Support the Arctic Sea Ice Forum and Blog

Poll

How many will die of Covid19 in the 2020s directly and indirectly

Less than 10,000
10 (14.7%)
10,000-100,000
9 (13.2%)
100,000-1,000,000
9 (13.2%)
One to ten million
13 (19.1%)
Ten to a hundred million
14 (20.6%)
Hundred million to one billion
9 (13.2%)
Over a billion
4 (5.9%)

Total Members Voted: 61

Voting closed: March 03, 2020, 12:39:52 AM

Author Topic: COVID-19  (Read 418464 times)

HapHazard

  • Frazil ice
  • Posts: 379
    • View Profile
  • Liked: 152
  • Likes Given: 2785
Re: COVID-19
« Reply #4200 on: March 28, 2020, 07:31:04 PM »



jesus H. christ That dude has obviously never held or fired a firearm before.  :o


dnem

  • Grease ice
  • Posts: 598
    • View Profile
  • Liked: 269
  • Likes Given: 187
Re: COVID-19
« Reply #4201 on: March 28, 2020, 07:34:33 PM »
Once you beat the first wave and have a cheap, rapid test, the virus is in effect beaten.

Ain't it so?

Yes, after it is produced by the 100s of millions, distributed to 100s of thousands of locations, testers are trained and organized and you convince a recalcitrant, ill-informed, independent-mnded populace to conform.  Not gonna happen overnight.

vox_mundi

  • Young ice
  • Posts: 4383
    • View Profile
  • Liked: 2477
  • Likes Given: 335
Re: COVID-19
« Reply #4202 on: March 28, 2020, 07:45:19 PM »
The US Economy Has Come to a Standstill, Satellite Imagery Shows
https://www.cnbc.com/2020/03/28/the-us-economy-has-come-to-a-standstill-satellite-imagery-shows.html

Satellite imagery combined with alternative data gives a stark look at the U.S. situation during the coronavirus pandemic. These sources are pretty much all that is available at the moment to track the scope of the economic damage since most official statistics tracking the slowdown have not yet been released.

Airplanes are parked on unused runways, the busiest highways are empty during rush hour times, resorts have become ghost towns, ports are seeing sharp drops in shipping activity, and more.

The drop in U.S. consumer and business activity is apparent in satellite imagery collected by companies like Maxar Technologies, Planet Labs, ICEYE and Orbital Insight.









“There are three classes of people: those who see. Those who see when they are shown. Those who do not see.” ― Leonardo da Vinci

Insensible before the wave so soon released by callous fate. Affected most, they understand the least, and understanding, when it comes, invariably arrives too late

dnem

  • Grease ice
  • Posts: 598
    • View Profile
  • Liked: 269
  • Likes Given: 187
Re: COVID-19
« Reply #4203 on: March 28, 2020, 07:50:02 PM »
Italy again posting near record, but essentially plateaued, deaths and new cases.
https://www.worldometers.info/coronavirus/

Alexander555

  • Nilas ice
  • Posts: 1270
    • View Profile
  • Liked: 142
  • Likes Given: 44
Re: COVID-19
« Reply #4204 on: March 28, 2020, 08:18:26 PM »



jesus H. christ That dude has obviously never held or fired a firearm before.  :o



Looks risky to go stand behind him.

Archimid

  • Young ice
  • Posts: 3261
    • View Profile
  • Liked: 829
  • Likes Given: 204
Re: COVID-19
« Reply #4205 on: March 28, 2020, 08:28:56 PM »

Once you beat the first wave and have a cheap, rapid test, the virus is in effect beaten.
 

If the first wave goes through we already lost. A cheap effective and rapid test minimizes further losses.

There was no reason for the US not to deploy testing except Trump's ego and statistics manipulation.

Masks would've saved so many people, they still can.

This is like the 100th announcement of a rapid tests that can be made widely available, forgive my disbelief until I see it in action.
I am an energy reservoir seemingly intent on lowering entropy for self preservation.

El Cid

  • Nilas ice
  • Posts: 1318
    • View Profile
  • Liked: 567
  • Likes Given: 105
Re: COVID-19
« Reply #4206 on: March 28, 2020, 08:30:00 PM »
Once you beat the first wave and have a cheap, rapid test, the virus is in effect beaten.

Ain't it so?

Yes, after it is produced by the 100s of millions, distributed to 100s of thousands of locations, testers are trained and organized and you convince a recalcitrant, ill-informed, independent-mnded populace to conform.  Not gonna happen overnight.

Not overnight, but by summer: possibble.
They say:
"The company is deploying 150,000 laboratory tests immediately. Tests already have been sent to hospital and academic medical center labs in 18 states including Illinois, California, New York, Massachusetts and Washington. Abbott is scaling up production at its U.S. manufacturing location to reach capacity for one million tests per week by end of March."

This will easily reach 10-20 million tests produced per month by summer. This will also be licensed with lightning speed to Europe as well. This is THE solution (after the first wave has passed)

El Cid

  • Nilas ice
  • Posts: 1318
    • View Profile
  • Liked: 567
  • Likes Given: 105
Re: COVID-19
« Reply #4207 on: March 28, 2020, 08:31:48 PM »
This is like the 100th announcement of a rapid tests that can be made widely available, forgive my disbelief until I see it in action.

Nonetheless. IF and WHEN we have cheap, rapid testing either by Abbot or anyone else, wouldn't you say that the problem is mostly solved? Testing millions of people even every week is far cheaper than an economic collapse. Even your orange-haired friend will understand that

Sam

  • Guest
Re: COVID-19
« Reply #4208 on: March 28, 2020, 08:44:33 PM »
Crude, rude, blunt, and my sentiments precisely... you have been warned.
 
Stay the *$&#% at home!

https://m.youtube.com/watch?v=8BA9eTXwGIk&feature=youtu.be

Sam

Alexander555

  • Nilas ice
  • Posts: 1270
    • View Profile
  • Liked: 142
  • Likes Given: 44
Re: COVID-19
« Reply #4209 on: March 28, 2020, 08:50:39 PM »
Once you beat the first wave and have a cheap, rapid test, the virus is in effect beaten.

