Coronavirus (No politics)

InVOLuntary

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This from a poster in the recruiting forum. He's on the front line of this thing...

Apologies in advance. Long post-night-shift observations coming.

My main fear is that we're more on-course to be like Italy. As I've revealed in prior posts, I'm an ER doc in the San Francisco area. We had our first positive at my hospital in January. The testing criteria were so geographically strict initially that we were basically shut down from testing anyone aside from critically ill, admitted patients for the next month and change. We could see on the ground that we were letting through suspicious cases, and so it was no surprise that we had community transmission when we did with the degree of business travel from Silicon Valley to China (similar in the Seattle area). I have implicit trust in the CDC - the folks I've interacted with from CDC in the past have been nothing short of spectacular. Based on what I understand, they tried to make a comprehensive test - a COVID component (which functioned perfectly) and a much, much broader PCR viral panel that likely mirrors a test I have available at my hospital (testing for 15-20 common respiratory viruses and a few bacterial pathogens) which we use frequently to avoid invasive workups in small children and which is also useful in the elderly. That would allow hospitals that didn't have the capacity to run a PCR test on their own to not only get a +/- on COVID, but would give some confirmation to a negative COVID test by potentially providing an alternative explanation for symptoms with diagnosis of another viral illness. The viral panel was evidently the problem, as it returned inconclusive results. That forced a recall, and set us back by weeks. They tried to make it perfect for all settings, but proved once again that doing something very complex, for the first time, at speed, is very hard. The only real knock I have on the initial plan was that I think that there was a false sense of security that in concert with the very draconian response in China, we would be able to catch cases with airport screening, and that locally-based testing - versus a 3-4 day turnaround to send a test to the reference lab in Atlanta - wouldn't be necessary. I think that they were expecting much lower numbers of tests initially, and the lack of available test kits forced them into very restrictive testing criteria.

As a result, we missed our chance at any significant local control of infection here. An earlier declaration of a national state of emergency would have at least loosened the reins on University medical centers and private labs to get their own tests approved sooner. That has finally happened, and the news today was positive, though far, far too late.

I don't have exact numbers, but I would imagine that we are in the mid-teens in terms of positive tests in my medium-sized hospital. A couple deaths (one as-yet unreported, likely due to coroner review). Five or so positives in the hospital. A number of recovered patients discharged. A number of pending tests in the ED this morning with very suspicious stories.

Testing has definitely improved in the last week, and I am now able to be a doctor again and make testing decisions based on my clinical thinking, which is a definite plus. My gripe is that if we all had been able to do this a month or two ago, we might have been able to slow community transmission with strict quarantines for positive patients as opposed to a catch-and-release method with a hopeful self-quarantine. Much less effective if you as a patient can convince yourself that you might not have the disease and you aren't really that likely to kill your neighbors accidentally if you go out.

This is very much hub-and-spoke transportation-based spread. Initial cases largely clustered around major international airports. Now new cases cropping up in regional airport cities. Soon to arrive in rural areas. We aren't likely to be as good at strict quarantine for hard-hit geographic areas as the Chinese. Lots of cat-herding would be necessary to make that happen, and a nation of 330+ million unruly, self-important and indignant cats will make that quite difficult, until the cats are well and truly concerned.

We found out thursday evening that today is the last day of school for my three kids until April 20th. While that really, really sucks for a household with two full-time physicians and no local family support, I'm in full agreement. Each day in the ED over the last two weeks has had just a bit more flavor of exponential spread - more and more suspicious cases each day. My hospital is still coping relatively well, but even before this started, we were running at close to capacity with general medical illness and wintertime flu, pneumonia and other viral illnesses. The hospital has definitely hired up and tried to open new areas that were previously underutilized in other roles, but the fact remains that we (and most other hospitals) don't have that much unused capacity left over.

The whole idea of shutting everything down is to decrease the rate of transmission and flatten the exponential growth curve. The same number of people will contract the virus, but over a longer time period, hopefully leaving us in a situation that we can flex up to handle. The alternative (which is feeling more concerningly real by the day, at least in my area) is that hospital resources are at some point suddenly outstripped by the flood of patients and we are in an Italy, Wuhan or Katrina-like nightmare situation, making horrific decisions because we have no other options.

