Coronavirus (No politics)

#326
#326
This thing is way overblown though. Flu kills 50,000 a year, pneumonia kills 50,000 a year. Coronavirus mortality rate is not that high. Yes, it is contagious, but the news got this stuff up there with Ebola and H1N1. Go compare the rates.
 
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#329
#329
Grudenator said:
This thing is way overblown though. Flu kills 50,000 a year, pneumonia kills 50,000 a year. Coronavirus mortality rate is not that high. Yes, it is contagious, but the news got this stuff up there with Ebola and H1N1. Go compare the rates.
Click to expand...
You can't really compare a year of data to two months. And the thing that makes this extremely dangerous is being contagious for 14 days before showing symptoms.
 
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#335
#335
Grudenator said:
This thing is way overblown though. Flu kills 50,000 a year, pneumonia kills 50,000 a year. Coronavirus mortality rate is not that high. Yes, it is contagious, but the news got this stuff up there with Ebola and H1N1. Go compare the rates.
Click to expand...
How many people get the flu and recover? I think it’s way more than 100,000 plus. This virus is spreading very fast. That alone is something that I personally am considering.
 
#338
#338
salutethehill said:
Depending on where you look, the coronavirus death rate is 3%, compared to the flu's 0.1%
Click to expand...

I think more people have had it or been exposed to it than what the numbers probably say. There are some that have never had symptoms but had it. Plus, I am not sure there have been many, if at all, kids who have gotten it. All the cases have been adults.

While people certainly need to be careful, especially older adults, I do think it's being hyped up a lot.
 
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#339
#339
Grudenator said:
This thing is way overblown though. Flu kills 50,000 a year, pneumonia kills 50,000 a year. Coronavirus mortality rate is not that high. Yes, it is contagious, but the news got this stuff up there with Ebola and H1N1. Go compare the rates.
Click to expand...
so are you saying I don't need to buy this 240 roll case of toilet paper from Costco?
 
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#341
#341
My business partner called Royal Caribbean yesterday to cancel/reschedule a cruise booked for next week. He said he was on hold for two hours, but he was able to get vouchers issued to redeem at a later date.
 
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#344
#344
BigOrangeAl 1979 said:
You couldn’t pay me enough to get on a cruise ship right now
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My coworker supposedly left with his family on a cruise this past Sunday. Caribbean/Atlantic. I'd been playfully giving him grief about making him sit at the corner computer away from everyone else at work when he gets back next week. A few other people were much more aggressive about he should really consider cancelling.
 
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#346
#346
TheDeeble said:
My coworker supposedly left with his family on a cruise this past Sunday. Caribbean/Atlantic. I'd been playfully giving him grief about making him sit at the corner computer away from everyone else at work when he gets back next week. A few other people were much more aggressive about he should really consider cancelling.
Click to expand...
. Lol I don’t blame you
 
#347
#347
The following was shared with me by a colleague. It was cleared to be seen by the public, but I have removed names for privacy. Much of this information is new and quite interesting:

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

Notes from the Infectious Disease Association of California Winter Symposium, 3/8/2020

In attendance were physicians from Santa Clara, San Francisco and Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence hospitals, who has 2 affected Seattle hospitals under his jurisdiction. The CDPH director of Hospital Acquired Infections was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.

1. The most common presentation was one week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.

2. Co-infection rate with other respiratory viruses like Influenza or RSV is <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China.

3. So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.

4. Patients with underlying cardiopulmonary disease seem to progress with variable rates to ARDS and acute respiratory failure requiring BiPAP then intubation. There may be a component of cardiomyopathy from direct viral infection as well. Intubation is considered “source control” equal to patient wearing a mask, greatly diminishing transmission risk. BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs.

5. To date, patients with severe disease are most all (excepting those whose families didn’t sign consent) getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5 vs 10 days of Remdesivir) or the NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, but didn’t seem to be much benefit.

6. If our local lab ran out of test kits we could use Quest labs to test. Their test is 24-48 hour turn-around-time. Both Quest and ordering physician would be required to notify Public Health immediately with any positive results. Ordering physician would be responsible for coordinating with the Health Department regarding isolation.

7. At facilities that had significant numbers of exposed healthcare workers they did allow those with low and moderate risk exposures to return to work well before 14 days. Only HCW with highest risk exposures were excluded for almost the full 14 days (I think 9 days). After return to work, all wore surgical masks while at work until the 14 days period expired. All had temperature check and interview with employee health prior to start of work, also only until the end of the 14 days. Obviously, only asymptomatic individuals were allowed back.

8. Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort.

9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart.

10. All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines.

11. Sutter and other larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments.

12. Health Departments state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in San Jose area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.
 
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#348
#348
kiddiedoc said:
The following was shared with me by a colleague. It was cleared to be seen by the public, but I have removed names for privacy. Much of this information is new and quite interesting:

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

Notes from the Infectious Disease Association of California Winter Symposium, 3/8/2020

In attendance were physicians from Santa Clara, San Francisco and Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence hospitals, who has 2 affected Seattle hospitals under his jurisdiction. The CDPH director of Hospital Acquired Infections was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.

1. The most common presentation was one week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.

2. Co-infection rate with other respiratory viruses like Influenza or RSV is <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China.

3. So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.

4. Patients with underlying cardiopulmonary disease seem to progress with variable rates to ARDS and acute respiratory failure requiring BiPAP then intubation. There may be a component of cardiomyopathy from direct viral infection as well. Intubation is considered “source control” equal to patient wearing a mask, greatly diminishing transmission risk. BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs.

5. To date, patients with severe disease are most all (excepting those whose families didn’t sign consent) getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5 vs 10 days of Remdesivir) or the NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, but didn’t seem to be much benefit.

6. If our local lab ran out of test kits we could use Quest labs to test. Their test is 24-48 hour turn-around-time. Both Quest and ordering physician would be required to notify Public Health immediately with any positive results. Ordering physician would be responsible for coordinating with the Health Department regarding isolation.

7. At facilities that had significant numbers of exposed healthcare workers they did allow those with low and moderate risk exposures to return to work well before 14 days. Only HCW with highest risk exposures were excluded for almost the full 14 days (I think 9 days). After return to work, all wore surgical masks while at work until the 14 days period expired. All had temperature check and interview with employee health prior to start of work, also only until the end of the 14 days. Obviously, only asymptomatic individuals were allowed back.

8. Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort.

9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart.

10. All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines.

11. Sutter and other larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments.

12. Health Departments state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in San Jose area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.
Click to expand...
Kiddiedoc, I assume that you’re a pediatrician, but do you have any guidance as to what lung conditions are adult risk factors for progression to ICU level of care? We have three with asthma in the family: three with allergy- or exercise-induced asthma (one who is a primary care physician with pretty impressive acute exacerbation of asthma once it gets going; one with mild allergy-induced asthma + mild COPD (age 70).)

Completely understand if you say “Ask your provider.” We just can’t figure the guidance on how asthma rates on the pulmonary risk scale. thanks
 
#349
#349
Let’s hope further study shows this tidbit to be a big nothing burger, otherwise, damn...just damn.

9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus.
 
#350
#350
DynaLo said:
Let’s hope further study shows this tidbit to be a big nothing burger, otherwise, damn...just damn.

9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus.
Click to expand...
This is not terribly unusual for a viral infection. Some people with GI bugs, for instance, have been found to shed viral material for many weeks. I would highly doubt that a person remains very infective for more than 7-10 days.
 
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