Ain't it so?

Yes, after it is produced by the 100s of millions, distributed to 100s of thousands of locations, testers are trained and organized and you convince a recalcitrant, ill-informed, independent-mnded populace to conform.  Not gonna happen overnight.

Not overnight, but by summer: possibble.
They say:
"The company is deploying 150,000 laboratory tests immediately. Tests already have been sent to hospital and academic medical center labs in 18 states including Illinois, California, New York, Massachusetts and Washington. Abbott is scaling up production at its U.S. manufacturing location to reach capacity for one million tests per week by end of March."

This will easily reach 10-20 million tests produced per month by summer. This will also be licensed with lightning speed to Europe as well. This is THE solution (after the first wave has passed)

I think they should have send them to the states with low numbers of infected people first. There they can make a difference, contact tracing....... Than at least they can be saved from troubles. The states you mention, in reality they already have tens of thousands infected people. So they will all have to go in lockdown to stop it. Ofcourse they will need tests to, but they will be less efficient. And they should send them to africa, now the numbers are hopefully still low. Maybe they can still stop it with contact tracing.

sigma_squared

  • Frazil ice
  • Posts: 109
    • View Profile
  • Liked: 45
  • Likes Given: 0
Re: COVID-19
« Reply #4210 on: March 28, 2020, 09:09:24 PM »
Mortality monitoring in Europe, http://www.euromomo.eu/index.html


Quote
European mortality bulletin week 12, 2020

Pooled estimates of all-cause mortality show, overall, normal expected levels in the participating countries; however, increased excess mortality is notable in Italy.

Data from 24 participating countries or regions were included in this week’s pooled analysis of all-cause mortality in Europe.

The number of deaths in the recent weeks should be interpreted with caution as adjustments for delayed registrations may be imprecise. Furthermore, results of pooled analyses may vary depending on countries included in the weekly analyses. Pooled analyses are adjusted for variation between the included countries and for differences in the local delay in reporting.

Note concerning COVID-19 related mortality as part of the all-cause mortality figures reported by EuroMOMO

Over the past few days, the EuroMOMO hub has received many questions about the weekly all-cause mortality data and the possible contribution of any COVID-19 related mortality. Some wonder why no increased mortality is observed in the reported mortality figures for the COVID-19 affected countries.

The answer is that increased mortality that may occur primarily at subnational level or within smaller focal areas, and/or concentrated within smaller age groups, may not be detectable at the national level, even more so not in the pooled analysis at European level, given the large total population denominator. Furthermore, there is always a few weeks of delay in death registration and reporting. Hence, the EuroMOMO mortality figures for the most recent weeks must be interpreted with some caution.

Therefore, although increased mortality may not be immediately observable in the EuroMOMO figures, this does not mean that increased mortality does not occur in some areas or in some age groups, including mortality related to COVID-19.

etienne

  • Nilas ice
  • Posts: 1087
    • View Profile
    • About energy
  • Liked: 184
  • Likes Given: 3
Re: COVID-19
« Reply #4211 on: March 28, 2020, 09:20:33 PM »
Crude, rude, blunt, and my sentiments precisely... you have been warned.
 
Stay the *$&#% at home!

https://m.youtube.com/watch?v=8BA9eTXwGIk&feature=youtu.be

Sam

I love it, already shared it twice.

Etienne

wili

  • Young ice
  • Posts: 3257
    • View Profile
  • Liked: 587
  • Likes Given: 390
Re: COVID-19
« Reply #4212 on: March 28, 2020, 09:28:17 PM »
Along the same lines, and similarly crude though less musical...esp for those who like 'Peaky Blinders':

"A force de chercher de bonnes raisons, on en trouve; on les dit; et après on y tient, non pas tant parce qu'elles sont bonnes que pour ne pas se démentir." Choderlos de Laclos "You struggle to come up with some valid reasons, then cling to them, not because they're good, but just to not back down."

wili

  • Young ice
  • Posts: 3257
    • View Profile
  • Liked: 587
  • Likes Given: 390
Re: COVID-19
« Reply #4213 on: March 28, 2020, 09:37:30 PM »
EC wrote: " IF and WHEN we have cheap, rapid testing either by Abbot or anyone else, wouldn't you say that the problem is mostly solved?"

Probably not, at this point. Testing and tracing can be very effective steps at the very beginning and toward the end of a pandemic. In the midst of it, as we are now in much of the US and other places, is basically useless...we have to assume that nearly everyone either has it or soon will, so what's the point?

Yes, in medical facilities it would be helpful, and it may be useful to have widespread testing for antibodies soon, to know who has already had it, often without realizing it, and there fore is presumably safe or reinfection at least for a while. But otherwise...not at this point the most important thing to do. The most important thing to do now is STAY THE F*** AT HOME :)

But, as has been pointed out, the very earliest these tests will be available will likely be months away or longer, and yes, by then it may be useful.
"A force de chercher de bonnes raisons, on en trouve; on les dit; et après on y tient, non pas tant parce qu'elles sont bonnes que pour ne pas se démentir." Choderlos de Laclos "You struggle to come up with some valid reasons, then cling to them, not because they're good, but just to not back down."

Sam

  • Guest
Re: COVID-19
« Reply #4214 on: March 28, 2020, 09:53:04 PM »
EC wrote: " IF and WHEN we have cheap, rapid testing either by Abbot or anyone else, wouldn't you say that the problem is mostly solved?"

Probably not, at this point. Testing and tracing can be very effective steps at the very beginning and toward the end of a pandemic. In the midst of it, as we are now in much of the US and other places, is basically useless...we have to assume that nearly everyone either has it or soon will, so what's the point?

Yes, in medical facilities it would be helpful, and it may be useful to have widespread testing for antibodies soon, to know who has already had it, often without realizing it, and there fore is presumably safe or reinfection at least for a while. But otherwise...not at this point the most important thing to do. The most important thing to do now is STAY THE F*** AT HOME :)

But, as has been pointed out, the very earliest these tests will be available will likely be months away or longer, and yes, by then it may be useful.

