen data indicating this, but would appreciate it if you have. The Chinese algorithm was to perform 2 swabs, 12-24 hours apart, as well as chest CT on every single suspect case, before clearing them.

My feeling is that we, a country and a healthcare "system" are simply not equipped for this, at least at the current time. I agree that outpatient testing should be a part of a mitigation strategy. However, we're not there yet. PCPs don't want infectious patients in their offices (rightly so) and hence tell their patients to come to the ER for testing. Urgent care centers are a waste of space, and send patients to the ER for testing. Patients, for reasons I can't fathom, still think the ER is the place to get an MRI for their chronic knee pain and a side of coronavirus testing.

As a country, we have a toxic mix of complacency and panic. Which doesn't bode well when combined with a lack of public health infrastructure, poor planning and inadequate leadership.

Thanks for the link. Interesting that they don't consider RT-PCR the gold standard. Infact I'm not sure what the gold standard is, like how are they defining those with positive CT but negative pCR as having COVID-19? What if they have something else?

I don't have data for the american tests, so I will concede that maybe testing is not the end all be all.

In regards to the rest of your post about issues with the US healthcare system, complacency, panic, etc. etc. I completely agree with you. Wish we could have had drive-through testing available from the get-go instead of waiting.

Thanks for the work you do. Stay safe on the front lines.

 

[GeneralVeers]

I disagree about infrastructure. We have a massive healthcare system, and about 80% of our Emergency system is designed to deal with urgent, or non-urgent complaints. In a true emergency, I think we could simply not see the BS like ankle sprain, anxiety, chronic pain, back pain etc if we are truly over-burdened with COVID patients. We also have a much higher ratio of critical care beds than Italy has, as well as most of Europe. I strongly believe we can deal with whatever comes if we are willing to change our work flow in the ED.

All those BS admissions for low-medium risk chest pain, chronic abdominal pain, intractable back pain etc need to just go home.

 

[TooMuchResearch]

I've been telling patients that in normal times I might obs or admit that they might just want to go home. Most of them have done so.

I disagree about infrastructure. We have a massive healthcare system, and about 80% of our Emergency system is designed to deal with urgent, or non-urgent complaints. In a true emergency, I think we could simply not see the BS like ankle sprain, anxiety, chronic pain, back pain etc if we are truly over-burdened with COVID patients. We also have a much higher ratio of critical care beds than Italy has, as well as most of Europe. I strongly believe we can deal with whatever comes if we are willing to change our work flow in the ED.

All those BS admissions for low-medium risk chest pain, chronic abdominal pain, intractable back pain etc need to just go home.

 

[TooMuchResearch]

It's getting harder for me to accept a 2% mortality rate when the John's Hopkins University arcgis tracker shows a 4.3% rate to date.

 

[Dr Mantis Toboggan]

China widely used steroids and chloroquine. Our current protocols utilize neither. Maybe they are of benefit.

It's getting harder for me to accept a 2% mortality rate when the John's Hopkins University arcgis tracker shows a 4.3% rate to date.

 

[dadaddadaBATMAN]

It's getting harder for me to accept a 2% mortality rate when the John's Hopkins University arcgis tracker shows a 4.3% rate to date.

In looking at the cases worldwide, I've noticed the USA and Germany infected numbers seem to be tracking at approximately the same rate as italy, france and spain and yet the mortality and critical ill percentages are far lower (like an order of magnitude. )

Any thoughts on this from anyone? Are we simply lagging in terms of our critical presentations?

It's odd, because france seemingly had it's infection rate track at approximately the same speed as the usa. We also have a far lower mortality or critical ill percentage than Italy did at a similar point a week or so ago when the infections were similar. Are we just getting infected faster?

 

[thegenius]

It's getting harder for me to accept a 2% mortality rate when the John's Hopkins University arcgis tracker shows a 4.3% rate to date.

I think what we are finding is that a prompt response by governments to initiate social distancing, wear masks, etc VERY EARLY ON has reduced the spread of disease and made disease easier to manage, thus lowering death rate.