That's the rationale behind all the seemingly knee-jerk closures. If you're in East TN, behavior change and expanded testing still have a chance to help out significantly given the likely small degree of local spread to this point. This isn't some horrible disease that will kill us all. It is far, far worse for those in my parents generation than for me or my kids. But given the prolonged recovery time, even five of those patients per day admitted to most hospitals will quickly outstrip our capacity to keep things under control. The real challenge now is to see if we can mount a coordinated public response to limit the rate of spread to avoid a worst-case-scenario. If we can do that, the next step will be looking outward to try to help keep the rest of the developing world (just now starting to be touched by COVID) from arriving at the worst-case-scenario, with far more dire political stability and societal consequences.

In the meantime, this is going to suck for at least the next few months. The economy is going to take a huge hit. Try to support local businesses - get take-out even if you're too concerned to go out to dinner. Small businesses are going to need all the help they can get. The other group that is going to be absolutely (and legitimately) terrified by all this is the over-60 crowd. Offer to run errands, get groceries, so that they don't have to run the risk of doing it themselves. You may save a life. At the least, you'll take some of the fear out of their daily lives.

This was always coming, regardless of governmental missteps on both sides of the Pacific. And something like this will always come again - it's just a matter of time and chance. I think that the lesson is that regardless of political divisions and the hyperpartisanship of the last few decades, we are, together, facing a stark threat. If we can pull in the same direction as a group (and more broadly, as a species), we can muddle through, hopefully without too much personal or societal damage. If we can't, this gets much uglier and the fallout reverberates around the world for years.
 
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So, they may have no idea how many people have contracted Coronavirus, but they should have a very good idea of how many people are dying from it. It appears that the spread was underestimated and the severity was overestimated outside of people with compromised immune systems i.e. older people. Why cant they just make them stay home? Why everyone? I mean if you can tell 20 year olds they can't smoke.
 

YankeeVol

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So, they may have no idea how many people have contracted Coronavirus, but they should have a very good idea of how many people are dying from it. It appears that the spread was underestimated and the severity was overestimated outside of people with compromised immune systems i.e. older people. Why cant they just make them stay home? Why everyone? I mean if you can tell 20 year olds they can't smoke.
Because telling them is stopping them, LOL.
 

burntorangeVOLffle

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7000 people contract HIV daily. Again, people do not understand how many people there are, how many of them die, the types of things they die of. It's sad because these things are tracked and estimated in great detail and are readily available for the most part with a google search.

3000+ people die daily in car accidents.
2000+ people commit suicide every day.
Around 1000 die daily from the flu, malaria kills about the same.
in 2009 an estimated 203,000 people died from just from H1N1.

Why are we not asking people to show their work mathematically when they suggest and implement such extreme measures? Pandemic is a very vague term and it seems that it could be applied more appropriately towards other diseases. Crisis is even more broad and there are a lot of them that are more serious, deadly, and lasting.
Are hospitals overflowing with people who contracted HIV in a matter of days? Last I heard, I can be in a room full of people with HIV but not contract it. Transmission of this is fast and only needs minor contact.

The problem isn’t JUST the virus. Go read about Northern Italy where they are having to make decisions on who lives and dies based on available ventilators or even just beds. And that’s just for COVID patients. Not like those other ailments are just going to stop.

I do think there is an unreasonable amount of freakout going on. But I also think dismissing it because numbers of deaths from other causes are higher is unreasonably flippant as well.
 

Shades

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7000 people contract HIV daily. Again, people do not understand how many people there are, how many of them die, the types of things they die of. It's sad because these things are tracked and estimated in great detail and are readily available for the most part with a google search.

3000+ people die daily in car accidents.
2000+ people commit suicide every day.
Around 1000 die daily from the flu, malaria kills about the same.
in 2009 an estimated 203,000 people died from just from H1N1.

Why are we not asking people to show their work mathematically when they suggest and implement such extreme measures? Pandemic is a very vague term and it seems that it could be applied more appropriately towards other diseases. Crisis is even more broad and there are a lot of them that are more serious, deadly, and lasting.

With an extremely high transmission rate (notably higher than the flu), Covid19 has the potential to infect 70% of the world's population if left unchecked. The world's population has zero immunity to Covid19.
Death rates are currently 3-4%. Let's say we trim that down to 1% due to unreported cases. This is still 10x the death rate of the common flu.
Left unchecked, Covid could kill several million within the period of less than a year.

In addition, the complication rate of Covid19 is around at least 10%-20% (10%-20% of people need to be hospitalized to survive). This is 10x-20x higher than the common flu.
Left unchecked, this would produce many millions of people in the US that need a hospital bed. There are only a few hundred thousand hospital beds in the US, and usually less than 200k are unoccupied at a given time.
Left unchecked, hospitals would become overwhelmed (this is happening in Italy), and other people needing medical care would not be able to get in the hospital, resulting in more deaths.