Wili,

Remember that they have to manufacture the tests. That takes employees and raw materials. Then they have to distribute them.

The mail and parcel services are run by human beings. They are getting sick too. And they like all of us are afraid for themselves, their families, their coworker's and their customers. They are already stressed to the limit and collapsing, and we have just started the horrible part in earnest.

We haven't yet introduced comprehensive medical quarantine to stop the spread. But Donald the jerk and asshole is already talking about isolationist, cut them off and let them die alone quarantines. Shipping through those barriers will be hard.

Sam

pietkuip

  • Frazil ice
  • Posts: 345
    • View Profile
  • Liked: 123
  • Likes Given: 281
Re: COVID-19
« Reply #4215 on: March 28, 2020, 10:21:30 PM »
Interesting Japanese documentary:
https://www3.nhk.or.jp/nhkworld/en/ondemand/video/5001289/

Japan is struggling to contain this, to keep track of clusters and shut them down.

Also interesting footage about Wuhan. Not much reason for optimism there.

Alexander555

  • Nilas ice
  • Posts: 1270
    • View Profile
  • Liked: 142
  • Likes Given: 44
Re: COVID-19
« Reply #4216 on: March 28, 2020, 10:25:09 PM »
How big is the part of people that have permanent lung damage after being infected ?

Tom_Mazanec

  • Young ice
  • Posts: 3925
  • Earth will survive AGW...but will Homo sapiens?
    • View Profile
    • Planet Mazanec
  • Liked: 641
  • Likes Given: 383
Re: COVID-19
« Reply #4217 on: March 28, 2020, 10:33:43 PM »
Also, how long are the emergency powers the government has to take to fight this going to last? Or will they become the "new normal"?
SHARKS (CROSSED OUT) MONGEESE (SIC) WITH FRICKIN LASER BEAMS ATTACHED TO THEIR HEADS

Archimid

  • Young ice
  • Posts: 3261
    • View Profile
  • Liked: 829
  • Likes Given: 204
Re: COVID-19
« Reply #4218 on: March 28, 2020, 11:14:42 PM »
Quote
How big is the part of people that have permanent lung damage after being infected?

I think that there will be lung damage according to the severity of the disease. A patient whose disease got so severe that it required intubation will likely have a significant loss of function for a long time or permanently. A patient that merely requires oxygen might have only slight permanent damage.


Besides direct damage, I don't think there is a way to know of other future consequences. We just have to wait for them to emerge.
I am an energy reservoir seemingly intent on lowering entropy for self preservation.

Grubbegrabben

  • New ice
  • Posts: 84
    • View Profile
  • Liked: 39
  • Likes Given: 16
Re: COVID-19
« Reply #4219 on: March 28, 2020, 11:14:56 PM »
The main news here in Sweden is that the rest of europe or even the world think we are a little bit crazy. The only thing strictly locked down is schools (for people aged 16-25) and gatherings with more than 50 people.

Other than that: Wash hands. Don't touch your face. Work from home. Don't visit old people. Stay home at the slightest flu symptom. If you have been Ill, stay home for two days after symptoms are gone.

Apparently, the rest of the world thinks this is a road to disaster.

The swedish ministry of health has justified the actions with this (and the government follows their recommendations. In line with Greta Thunbergs "Listen to the Scientists"):

1. Young children are not the driving force of this outbreak. Closing kindergartens and elementary schools causes more problems than it solves. Their parents are health care professionals, shop assistants, truck drivers and so on. If they are forced to stay home we are just adding another problem. If we are forcing grandparents to take care of their grandkids we are basically handing out death sentences.

2. Asymptomatic or presymptomatic spread is not the driving force of this outbreak. Forcing entire families into quarantine if just one member is ill causes more problems than it solves (see 1 above).

Last but not least - and this is where social media (largely driven by Chinese and Russian troll factories) goes bananas :

3. A too strict lock down may be "too" effective. The virus won't go away no matter what restrictions we put on ourselves. Once too strict restrictions are lifted, the outbreak will come back and we will be forced to lock down again. This is very disruptive and causes more harm than good. Instead, a well measured and timely implemented course of action will be chosen to ensure that health care can cope with the number of patients (the "flatten the curve" idea).

A quick look around the situation in many EU countries reveals a wide range of restrictions. Poland for example, where a strict quarantine is in effect. Only 1400 cases and 17 deaths. Exactly how are they going to go back to normal? Did they chose to go the other way around, start with complete lock down to shut down the outbreak completely and then step by step reopening? I don't know.

My theory is that many EU contries got scared by the situation in Italy/Spain and implemented very strict restrictions, mainly driven by politicians, media and opinions - not by science and facts. My only worry is that the swedish ministry of health got their assumptions, calculations and forecasts wrong and we end up with an Italian-like situation. Interesting times.

Archimid

  • Young ice
  • Posts: 3261
    • View Profile
  • Liked: 829
  • Likes Given: 204
Re: COVID-19
« Reply #4220 on: March 28, 2020, 11:39:56 PM »
How some cities ‘flattened the curve’ during the 1918 flu pandemic

https://www.nationalgeographic.com/history/2020/03/how-cities-flattened-curve-1918-spanish-flu-pandemic-coronavirus/

Quote
The 1918 flu, also known as the Spanish Flu, lasted until 1920 and is considered the deadliest pandemic in modern history. Today, as the world grinds to a halt in response to the coronavirus, scientists and historians are studying the 1918 outbreak for clues to the most effective way to stop a global pandemic. The efforts implemented then to stem the flu’s spread in cities across America—and the outcomes—may offer lessons for battling today’s crisis

FTA:

I am an energy reservoir seemingly intent on lowering entropy for self preservation.

oren

  • First-year ice
  • Posts: 6421
    • View Profile
  • Liked: 2387
  • Likes Given: 2039
Re: COVID-19
« Reply #4221 on: March 28, 2020, 11:40:17 PM »
A well-thought out post Grubbbengrabben. I was wondering about the rationale behind the Swedish situation.
I believe 1 and 2 are wrong. Experience in Italy has shown that young asymptomatic people were major drivers of spreading the disease. In addition, not only old people are at risk, and hospitalization rates are high even for young people, which could lead to health system overwhelm.
I hope for your sake that I am wrong.