It is true that once you get coronavirus, whatever happens to you physically will happen. If you end up on the vent there is nothing we can do about it. No amount of ventilators will save you.

However we must be able to explain why there is a 10 fold difference in mortality in some countries vs others.
S. Korea 0.7%
Italy 7%

Is it all due to age? I think age is going to probably be the biggest independent factor predicting death. S. Korea average age of infectivity is 40s. Italy it's 60s.

It is likely multifactorial. Age, public health response, people's willingness to abide by social distancing, etc.

 

[GeneralVeers]

I think what we are finding is that a prompt response by governments to initiate social distancing, wear masks, etc VERY EARLY ON has reduced the spread of disease and made disease easier to manage, thus lowering death rate.

It is true that once you get coronavirus, whatever happens to you physically will happen. If you end up on the vent there is nothing we can do about it. No amount of ventilators will save you.

However we must be able to explain why there is a 10 fold difference in mortality in some countries vs others.
S. Korea 0.7%
Italy 7%

Is it all due to age? I think age is going to probably be the biggest independent factor predicting death. S. Korea average age of infectivity is 40s. Italy it's 60s.

It is likely multifactorial. Age, public health response, people's willingness to abide by social distancing, etc.

We do have younger population (~10 years younger than Italy on average) which likely contributes to certain amount of reduction in our mortality.

Also no one has explained to me yet how infected, but asymptomatic patients can spread the disease to us, assuming appropriate handwashing precautions.

 

[evilbooyaa]

I think what we are finding is that a prompt response by governments to initiate social distancing, wear masks, etc VERY EARLY ON has reduced the spread of disease and made disease easier to manage, thus lowering death rate.

It is true that once you get coronavirus, whatever happens to you physically will happen. If you end up on the vent there is nothing we can do about it. No amount of ventilators will save you.

However we must be able to explain why there is a 10 fold difference in mortality in some countries vs others.
S. Korea 0.7%
Italy 7%

Is it all due to age? I think age is going to probably be the biggest independent factor predicting death. S. Korea average age of infectivity is 40s. Italy it's 60s.

It is likely multifactorial. Age, public health response, people's willingness to abide by social distancing, etc.

Italy has had an overwhelming of their health care system. This is the whole premise behind flattening the curve. Total incidence will be similar, but if you spread it out, then the mortality rate can be kept relatively low.

If everyone gets it all at once, then what happened in Italy happens, where there was 'battlefield medicine' and at times, patients over age 65 or with co-morbidities showing up with bad symptoms were given an O2 mask and left to live the rest of their short life, as all vents were being used by patients with better prognosis.

Italy's older population (as a perecntage) likely has something to do with the mortality rate as well.

While we have less healthcare resources per capita compared to Italy, the majority of cases right now are in 3-4 major areas - Seattle, NYC, and Cali (SF/LA) which may be playing a role to the ongoing mortality rate. Or it's too early to tell, one of the two.

 

[turkeyjerky]

I strongly believe we can deal with whatever comes if we are willing to change our work flow in the ED.

I agree but that’s a tall order. The clipboard nurses aren’t going away. EMTALA is still in effect (and still being misinterpreted).

At one of my sites, when we were going over the changes in triage, the nursing director reassured us that hospital admin is aware that door2doc times will suffer as a result. Wtf is that even in your thought process??

 

[Angry Birds]

I'm working part time at one of the main academic hospitals in NYC right now.

We're seeing a steady increase in the number of serious COVID cases.

Gone from 1-2 per shift last week to 10-20 per shift this week.

Wow that's a lot. Hope you and your family stay safe and healthy. Good luck man

 

[Angry Birds]

I disagree about infrastructure. We have a massive healthcare system, and about 80% of our Emergency system is designed to deal with urgent, or non-urgent complaints. In a true emergency, I think we could simply not see the BS like ankle sprain, anxiety, chronic pain, back pain etc if we are truly over-burdened with COVID patients. We also have a much higher ratio of critical care beds than Italy has, as well as most of Europe. I strongly believe we can deal with whatever comes if we are willing to change our work flow in the ED.