Below are some reports from Europe, including a doctor in Italy:
Coronavirus: European Leaders Finally Acknowledge Scale of Crisis
The situation is dire in Italy. And has the potential to become dire in the US also.

China put down extremely drastic measured to contain the virus, probably much more draconian than will ever be considered inside the US, and still their hospitals were overwhelmed. But they slowed the rate of infections by doing so.
South Korea, the first major outbreak outside of China, dodged a bullet by also acting quickly and decisively. Their cases rose exponentially to about 7000 cases, but has now slowed tremendously due to aggressive measures.


Italy did not take measures like South Korea, and their cases are rising exponentially already past 17000 cases and as a result they just recently shut the country down; we will see if it was too little to late or not.
Germany and France and Spain are next with several thousand cases, and increasing exponentially with no signs of slowdown yet; we will see if they take measures to slow down the rate of infection.
USA is not far behind with 2000 confirmed cases and increasing rapidly.

Left unchecked, Covid19 will infect at exponential rates everywhere there are not measures taken to reduce the spread, and this has shown to be the case in every country so far.
Left unchecked, exponential spread means that the number of cases doubles every few to several days.

Data below from:
COVID19info.live

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1584195307056.png
 

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With an extremely high transmission rate (notably higher than the flu), Covid19 has the potential to infect 70% of the world's population if left unchecked. The world's population has zero immunity to Covid19.
Death rates are currently 3-4%. Let's say we trim that down to 1% due to unreported cases. This is still 10x the death rate of the common flu.
Left unchecked, Covid could kill several million within the period of less than a year.

In addition, the complication rate of Covid19 is around at least 10%-20% (10%-20% of people need to be hospitalized to survive). This is 10x-20x higher than the common flu.
Left unchecked, this would produce many millions of people in the US that need a hospital bed. There are only a few hundred thousand hospital beds in the US, and usually less than 200k are unoccupied at a given time.
Left unchecked, hospitals would become overwhelmed (this is happening in Italy), and other people needing medical care would not be able to get in the hospital, resulting in more deaths.

Below are some reports from Europe, including a doctor in Italy:
Coronavirus: European Leaders Finally Acknowledge Scale of Crisis
The situation is dire in Italy. And has the potential to become dire in the US also.

China put down extremely drastic measured to contain the virus, probably much more draconian than will ever be considered inside the US, and still their hospitals were overwhelmed. But they slowed the rate of infections by doing so.
South Korea, the first major outbreak outside of China, dodged a bullet by also acting quickly and decisively. Their cases rose exponentially to about 7000 cases, but has now slowed tremendously due to aggressive measures.


Italy did not take measures like South Korea, and their cases are rising exponentially already past 17000 cases and as a result they just recently shut the country down; we will see if it was too little to late or not.
Germany and France and Spain are next with several thousand cases, and increasing exponentially with no signs of slowdown yet; we will see if they take measures to slow down the rate of infection.
USA is not far behind with 2000 confirmed cases and increasing rapidly.

Left unchecked, Covid19 will infect at exponential rates everywhere there are not measures taken to reduce the spread, and this has shown to be the case in every country so far.
Left unchecked, exponential spread means that the number of cases doubles every few to several days.

Data below from:
COVID19info.live

View attachment 266285

View attachment 266286

View attachment 266288

View attachment 266289



View attachment 266292
With an extremely high transmission rate (notably higher than the flu), Covid19 has the potential to infect 70% of the world's population if left unchecked. The world's population has zero immunity to Covid19.
Death rates are currently 3-4%. Let's say we trim that down to 1% due to unreported cases. This is still 10x the death rate of the common flu.
Left unchecked, Covid could kill several million within the period of less than a year.

In addition, the complication rate of Covid19 is around at least 10%-20% (10%-20% of people need to be hospitalized to survive). This is 10x-20x higher than the common flu.
Left unchecked, this would produce many millions of people in the US that need a hospital bed. There are only a few hundred thousand hospital beds in the US, and usually less than 200k are unoccupied at a given time.
Left unchecked, hospitals would become overwhelmed (this is happening in Italy), and other people needing medical care would not be able to get in the hospital, resulting in more deaths.