Grubbegrabben

  • New ice
  • Posts: 84
    • View Profile
  • Liked: 39
  • Likes Given: 16
Re: COVID-19
« Reply #4222 on: March 29, 2020, 12:22:41 AM »
A well-thought out post Grubbbengrabben. I was wondering about the rationale behind the Swedish situation.
I believe 1 and 2 are wrong. Experience in Italy has shown that young asymptomatic people were major drivers of spreading the disease. In addition, not only old people are at risk, and hospitalization rates are high even for young people, which could lead to health system overwhelm.
I hope for your sake that I am wrong.

Thanks.

The quote below is the main assumption made by the Swedish ministry of health and the basis of all their calculations regarding number of hospital beds and ventilators (intensive care). Google translate.

Apparently many other countries use a significantly higher CAR number in their forecasts, and as a consequence they think stricter regulations are needed. As for the hospitalisation rates - I don't know. Do they look wrong? Emphasis added by me.

Quote
For all outbreaks, both regional and national, we have adopted a Clinical Attack Rate (CAR) of 1%. A CAR of 1% means that 1% of the entire population has been clinically infected after completion of the outbreak. We only include reported cases. Based on analysis of external data, especially from China, we believe that 1% CAR is a realistic worst-case scenario. To estimate probable CAR in China and Italy we have doubled today's accumulated number of infected, as if we were at the top today, and divided by population. In this way we take heed that the outbreak may not be over yet. Given today's situation, that would mean less than 1% of the population of Wuhan city gets a clinical infection, in the Hubei region about 0.2% and throughout China 0.01%. When we do the same for Italy, we get a CAR in Lombardy of 0.7%

Severity distribution among infected per age group given target value of
severity among infected and size of the risk groups.

Severity0-1920-6465+
Mild93%83%67%
Severe6%13%26%
Critical1%4%7%

All mild cases are assumed to be self treated. Severe and Critical admitted in hospital. Critical cases are assumed to need intensive care for an average time period of 14 days.


gandul

  • Grease ice
  • Posts: 761
    • View Profile
  • Liked: 183
  • Likes Given: 10
Re: COVID-19
« Reply #4223 on: March 29, 2020, 12:44:52 AM »
A different way to visualize covid evolution per country, and to discriminate clearly which countries have been successful so far


pietkuip

  • Frazil ice
  • Posts: 345
    • View Profile
  • Liked: 123
  • Likes Given: 281
Re: COVID-19
« Reply #4224 on: March 29, 2020, 12:50:32 AM »
A well-thought out post Grubbbengrabben. I was wondering about the rationale behind the Swedish situation.
I believe 1 and 2 are wrong. Experience in Italy has shown that young asymptomatic people were major drivers of spreading the disease. In addition, not only old people are at risk, and hospitalization rates are high even for young people, which could lead to health system overwhelm.
I hope for your sake that I am wrong.
This article explains some social differences:
https://www.theguardian.com/world/2020/mar/28/as-the-rest-of-europe-lives-under-lockdown-sweden-keeps-calm-and-carries-on

In the end, there will be few differences. And they may be related more to other stuff (smoking for example) than to policy.

In the meantime, we might as well try to enjoy the Spring.

Grubbegrabben

  • New ice
  • Posts: 84
    • View Profile
  • Liked: 39
  • Likes Given: 16
Re: COVID-19
« Reply #4225 on: March 29, 2020, 12:53:35 AM »
Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study

Source: https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1

Quote
COVID-19 has spread to most countries in the world. Puzzlingly, the impact of the disease is different in different countries. These differences are attributed to differences in cultural norms, mitigation efforts, and health infrastructure. Here we propose that national differences in COVID-19 impact could be partially explained by the different national policies respect to Bacillus Calmette-Guerin (BCG) childhood vaccination. BCG vaccination has been reported to offer broad protection to respiratory infections. We compared large number of countries BCG vaccination policies with the morbidity and mortality for COVID-19. We found that countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies

Hefaistos

  • Grease ice
  • Posts: 726
    • View Profile
  • Liked: 76
  • Likes Given: 515
Re: COVID-19
« Reply #4226 on: March 29, 2020, 03:12:51 AM »
Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study

Source: https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1

Quote
COVID-19 has spread to most countries in the world. Puzzlingly, the impact of the disease is different in different countries. These differences are attributed to differences in cultural norms, mitigation efforts, and health infrastructure. Here we propose that national differences in COVID-19 impact could be partially explained by the different national policies respect to Bacillus Calmette-Guerin (BCG) childhood vaccination. BCG vaccination has been reported to offer broad protection to respiratory infections. We compared large number of countries BCG vaccination policies with the morbidity and mortality for COVID-19. We found that countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies

Interesting.
Although Sweden stopped the general program of BCG vaccination (against Tuberculosis) already 1975. After that it has been done only for risk groups.

https://www.folkhalsomyndigheten.se/smittskydd-beredskap/vaccinationer/vacciner-a-o/tuberkulos-tb/

Hefaistos

  • Grease ice
  • Posts: 726
    • View Profile
  • Liked: 76
  • Likes Given: 515
Re: COVID-19
« Reply #4227 on: March 29, 2020, 03:22:03 AM »
Still growing...
https://www.worldometers.info/world-population/

Hypothesis: C19 won't be able to halt the population growth even during Covid year of 2020. Pandemia?

pileus

  • Grease ice
  • Posts: 509
    • View Profile
  • Liked: 31
  • Likes Given: 6
Re: COVID-19
« Reply #4228 on: March 29, 2020, 03:25:55 AM »
But that also highlights what has been one of my primary concerns for the US, in the state of Florida and other communities with a high proportion of 70+ residents.