All those BS admissions for low-medium risk chest pain, chronic abdominal pain, intractable back pain etc need to just go home.

Man we disagree on politics but sometimes you really post gold like this.

I think we should just be able to refuse care now to non-sick patients, especially if we are expected to use scarves as PPE

 

[miacomet]

I'm working part time at one of the main academic hospitals in NYC right now.

We're seeing a steady increase in the number of serious COVID cases.

Gone from 1-2 per shift last week to 10-20 per shift this week.

How's your PPE @alpinism ? Are you scared? Overwhelmed? Or doing OK?

 

[thegenius]

In looking at the cases worldwide, I've noticed the USA and Germany infected numbers seem to be tracking at approximately the same rate as italy, france and spain and yet the mortality and critical ill percentages are far lower (like an order of magnitude. )

Any thoughts on this from anyone? Are we simply lagging in terms of our critical presentations?

It's odd, because france seemingly had it's infection rate track at approximately the same speed as the usa. We also have a far lower mortality or critical ill percentage than Italy did at a similar point a week or so ago when the infections were similar. Are we just getting infected faster?

Very important question.
Doesn't it seem like one day Italy had nothing, then the next day we hear about 8% CFR (case fatality rate)?

In reality the virus had been there for weeks, moving around and they didn't heed warnings for social distancing.

Another thing
I believe people think there is a "true" or canonical death rate from a virus. That is, they believe if you were to put this virus into a closed population of people with no medical care (like on a deserted island of 10,000 people) and wait 3 months, the virus would sweep through the island, people either survive or die, and you would get the canonical death rate. On this island people are allowed to social distance if they want. They can do anything they want in that system (except leave). But there are no hospitals or doctors.

A theoretical Closed System on an island
Total Population: 10,000
Introduce virus on Day 1, then wait 90 days

Number Infected: 4,600
Number Survived: 4,485
Number Dead: 115

Statistics in this closed system:
Infected Rate: 46%
CFR: 2.5%


One might ask, why don't all 10,000 people infected?
A: at some point people naturally move away from others, people develop immunity early on, and eventually herd immunity develops and the virus cannot spread anymore.



In reality though...there is no canonical CFR. We see different death rates in different populations due to a variety of things
- age
- population density
- comorbidities
- ability to manufacture a vaccine or develop treatment
- public health measures (wearing a mask, etc. social distancing)
- medical technology

Think what is happening in Italy. Doctors have had to ration medical supplies and decide who gets ventilators. That means they are allowing some people to die when they might had lived if they were put on a ventilator. This increases the death rate.

This is also why I believe the countries who got it early (China, Italy, Iran, Spain) will get hurt more than countries that get it late. Countries where there isn't mass spread yet can start to do social distancing very early on, containing the spread.

Just think we've heard almost nothing from India. A county of 1B people. Imagine it if spreads there? You think India's infrastructure can handle 30% infectivity rate with 1% CFR?

1,000,000,000 x 30% x 1% = 3,000,000 dead. Probably 10 million in hospitals all within a span of 6-12 months, maybe sooner.


The moment there are a few dozen cases in India, I would shut down the country if I were president. I would order mass shelter-in-place and quarantine for EVERYBODY. Especially since I doubt they will have quick access to tests. If this virus spreads in India their CFR might be 4-6%. Maybe their infectivity rate is higher than average because I think India is densely populated.

1,000,000,000 x 50% x 4% = 20,000,000 dead. Probably 50 million in hospitals all within a span of 6-12 months.




I think what's hard for people to understand, and it even took me some time to understand and I'm a freaking doctor...is the scale of how exponentially rapid these kind of novel viruses can spread. They can potentially blow up and infect 100s of millions of people in a matter of a few months. It also took me a long time to understand that despite having a relatively low COVID+ confirmation rate, it is falsely reassuring. There are AT LEAST 10x, perhaps 20x more cases out there. Perhaps even higher.




For the next century, all high school kids should take a mandatory course called "The Epidemiology of Coronavirus" and be forced to take it, and the class must spend 50% of the time talking about how to protect yourself when the next virus gets released into society.