Below are some reports from Europe, including a doctor in Italy:
Coronavirus: European Leaders Finally Acknowledge Scale of Crisis
The situation is dire in Italy. And has the potential to become dire in the US also.

China put down extremely drastic measured to contain the virus, probably much more draconian than will ever be considered inside the US, and still their hospitals were overwhelmed. But they slowed the rate of infections by doing so.
South Korea, the first major outbreak outside of China, dodged a bullet by also acting quickly and decisively. Their cases rose exponentially to about 7000 cases, but has now slowed tremendously due to aggressive measures.


Italy did not take measures like South Korea, and their cases are rising exponentially already past 17000 cases and as a result they just recently shut the country down; we will see if it was too little to late or not.
Germany and France and Spain are next with several thousand cases, and increasing exponentially with no signs of slowdown yet; we will see if they take measures to slow down the rate of infection.
USA is not far behind with 2000 confirmed cases and increasing rapidly.

Left unchecked, Covid19 will infect at exponential rates everywhere there are not measures taken to reduce the spread, and this has shown to be the case in every country so far.
Left unchecked, exponential spread means that the number of cases doubles every few to several days.

Data below from:
COVID19info.live

View attachment 266285

View attachment 266286

View attachment 266288

View attachment 266289



View attachment 266292
This garbage reminds of those climate projections from the turn of the century and those old projection charts that said Whites would be a minority in America by 2020. in this instance It's a logical fallacy that assumes human behavior and circumstances are constant and unchanged. Since this is obviously not the. For example, Some individuals were almost certainly infected because they don't wash their hands. Others avoided infection even with exposure due to washing their hands which they will continue to do so indefinitely. Others will forget once and get infected despite usually washing etc. etc. People make contact with wide ranges of individuals from none, to hundreds etc. etc. Exponential growth my ass.

As far as Italy goes, what is occurring is obvious. Individuals without the virus and/or perfectly healthy immune systems are seeking medical attention for no reason. What needs to be stated clearly by "experts" is that young people who are sick should isolate themselves in their homes and allow their immune system to do what it does. What happens is that a person get sick, maybe even the coronavirus, and because they have heard how scary and deadly it is, they run to get tested in a panic hoping they don't die. If they had never heard of the virus, they would correctly assume that their immune system would allow them to easily recover.

Unfortunately our medical "experts" cant say that because of the exceptions. Those exceptions would produce incredible backlash if not liability issues for our experts, so they cant say that. it's unfortunate because it is ultimately making things "exponentially" worse.
 

InVOLuntary

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With an extremely high transmission rate (notably higher than the flu), Covid19 has the potential to infect 70% of the world's population if left unchecked. The world's population has zero immunity to Covid19.
Death rates are currently 3-4%. Let's say we trim that down to 1% due to unreported cases. This is still 10x the death rate of the common flu.
Left unchecked, Covid could kill several million within the period of less than a year.

In addition, the complication rate of Covid19 is around at least 10%-20% (10%-20% of people need to be hospitalized to survive). This is 10x-20x higher than the common flu.
Left unchecked, this would produce many millions of people in the US that need a hospital bed. There are only a few hundred thousand hospital beds in the US, and usually less than 200k are unoccupied at a given time.
Left unchecked, hospitals would become overwhelmed (this is happening in Italy), and other people needing medical care would not be able to get in the hospital, resulting in more deaths.

Below are some reports from Europe, including a doctor in Italy:
Coronavirus: European Leaders Finally Acknowledge Scale of Crisis
The situation is dire in Italy. And has the potential to become dire in the US also.

China put down extremely drastic measured to contain the virus, probably much more draconian than will ever be considered inside the US, and still their hospitals were overwhelmed. But they slowed the rate of infections by doing so.
South Korea, the first major outbreak outside of China, dodged a bullet by also acting quickly and decisively. Their cases rose exponentially to about 7000 cases, but has now slowed tremendously due to aggressive measures.


Italy did not take measures like South Korea, and their cases are rising exponentially already past 17000 cases and as a result they just recently shut the country down; we will see if it was too little to late or not.
Germany and France and Spain are next with several thousand cases, and increasing exponentially with no signs of slowdown yet; we will see if they take measures to slow down the rate of infection.
USA is not far behind with 2000 confirmed cases and increasing rapidly.

Left unchecked, Covid19 will infect at exponential rates everywhere there are not measures taken to reduce the spread, and this has shown to be the case in every country so far.
Left unchecked, exponential spread means that the number of cases doubles every few to several days.