I’m keeping an eye on The Villages, which is one of the if not the largest retirement age communities in the world.  They’ve had past issues with rampant STD spread, and mix that history with the high proportion of MAGA supporters (apt to dismiss this as a hoax and accept what the cult leader says), and it’s trouble ahead.

Lake, Sumter cases grow to 68, with 31 in The Villages

https://www.orlandosentinel.com/coronavirus/os-ne-coronavirus-lake-county-infected-20200326-2u3suejfybarbi7czwl7jyh4ky-story.html?outputType=amp&__twitter_impression=true

So it begins.  120k clustered elderly residents, many with comorbidities.  Florida’s trajectory is several weeks behind the current US hotspots, and will be made worse by the atrocious leadership of Governor DeSantis, who failed to take this seriously or take aggressive mitigation measures, as his primary concerns are big business and keeping Lord Trump happy. 

vox_mundi

  • Young ice
  • Posts: 4383
    • View Profile
  • Liked: 2477
  • Likes Given: 335
Re: COVID-19
« Reply #4229 on: March 29, 2020, 04:03:03 AM »
Coronavirus Deaths Surge Past 2,000 in US
https://www.aljazeera.com/news/2020/03/trump-weighs-coronavirus-lockdown-york-live-updates-200328234401911.html

Confirmed coronavirus-related deaths in the US doubled in two days, surpassing 2,000 on Saturday, according to the Johns Hopkins University, and highlighting how quickly the virus is spreading through the country.

The US ranked sixth in deaths, after Italy, Spain, China, Iran and France. Italy alone had more than 10,000 dead.

-------------------------------

Trump to Issue 'Strong Travel Advisory' for New York Region https://www.aljazeera.com/news/2020/03/trump-weighs-coronavirus-lockdown-york-live-updates-200328234401911.html

Trump said he will not impose a quarantine in coronavirus hotspots in three states, including New York, but would instead issue a "strong Travel Advisory" for the region.

After consulting with the White House task force leading the federal response and the governors of the three affected states, Trump said: "I have asked the @CDCgov to issue a strong Travel Advisory, to be administered by the Governors, in consultation with the Federal Government. A quarantine will not be necessary."

https://mobile.twitter.com/realDonaldTrump/status/1244056559577071616

“There are three classes of people: those who see. Those who see when they are shown. Those who do not see.” ― Leonardo da Vinci

Insensible before the wave so soon released by callous fate. Affected most, they understand the least, and understanding, when it comes, invariably arrives too late

Pmt111500

  • Guest
Re: COVID-19
« Reply #4230 on: March 29, 2020, 08:21:11 AM »
Informing the last province in Finland which was free of this menace has now reported first two cases. Probably they are also returning tourists but I've got no confirmation of that. Some Bars/Clubs etc. are still open. At least in Helsinki suburbs, these are an excellent location to get familiar with the disease.

Archimid

  • Young ice
  • Posts: 3261
    • View Profile
  • Liked: 829
  • Likes Given: 204
Re: COVID-19
« Reply #4231 on: March 29, 2020, 08:42:28 AM »
Mar 25 1000  Ahead of schedule. At least they had the "courtesy" of not reporting during market hours.

But this thing can't keep doubling every 2 days. A lot of places called for stay in place today.  Alot of place didn't. let's hope it goes back to doubling every 3 days.

Mar 25 1000
Mar 28 2000
Mar 31 4000
Apr 3   8000
Apr 6  16000

There is no reason to go any further than that. Surely people in the US will come to their senses before then.

Right on schedule again.

Mar 28 2020

I think we have at least 2 more 3-day doublings before social distancing efforts show in the accumulations. After that doublings happen every 4 days. After that, I might have to add a day or two for the end of winter. Florida keeps this going.

Mar 31 4040
Apr 3   8080
Apr 7   16160
Apr 11  32320
Apr 15  64640


Btw I now know 2 people with C19, one of them passed. Getting close to me too. The N18 heat was not enough protection. I had to take my kid to the pediatrician for pink eye. The pediatrician didn't wear a mask when examining my kid. He had none to wear. However, many precautions were taken. Every patient waited outside in their cars until thier turn. That mask tho.
I am an energy reservoir seemingly intent on lowering entropy for self preservation.

sidd

  • First-year ice
  • Posts: 5722
    • View Profile
  • Liked: 796
  • Likes Given: 0
Re: COVID-19
« Reply #4232 on: March 29, 2020, 09:04:28 AM »
Stay home and have the baby: Ohio, Texas order stop to abortions

https://jacobinmag.com/2020/03/coronavirus-abortions-health-care

Makes a fitting addition to "Kill Grandma for the Dow."

sidd

Tom_Mazanec

  • Young ice
  • Posts: 3925
  • Earth will survive AGW...but will Homo sapiens?
    • View Profile
    • Planet Mazanec
  • Liked: 641
  • Likes Given: 383
Re: COVID-19
« Reply #4233 on: March 29, 2020, 10:30:36 AM »
Still growing...
https://www.worldometers.info/world-population/

Hypothesis: C19 won't be able to halt the population growth even during Covid year of 2020. Pandemia?
Unless indirect effects swamp the actual C-19 deaths, we will, at most, drop a little bit this year when it peaks in a couple months or so.
SHARKS (CROSSED OUT) MONGEESE (SIC) WITH FRICKIN LASER BEAMS ATTACHED TO THEIR HEADS

nanning

  • Nilas ice
  • Posts: 2401
  • 0Kg CO₂, 37 KWh/wk,125L H₂O/wk, No offspring
    • View Profile
  • Liked: 304
  • Likes Given: 20397
Re: COVID-19
« Reply #4234 on: March 29, 2020, 10:33:17 AM »
Some news from The Netherlands.

In my province Fryslân the police has entered a youngsters' party at someones house. Stopped the party and fined the participants.

Large supermarkets can be entered only one-at-a-time.