 

[Birdstrike]

In looking at the cases worldwide, I've noticed the USA and Germany infected numbers seem to be tracking at approximately the same rate as italy, france and spain and yet the mortality and critical ill percentages are far lower (like an order of magnitude. )

Any thoughts on this from anyone? Are we simply lagging in terms of our critical presentations?

It's odd, because france seemingly had it's infection rate track at approximately the same speed as the usa. We also have a far lower mortality or critical ill percentage than Italy did at a similar point a week or so ago when the infections were similar. Are we just getting infected faster?

Chance of death and critical illness is proportional to age. Italy’s average age is 10 years greater than US. That difference is huge. The average age of patients dying in Italy has been 80. Simply put, they have a helluva lot more 80 year olds than us, and many more of them live with all 3 generations and are therefore more likely exposed, and more likely to die.

 

[Birdstrike]

Also no one has explained to me yet how infected, but asymptomatic patients can spread the disease to us

Nose picking.

 

[Renaissance Man]

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

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

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

Of all the asinine things you post in this forum, finding a way to praise Trump (slash bash Biden) for the handling of this pandemic is truly next level. There is no truth anymore, unbelievable.

 

[ShockIndex]

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.

Question: How is the disease spread from asymptomatic patients who aren't producing droplets by coughing or sneezing? This is assuming rigourous hand gel/washing after every patient.

HSV and EBV are other diseases that are known to have asymptomatic viral shedding contribute to spread. People touch their faces, pick their noses, share utensils, put their tongue down someone’s throat (or up someone’s...you get the picture) - it’s the gift that keeps on giving all year long.

I suspect that IL-6 and TNF play a big role in the pathogenesis of COVID lung injury and IL-6 may be a therapeutic target. Adult lungs don’t like spikes in IL-6 and some data coming out of China suggests that levels correlate with illness severity. This might explain why neonates and infants has mild disease since they seem to have baseline high levels of IL-6:TNF

 

[NITRAS]

Also no one has explained to me yet how infected, but asymptomatic patients can spread the disease to us, assuming appropriate handwashing precautions.

I think the person who has a little runny nose that thinks, "allergies are bad today" is practically considered "asymptomatic".

 

[ShockIndex]

Of all the asinine things you post in this forum, finding a way to praise Trump (slash bash Biden) for the handling of this pandemic is truly next level. There is no truth anymore, unbelievable.

Like him or not, the decision to suspend travel from China will like be the single most important decision of Trump’s presidency. Waiting even a few more days would have likely cost thousands of lives and made us look like Italy. Binden’s opposition is another example of his pattern of really bad foreign policy ideas.

 

[Money-Moniker]

Germany is playing the world for fools. They have 20,000 cases, but 60 deaths and 2 people listed as having serious illness currently! What a crock of crap. It's now patently obvious that if you have so much as pre-hypertension, the Germans will chalk up your death or your ICU admit to that and not to Corona. Utterly ridiculous.

 

[true2life]

Of all the asinine things you post in this forum, finding a way to praise Trump (slash bash Biden) for the handling of this pandemic is truly next level. There is no truth anymore, unbelievable.

We really need to do a better job of keeping this apolitical. Clearly you do not like trump. This isn't the time or place to air that out. What you wrote doesn't even have any substance, just pure unadulterated bias. There should be no place for that in medicine, fir or against any political leader. Im really sick of the pro and anti trump bickering in all of these threads. This problem is not about him, it's about the Coronavirus. Continuing to shift the discussion back to him literally dies nothing but increase division. Regardless of whether you like trump (and perhaps more so if you do in a weird way) it's clear the government is not solving this problem. If we can even contribute minimally to something positive, let's do it. Stop using this as a platform to trash the president. Instead, focus on discussing potential solutions (and not backhanded political "solutions" like impeachment or waiting till he's replaced at the end of the year). We may actually have to take responsibility for this one and figure it out without the government holding our hands

 

[Birdstrike]

Like him or not, the decision to suspend travel from China will like be the single most important decision of Trump’s presidency. Waiting even a few more days would have likely cost thousands of lives and made us look like Italy. Binden’s opposition is another example of his pattern of really bad foreign policy ideas.