Data below from:
COVID19info.live

View attachment 266285

View attachment 266286

View attachment 266288

View attachment 266289



View attachment 266292
What concerns me about these charts are the deaths vs recovered are about the same. That tells me you really can't place a percentage of death until more recover. This may be good or it may be bad. We still are trying to gather data on it.
 
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burntorangeVOLffle

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This garbage reminds of those climate projections from the turn of the century and those old projection charts that said Whites would be a minority in America by 2020. in this instance It's a logical fallacy that assumes human behavior and circumstances are constant and unchanged. Since this is obviously not the. For example, Some individuals were almost certainly infected because they don't wash their hands. Others avoided infection even with exposure due to washing their hands which they will continue to do so indefinitely. Others will forget once and get infected despite usually washing etc. etc. People make contact with wide ranges of individuals from none, to hundreds etc. etc. Exponential growth my ass.

As far as Italy goes, what is occurring is obvious. Individuals without the virus and/or perfectly healthy immune systems are seeking medical attention for no reason. What needs to be stated clearly by "experts" is that young people who are sick should isolate themselves in their homes and allow their immune system to do what it does. What happens is that a person get sick, maybe even the coronavirus, and because they have heard how scary and deadly it is, they run to get tested in a panic hoping they don't die. If they had never heard of the virus, they would correctly assume that their immune system would allow them to easily recover.

Unfortunately our medical "experts" cant say that because of the exceptions. Those exceptions would produce incredible backlash if not liability issues for our experts, so they cant say that. it's unfortunate because it is ultimately making things "exponentially" worse.
The problem in Italy is not just about people with minor symptoms coming for tests. They are literally having to decide who gets oxygen and who doesn’t or worse, a ventilator, based on available resources. This not some backwater part of the world. They have more beds per patient than the average US hospital.

It’s not only the elderly either.

Young and unafraid of the coronavirus? Good for you. Now stop killing people | Opinion
 
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Shades

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The number of people requiring intensive care (about 10% of confirmed cases) is one of the largest concerns in Italy right now.
This is people requiring intensive care, not people coming in with the sniffles or a simple cough.

When Italy reaches 30,000 confirmed cases in another day or two, there will be 3000 in intensive care, and Italy will be out of beds, and the death rate would likely increase due to lack of care for severely infected patients.
As of March 14, Italy now has 21,157 cases (with about 2100 in intensive care) and will likely eclipse 30,000 cases in the next couple days.

South Korea headed off this scenario by slowing the rate of infection down before it got to 8000 cases, with aggressive measures.

It is TBD whether France, Germany, Spain and the US follow the route of Italy or South Korea. We will know within another couple weeks.

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Regulator

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Current mortality rate in the US is approximately 2% (50/2400+) and I think the actual rate is less than that because I’d be willing to bet that the unknown number of currently infected people greatly outpaces any number of deaths that could be attributed to coronavirus.

Take a deep breath, everyone..... just not within 6’ of any other person.
 
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This garbage reminds of those climate projections from the turn of the century and those old projection charts that said Whites would be a minority in America by 2020. in this instance It's a logical fallacy that assumes human behavior and circumstances are constant and unchanged. Since this is obviously not the. For example, Some individuals were almost certainly infected because they don't wash their hands. Others avoided infection even with exposure due to washing their hands which they will continue to do so indefinitely. Others will forget once and get infected despite usually washing etc. etc. People make contact with wide ranges of individuals from none, to hundreds etc. etc. Exponential growth my ass.

As far as Italy goes, what is occurring is obvious. Individuals without the virus and/or perfectly healthy immune systems are seeking medical attention for no reason. What needs to be stated clearly by "experts" is that young people who are sick should isolate themselves in their homes and allow their immune system to do what it does. What happens is that a person get sick, maybe even the coronavirus, and because they have heard how scary and deadly it is, they run to get tested in a panic hoping they don't die. If they had never heard of the virus, they would correctly assume that their immune system would allow them to easily recover.

Unfortunately our medical "experts" cant say that because of the exceptions. Those exceptions would produce incredible backlash if not liability issues for our experts, so they cant say that. it's unfortunate because it is ultimately making things "exponentially" worse.
Color me shocked you had this response.
 

burntorangeVOLffle

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Publix now says, as of March 14, it will close its store at 8 p.m. until further notice as a way of better serving its customers. The closures will help crews by giving them more time for preventative sanitation, as well as time to restock their shelves.
Kroger pick up kid told me they are closing to restock as well.
 

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