Contrary to earlier statements here, The Netherlands are not in a total lockdown such as Italy and Spain are.

I see and read much solidarity here. Attention for the elderly and many people wanting to help.
What really suprises me is that there are no children outside playing even though the schools are closed and there are far fewer cars on the roads. They and their parents must be sitting inside every day. On top of that, it has been beautiful sunny weather and there are woods very close by. Unf*king believable. What a misled generation (I am looking at you commerce and especially the U.S.A. social media shit. Poor children.)

The manufacturing company Philips has brought 100 artificial respiration machines from the U.S.A. to The Netherlands for use in our growing number of I.C.'s.
Aren't they needed more in the U.S.A.? Well, perhaps it's a good counter action for the callous Mexico trip from someone in the U.S.A.. At least it is not stealing from the less rich.

The Netherlands received 1.2 million face masks from China but after testing, half of them were found to be of very poor quality.

Some patients are going to be moved to Germany to free up I.C. space in our hospitals.
"It is preoccupation with possessions, more than anything else, that prevents us from living freely and nobly" - Bertrand Russell
"It is preoccupation with what other people from your groups think of you, that prevents you from living freely and nobly" - Nanning
Why do you keep accumulating stuff?

sigma_squared

  • Frazil ice
  • Posts: 109
    • View Profile
  • Liked: 45
  • Likes Given: 0
Re: COVID-19
« Reply #4235 on: March 29, 2020, 10:39:59 AM »
https://texags.com/forums/84/topics/3102444

Clinical Pearls Covid 19 for ER practitioners

Quote
I just spent an hour typing a long post that erased when I went to change the title so I apologize to the grammar and spelling police. This one will not be proofread and much shorter.

I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.

*****************************************************************************

In uncertain times, we search for facts to provide comfort and clarity. Throw in the power of Texags.com and I should not be so dumbfounded by the run this is getting.

My first expanded lost draft (thanks again MacBook Touch Bar) contained the appropriate hedging, disclaimers, and uncertainty the current understanding of this pandemic deserves. Some of the more concise, unproofread, hastily rewritten original post (OP) presents itself as more definitive instead of "what I think I know". For this, my apologies. I am not performing clinical trials. I am not involved in cohorting and analyzing data. The academic physicians involved in ER, Infectious Disease and Pulmonary Critical Care are likely (hopefully) way beyond my understanding of Covid 19. Furthermore, I fail to appreciate any additional benefit I could provide to Hospital Administrators who have been preparing and communicating with each other for months; or for some already combating this daily.

Basically, several state medical licensing boards are temporarily loosening their independent practice regulations on NPs, PAs, and to a lesser extent Medical Students. I wrote the OP as much for me to collect and organize my thoughts, as it was to provide a jumping-off platform for providers who may find themselves in an ER-like setting and unknowingly be treating Covid 19 patients or will be treating them soon enough. If any of it helps some of my colleagues hit the ground running then that is something too.

The OP was a summary of thoughts from being emersed in Covid 19 for weeks, reading as much as I can, and following up on my own patients. It is not my intention for this to be taken as dogma. I do not have the answers or the algorithm everyone is searching for. I was merely looking to point the handful of people I thought would read it in a clinical direction best I could. What I think I know evolves every day with the presumption it may very well end up markedly different once this pandemic is better understood. I do not know when this crisis will ultimately be arrested, however, I maintain resolute that each one of us can help make that happen. Stay home. Be safe. Find a way not to have to visit grandma.

Thank you to all the well-wishers and good luck to us all.

Sincerely,

NawlinsAg

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.

etienne

  • Nilas ice
  • Posts: 1087
    • View Profile
    • About energy
  • Liked: 184
  • Likes Given: 3
Re: COVID-19
« Reply #4236 on: March 29, 2020, 11:10:06 AM »
A well-thought out post Grubbbengrabben. I was wondering about the rationale behind the Swedish situation.
I believe 1 and 2 are wrong. Experience in Italy has shown that young asymptomatic people were major drivers of spreading the disease. In addition, not only old people are at risk, and hospitalization rates are high even for young people, which could lead to health system overwhelm.
I hope for your sake that I am wrong.

Thanks.

The quote below is the main assumption made by the Swedish ministry of health and the basis of all their calculations regarding number of hospital beds and ventilators (intensive care). Google translate.

Apparently many other countries use a significantly higher CAR number in their forecasts, and as a consequence they think stricter regulations are needed. As for the hospitalisation rates - I don't know. Do they look wrong? Emphasis added by me.

Quote
For all outbreaks, both regional and national, we have adopted a Clinical Attack Rate (CAR) of 1%. A CAR of 1% means that 1% of the entire population has been clinically infected after completion of the outbreak. We only include reported cases. Based on analysis of external data, especially from China, we believe that 1% CAR is a realistic worst-case scenario. To estimate probable CAR in China and Italy we have doubled today's accumulated number of infected, as if we were at the top today, and divided by population. In this way we take heed that the outbreak may not be over yet. Given today's situation, that would mean less than 1% of the population of Wuhan city gets a clinical infection, in the Hubei region about 0.2% and throughout China 0.01%. When we do the same for Italy, we get a CAR in Lombardy of 0.7%

Severity distribution among infected per age group given target value of
severity among infected and size of the risk groups.

Severity0-1920-6465+
Mild93%83%67%
Severe6%13%26%
Critical1%4%7%

All mild cases are assumed to be self treated. Severe and Critical admitted in hospital. Critical cases are assumed to need intensive care for an average time period of 14 days.