In a sea of bad news, let’s take a moment acknowledge some positives. 2.2 million Americans were predicted to die from COVID-19, per experts (linked above on thread; other estimate of 1.6 million by Obama’s Fmr CDC Dir). 2 months in, we’re at 249 Americans dead. Love him or hate him, so far, 2,199,751 American lives have been saved by Trump’s decision. I pray that number holds as much as possible.

3/10, many experts predicted that, “In 10 days our hospital systems will be collapsing like Italy!” if “more isn’t done!” Ten days, multiple executive orders and a nationwide shutdown later, and so far that hasn’t happened. That’s another (*knock on wood*) success so far, that I’m praying holds.

Red tape slashed, vaccine trials started in record time, FDA forced to make experimental drugs available. Those are positives.

These are all ballsy, unprecedented moves I haven’t seen in my lifetime.

If the PPE supply can be replenished, which is due to a worldwide shortage that’s not US specific) that would be another potential positive. Even if you hate ‘em, you’ve gotta be at least pulling for this guy to get some of this done. Surely, people can’t be rooting for their worst case predictions to come true, so they can feel better out their hatin’, right?

 

[GeneralVeers]

In a sea of bad news, let’s take a moment acknowledge some positives. 2.2 million Americans were predicted to die from COVID-19, per experts (linked above on thread; other estimate of 1.6 million by Obama’s Fmr CDC Dir). 2 months in, we’re at 249 Americans dead. Love him or hate him, so far, 2,199,751 American lives have been saved by Trump’s decision. I pray that number holds.

3/10, many experts predicted that, “In 10 days our hospital systems will be collapsing like Italy!” if “more isn’t done!” Ten days, multiple executive orders and a nationwide shutdown later, and so far that hasn’t happened. That’s another (*knock on wood*) success so far, that I’m praying holds.

Agree completely. So far we really haven't been flooded with "sick patients" at a higher rate than normal. We still have the typical elderly with respiratory illness, CHF, COPD, and pneumonia. How many are COVID-induced? We don't know yet, but collapse is far from imminent.

Hopefully in another 10 days we are over the top of the curve and new cases are declining so that we can start to slowly get back to normal.

In my opinion the only major intervention that should have been done, but has not been would be to shut down ALL passenger air travel. Putting 200+ people in very close proximity is a much better way to spread the virus around the country than eating out at a restaurant or going to bar.

 

[miacomet]

NYC and Seattle have been.
China is sending PPE to other countries, but not here.

 

[GeneralVeers]

NYC and Seattle have been.
China is sending PPE to other countries, but not here.

Trump needs to make an executive order forbidding sale of PPE to private consumers. There is no reason the general public needs any of this, so long as there is a shortage at the hospitals.

 

[miacomet]

Trump needs to make an executive order forbidding sale of PPE to private consumers. There is no reason the general public needs any of this, so long as there is a shortage at the hospitals.

There is no PPE available. Most of the masks are made in China, and they aren't selling to the US right now.
He has the power to command companies to switch to making masks, but he refuses to issue such an order, believing that is too much government interference.

 

[Frazier]

Over 3000 new confirmed cases in NY today (likely mainly NYC region).

Def picking up in certain regions.

NY almost 15x the amount new confirmed today than in other hot states like WA/CA/etc. Sitting at +8000 in NY.

 

[miacomet]

Trump needs to make an executive order forbidding sale of PPE to private consumers. There is no reason the general public needs any of this, so long as there is a shortage at the hospitals.

That would go against the free market.

 

[miacomet]

Agree completely. So far we really haven't been flooded with "sick patients" at a higher rate than normal. We still have the typical elderly with respiratory illness, CHF, COPD, and pneumonia. How many are COVID-induced? We don't know yet, but collapse is far from imminent.

Hopefully in another 10 days we are over the top of the curve and new cases are declining so that we can start to slowly get back to normal.