Well,  there is no way to compare Sweden and Northern Italy. Population density, pollution... are totally different. Maybe low density countries don't need social distancing. If you look at the cases in the US and in Canada, you also see that it is mainly a virus for cities, at least in phase 1.

etienne

  • Nilas ice
  • Posts: 1087
    • View Profile
    • About energy
  • Liked: 184
  • Likes Given: 3
Re: COVID-19
« Reply #4237 on: March 29, 2020, 11:20:21 AM »
Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study

Source: https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1

Quote
COVID-19 has spread to most countries in the world. Puzzlingly, the impact of the disease is different in different countries. These differences are attributed to differences in cultural norms, mitigation efforts, and health infrastructure. Here we propose that national differences in COVID-19 impact could be partially explained by the different national policies respect to Bacillus Calmette-Guerin (BCG) childhood vaccination. BCG vaccination has been reported to offer broad protection to respiratory infections. We compared large number of countries BCG vaccination policies with the morbidity and mortality for COVID-19. We found that countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies

Interesting.
Although Sweden stopped the general program of BCG vaccination (against Tuberculosis) already 1975. After that it has been done only for risk groups.

https://www.folkhalsomyndigheten.se/smittskydd-beredskap/vaccinationer/vacciner-a-o/tuberkulos-tb/

What I don't like in this article is that I couldn't find which are the countries with a general BCG vaccination program that have been used. I guess that a few of these have data that is difficult to trust or are in an early stage of the pandemic. Looks like somebody has BCG vaccine ready for delivery. 

I also find that the correlation between what they want to prove and the result is too strong to be true.

Tom_Mazanec

  • Young ice
  • Posts: 3925
  • Earth will survive AGW...but will Homo sapiens?
    • View Profile
    • Planet Mazanec
  • Liked: 641
  • Likes Given: 383
Re: COVID-19
« Reply #4238 on: March 29, 2020, 11:27:36 AM »
Dreamed I was explaining to an alien that doctors name diseases after locations (Ebola, Zika) and scientists name diseases after acronyms ( Covid, AIDS).
When I start dreaming like this I am really obsessed.
SHARKS (CROSSED OUT) MONGEESE (SIC) WITH FRICKIN LASER BEAMS ATTACHED TO THEIR HEADS

bligh8

  • Frazil ice
  • Posts: 313
    • View Profile
  • Liked: 56
  • Likes Given: 4
Re: COVID-19
« Reply #4239 on: March 29, 2020, 11:33:26 AM »
USA Leadership


vox_mundi

  • Young ice
  • Posts: 4383
    • View Profile
  • Liked: 2477
  • Likes Given: 335
Re: COVID-19
« Reply #4240 on: March 29, 2020, 11:41:22 AM »
https://texags.com/forums/84/topics/3102444

Clinical Pearls Covid 19 for ER practitioners ...

Thank you, +1

That was very helpful.
“There are three classes of people: those who see. Those who see when they are shown. Those who do not see.” ― Leonardo da Vinci

Insensible before the wave so soon released by callous fate. Affected most, they understand the least, and understanding, when it comes, invariably arrives too late

Richard Rathbone

  • Grease ice
  • Posts: 832
    • View Profile
  • Liked: 139
  • Likes Given: 11
Re: COVID-19
« Reply #4241 on: March 29, 2020, 11:45:56 AM »
A well-thought out post Grubbbengrabben. I was wondering about the rationale behind the Swedish situation.
I believe 1 and 2 are wrong. Experience in Italy has shown that young asymptomatic people were major drivers of spreading the disease. In addition, not only old people are at risk, and hospitalization rates are high even for young people, which could lead to health system overwhelm.
I hope for your sake that I am wrong.
This article explains some social differences:
https://www.theguardian.com/world/2020/mar/28/as-the-rest-of-europe-lives-under-lockdown-sweden-keeps-calm-and-carries-on

In the end, there will be few differences. And they may be related more to other stuff (smoking for example) than to policy.

In the meantime, we might as well try to enjoy the Spring.

It may be that Swedes are better at following government advice to stay home when ill. Sweden is following essentially the same policies with the same rationale as the UK was before its U-turn and getting away with it so far, while the UK wasn't. There have been a couple of people jailed in the UK for coughing at police, and I've seen examples of people not just flouting the social distancing rules, but deliberately coughing and in one case deliberately coughing at me rather than just the world in general.

The Swede interviewed in that article says that the Imperial model would come up with rather different results if different parameters has been used, and he's right, they are rather pessimistic about what fraction of people followed the government advice, but they were chosen on the basis of studies of British society and epidemic spread rate, not Swedish.

GrauerMausling

  • New ice
  • Posts: 37
    • View Profile
  • Liked: 23
  • Likes Given: 0
Re: COVID-19
« Reply #4242 on: March 29, 2020, 12:15:57 PM »
Scary numbers from Germany.

The number of tests has been increased significantly, which is good. What scares me is that the percentage of positives also increased.


CW 11: 127.457 Tests, 5,9 % positive
CW 12: 348.619 Tests, 6,8 % positive

It seems that the requirements for being tested are slightly less strict now than they have been.

So even though the number of tests is nearly threefold there is a higher percentage of positive results.

The 5,9 % is surprisingly low compared to the requirements for being tested. You had to have contact to an infected person or must have stayed in a critical area PLUS you need to show symptoms to get tested.
But an increase of positive test while the criteria are less strict doesn't bode well

blumenkraft

  • Guest

oren

  • First-year ice
  • Posts: 6421
    • View Profile
  • Liked: 2387
  • Likes Given: 2039
Re: COVID-19
« Reply #4244 on: March 29, 2020, 12:34:18 PM »
A well-thought out post Grubbbengrabben. I was wondering about the rationale behind the Swedish situation.
I believe 1 and 2 are wrong. Experience in Italy has shown that young asymptomatic people were major drivers of spreading the disease. In addition, not only old people are at risk, and hospitalization rates are high even for young people, which could lead to health system overwhelm.
I hope for your sake that I am wrong.

Thanks.

The quote below is the main assumption made by the Swedish ministry of health and the basis of all their calculations regarding number of hospital beds and ventilators (intensive care). Google translate.

Apparently many other countries use a significantly higher CAR number in their forecasts, and as a consequence they think stricter regulations are needed. As for the hospitalisation rates - I don't know. Do they look wrong? Emphasis added by me.

Quote
For all outbreaks, both regional and national, we have adopted a Clinical Attack Rate (CAR) of 1%. A CAR of 1% means that 1% of the entire population has been clinically infected after completion of the outbreak. We only include reported cases. Based on analysis of external data, especially from China, we believe that 1% CAR is a realistic worst-case scenario. To estimate probable CAR in China and Italy we have doubled today's accumulated number of infected, as if we were at the top today, and divided by population. In this way we take heed that the outbreak may not be over yet. Given today's situation, that would mean less than 1% of the population of Wuhan city gets a clinical infection, in the Hubei region about 0.2% and throughout China 0.01%. When we do the same for Italy, we get a CAR in Lombardy of 0.7%

Severity distribution among infected per age group given target value of
severity among infected and size of the risk groups.

Severity0-1920-6465+
Mild93%83%67%
Severe6%13%26%
Critical1%4%7%

All mild cases are assumed to be self treated. Severe and Critical admitted in hospital. Critical cases are assumed to need intensive care for an average time period of 14 days.
I must admit I was quite in shock reading this.  The severity/hospitalization rates seem reasonable. But a CAR of 1% sounds like something from fantasyland. China and Italy have implemented lockdowns. If Sweden lets this outbreak run wild in (younger) schools and restaurants, I believe asymptomatic transmission will achieve a CAR of tens of percent. Even assuming that for each clinically diagnosed person there are two that were never diagnosed, and assuming that some of the population somehow is remote and escapes, I can't see how the CAR can be less than 10%.
Again, I really hope I am wrong.

etienne

  • Nilas ice
  • Posts: 1087
    • View Profile
    • About energy
  • Liked: 184
  • Likes Given: 3
Re: COVID-19
« Reply #4245 on: March 29, 2020, 12:57:27 PM »
I am not so pessimistic for Sweden, excepted for the few cities, but I really think that they should do some confinement between the regions.

Hefaistos

  • Grease ice
  • Posts: 726
    • View Profile
  • Liked: 76
  • Likes Given: 515
Re: COVID-19
« Reply #4246 on: March 29, 2020, 01:17:10 PM »
A well-thought out post Grubbbengrabben. I was wondering about the rationale behind the Swedish situation.
I believe 1 and 2 are wrong. Experience in Italy has shown that young asymptomatic people were major drivers of spreading the disease. In addition, not only old people are at risk, and hospitalization rates are high even for young people, which could lead to health system overwhelm.
I hope for your sake that I am wrong.

Thanks.

The quote below is the main assumption made by the Swedish ministry of health and the basis of all their calculations regarding number of hospital beds and ventilators (intensive care). Google translate.

Apparently many other countries use a significantly higher CAR number in their forecasts, and as a consequence they think stricter regulations are needed. As for the hospitalisation rates - I don't know. Do they look wrong? Emphasis added by me.

Quote
For all outbreaks, both regional and national, we have adopted a Clinical Attack Rate (CAR) of 1%. A CAR of 1% means that 1% of the entire population has been clinically infected after completion of the outbreak. We only include reported cases. Based on analysis of external data, especially from China, we believe that 1% CAR is a realistic worst-case scenario. To estimate probable CAR in China and Italy we have doubled today's accumulated number of infected, as if we were at the top today, and divided by population. In this way we take heed that the outbreak may not be over yet. Given today's situation, that would mean less than 1% of the population of Wuhan city gets a clinical infection, in the Hubei region about 0.2% and throughout China 0.01%. When we do the same for Italy, we get a CAR in Lombardy of 0.7%

Severity distribution among infected per age group given target value of
severity among infected and size of the risk groups.

Severity0-1920-6465+
Mild93%83%67%
Severe6%13%26%
Critical1%4%7%

All mild cases are assumed to be self treated. Severe and Critical admitted in hospital. Critical cases are assumed to need intensive care for an average time period of 14 days.
I must admit I was quite in shock reading this.  The severity/hospitalization rates seem reasonable. But a CAR of 1% sounds like something from fantasyland. China and Italy have implemented lockdowns. If Sweden lets this outbreak run wild in (younger) schools and restaurants, I believe asymptomatic transmission will achieve a CAR of tens of percent. Even assuming that for each clinically diagnosed person there are two that were never diagnosed, and assuming that some of the population somehow is remote and escapes, I can't see how the CAR can be less than 10%.
Again, I really hope I am wrong.

This has to be a case of something lost in translation. Or they changed the definition of attack rate. Or they are COMPLETE idiots.
 Sounds more like they estimate the hospitalisation rate.

Where was that information from, Grubbegrabben? I tried to search for it, can't find it.

SteveMDFP

  • Nilas ice
  • Posts: 1809
    • View Profile
  • Liked: 384
  • Likes Given: 25
Re: COVID-19
« Reply #4247 on: March 29, 2020, 01:42:00 PM »
https://texags.com/forums/84/topics/3102444

Clinical Pearls Covid 19 for ER practitioners

Quote

I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.
...

Thanks for posting this.  It's a great description of what it's like for doctors "in the trenches."  For those unfamiliar with the medical lingo, that link has a version in the comments where someone has inserted plain-english in parentheses to go with the lingo.

It's not at all surprising that they're using various agents off-label. But they seem to be doing this when cases have become severe, not early in the course for high-risk groups. Unfortunately, there's no national response to secure supplies to keep doing this.  Once ventilators are all in use, care in the US will likely degrade to being equivalent to Bangladesh.   Critical shortage of PPE is already making the comparison....comparable.
« Last Edit: March 29, 2020, 01:53:13 PM by SteveMDFP »

blumenkraft

  • Guest
Re: COVID-19
« Reply #4248 on: March 29, 2020, 01:52:47 PM »
Federalism (in Germany) be like:


blumenkraft

  • Guest
Re: COVID-19
« Reply #4249 on: March 29, 2020, 01:56:58 PM »
Confirmed cases in North America, showing the impact on NY (27 March)



Link >> https://www.reddit.com/r/dataisbeautiful/comments/fr0btz/oc_confirmed_cases_in_north_america_showing_the/