In my opinion the only major intervention that should have been done, but has not been would be to shut down ALL passenger air travel. Putting 200+ people in very close proximity is a much better way to spread the virus around the country than eating out at a restaurant or going to bar.

The mathematical model shows the cases getting really bad around April 3rd from what I've seen.

 

[bravotwozero]

China widely used steroids and chloroquine. Our current protocols utilize neither. Maybe they are of benefit.

Yeah so chloroquine has been shown to kill people with dosages as low as 1g, which is close to the therapeutic dose. They can also go blind. This is definitely a no go.

Also, things are BAD in NYC.




At Bellevue, the city’s largest public hospital, doctors have been told by supervisors to anticipate as many as a dozen coronavirus-related intubations a day, which is at least five times the amount on a normal day, a Bellevue doctor said. If the current trend continues, “it is totally unsustainable,” the doctor said.

In recent days, the number of confirmed cases in New York City more than doubled to 4,408 as a blitz of testing began to reveal the rapid march of the disease, officials said. New York City alone now makes up 42% of total U.S. confirmed cases. Across the entire state, there have been 7,102 total cases and 35 deaths, making up a quarter of nationwide deaths from the illness.


With the onslaught has come a surprise for many health-care workers: Far more young people than they expected are falling very ill. According to data published Friday morning by the New York City Department of Health and Mental Hygiene, 56% of confirmed cases of coronavirus in the city at the time involved patients under the age of 50.


At the Long Island Jewish Medical Center in Queens, several coronavirus patients under 40, including a few in their 20s, were on ventilators in the intensive-care unit as of Thursday. All were healthy before getting the virus, said Dr. Narasimhan.


The Wall Street Journal talked to about 20 medical workers on the front lines of the outbreak at New York area hospitals.


About 90% of Long Island Jewish Medical Center beds were full Thursday after Northwell Health hospitals in recent days sent home about 2,500 patients scheduled for release and canceled elective procedures, said Terry Lynam, a Northwell Health spokesman.

Coronavirus cases strain NYC hospitals

@alpinism, I wish you all the best man, i'm sure this isn't easy. Take care and stay safe.

 

[Money-Moniker]

With the onslaught has come a surprise for many health-care workers: Far more young people than they expected are falling very ill. According to data published Friday morning by the New York City Department of Health and Mental Hygiene, 56% of confirmed cases of coronavirus in the city at the time involved patients under the age of 50.

At the Long Island Jewish Medical Center in Queens, several coronavirus patients under 40, including a few in their 20s, were on ventilators in the intensive-care unit as of Thursday. All were healthy before getting the virus, said Dr. Narasimhan.

@alpinism, I wish you all the best man, i'm sure this isn't easy. Take care and stay safe.

Wow, no way! I'm so surprised too! I mean I certainly have been hearing for weeks now that this thing affects people of all age groups and health status, but I figured no way can it happen here in America. This is a real shocker folks, no way we could have seen this coming .

 

[thegenius]

If the PPE supply can be replenished, which is due to a worldwide shortage that’s not US specific) that would be another potential positive. Even if you hate ‘em, you’ve gotta be at least pulling for this guy to get some of this done. Surely, people can’t be rooting for their worst case predictions to come true, so they can feel better out their hatin’, right?

There is enough Trump fodder that can be used to hate him already.

He's still an idiot. We shall see about how things turn out here in the US. I am predicting a CFR of about 0.3-0.5% and total number of deaths to be akin to a normal flu season (25-50K)

 

[miacomet]

There is enough Trump fodder that can be used to hate him already.

He's still an idiot. We shall see about how things turn out here in the US. I am predicting a CFR of about 0.3-0.5% and total number of deaths to be akin to a normal flu season (25-50K)

What do you think we are doing correctly that will make the outbreak less deadly than in Italy?

 

[bravotwozero]

We have more icu beds per capita, population density in MOST of the country is lower, we started social distancing before they did. Hopefully, these factors will mitigate the outbreak. Hopefully.


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[GeneralVeers]

There is enough Trump fodder that can be used to hate him already.

He's still an idiot. We shall see about how things turn out here in the US. I am predicting a CFR of about 0.3-0.5% and total number of deaths to be akin to a normal flu season (25-50K)

My prediction as well (except for hating trump). Worse than normal flu season but not catastrophic.

 

[Apollyon]

We have more icu beds per capita, population density in MOST of the country is lower, we started social distancing before they did. Hopefully, these factors will mitigate the outbreak. Hopefully.


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Our governor (Andrew Cuomo) has turned the state into a ghost town. I stocked up with more that 6 gallons more of beer. Oh, and, I reloaded chips, too. And, the freezer is well-stocked.

 

[miacomet]

My prediction as well (except for hating trump). Worse than normal flu season but not catastrophic.

Why do you think the mortality and prevalence will be less?
We have fewer smokers and a younger population, but plenty of air pollution, nursing homes, obesity, and diabetes.
We may have more ICU beds, but aren't they always full?

 

[hundreddaysoff]

Random thoughts after reading this whole thread:

- It's interesting that China used CT findings as a substitute for a positive test as we know GGO are very nonspecific for anything. I'm wondering if China did so well with this strategy (if in fact they have done well and there is no cooking of stats) because it resulted in many false positives (ie, actually cases of viral PNA caused by a non-covid19 virus) and people (correctly) "overreacted" by self-quarantining before the system could be overwhelmed.

- Relatedly, agree w/ evilbooyaa that the realpolitik is we need more testing if social isolation/self-quarantining is to be effective in flattening the curve in this country. I'm getting inane scary texts daily from my local government and people are gonna get alarm fatigue within a couple weeks unless we personalize this disease for them by presenting them w/ their own personal positive test result. My extrovert wife is already getting cabin fever and they only shut down her daily workout classes yesterday!

Don't get me wrong, not saying ERs are the place for testing. One hospital I know of set up mass testing in the ER parking lot and apparently has been successful in avoiding worried well clogging up the real ER. If resources are available, this seems like the best approach to me.

- The grumpy old man mafia of Nassim Taleb, Yaneer Bar-Yam, Harry Crane, etc have been doing some excellent applied stats work on this virus. Eg, here's Crane's response to that Ioannidis paper:

Researchers.One

A platform for scholarly publishing and peer review.

www.researchers.one

Of course I immensely respect Ioannidis for his early work on the replication crisis; it and Taleb's work were what made me change careers and apply to med school. But as we have seen in the past week, this is not the time to collect more data before making decisions. The precautionary principle should win out given how little we know about this virus.

 

[thegenius]

Why do you think the mortality and prevalence will be less?
We have fewer smokers and a younger population, but plenty of air pollution, nursing homes, obesity, and diabetes.
We may have more ICU beds, but aren't they always full?

Mortality will not be ONE number. There is no one case fatality rate. For the Spanish Flu, there were 10 fold differences in death within locales of the same state.

So there is going to be a range.

Here in America I think it's going to be like 0.3-0.6% and maybe higher in certain locales (like NYC, maybe there it will be 1.5%).

I don't think we will be Italy because
- we are much less dense
- it did come a little bit later
- we are younger
- we have more capacity
- we probably have better supplies

All of those things will add up

 

[Apollyon]

- The grumpy old man mafia of Nassim Taleb, Yaneer Bar-Yam, Harry Crane

Do I suck because these names mean ZERO to me? Taleb may have changed the course of your life, but that doesn't even ring a bell for me, much less invoke a memory.

 

[hoot504]

Do I suck because these names mean ZERO to me? Taleb may have changed the course of your life, but that doesn't even ring a bell for me, much less invoke a memory.

Very odd post, and I don't know who they are either. Apollyon, you need to internet better.

 

[Apollyon]

Very odd post, and I don't know who they are either. Apollyon, you need to internet better.

I don't get what is "odd". I'm just saying that I've never heard of any of them. If anything, to compare my post and yours, I think, honestly, mine makes more sense. I'm still trying to understand yours.