Exactly gsgs, the 1% number seems to look right when you manage the number of infected through aggressive social distancing, tracing and containment AND you have a functioning public health care system. If you have a dysfunctional health care system and/or an overloaded one, then expect the fatality rates to climb (a lot).
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Discussion thread III - Covid-19 (new coronavirus)
- Thread starter sharon sanders
- Start date
I know a lot of effort has gone into CFR calculations but I am not sure I see the point. The CFR is a moving target and is going to vary greatly over time and in different locations. It is calculated for a given population in a given area over a set time period. The real CFR for an epidemic will be calculated after it is all over based on every case's outcome. The CFR for early Wuhan cases will be a reflection of the fact they had no idea what they were dealing with or how to treat it, nor could they even tell who had it until it was isolated, sequenced and PCR protocols established. They would not have known transmission characteristics or what PPE they should use. Later cases from the same population fared much better. Things that will effect the CFR will include overall health, age distribution, proportion with co-morbidities, how quickly they present for treatment (and get it), what treatment is available to them, how knowledgeable their HCWs are, how much load the system is under, what pharmaceuticals there are (and availability), how effective these are etc. You will get a range of wildly different CFRs depending on where and when you look. As mscox points out a major spike will occur anywhere the health system is overwhelmed and life saving treatments stop being available. Key bits of kit will be PPE, Lab capacity, ICU and CC beds, ventilators/ECMO, CT scanners (X-rays can help but are not as useful) & oxygen plus any of the drugs, currently in trials, that turn out to be useful. Ventilators will probably the first thing to max out. China was very good about shipping capacity into Wuhan (people and kit) which saved many at the peak of the wave which was also considerable smaller, than it would have been, due to their containment measures. They barely coped despite both massive interventions. How good other peoples are going to be about shipping their PPE, ventilators and best HCWs to cities on the other side of the country remains to be seen but it could be a major factor in preserving surge capacity and holding down that country's CFR.
Just what I could think of I am sure I missed lots of other important variables.
Just what I could think of I am sure I missed lots of other important variables.
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Emily
Editor, Senior Moderator
I've got this cued about 30 secs before Dr. Matt McCarthy, an infectious disease physician and "Superbugs" author talks about CFR of .2 to .4 based on Korea data. I think that could be as good an estimate as it gets. But he still predicts that there will be big problems. Worth listening to him if you can. So far I see Seattle repeating early Wuhan situation at hospitals. Maybe worse. UW docs, including Harborview have NO N95 masks. They are being told to use surgical masks.
https://www.youtube.com/watch?v=0Wg_OTTzUv8&feature=youtu.be&t=240
Ronan Kelly
Retired 2020
I agree that Korea has the best numbers because they are doing community surveillance and are catching asymptomatic and symptomatic cases. Korea has reported 32 deaths from 5,300 cases. That's 0.6%, (not .2 or .4) and does not take into account that some who are currently sick will die.
Emily
Editor, Senior Moderator
I've wondered about obesity and SAR-CoV-2. Fauci is the only one I have heard mention that as a risk factor, more along the lines of the problems seen in young obese patients with the pH1N1 - a mechanical problem, though there could have been something metabolic, too. Now Chinese scientists are thinking that the ACE2 expression in fat tissue could be a factor. We have a lot of obesity in the US relative to China, even here in the outdoorsy Pacific Northwest.
gsgs
Registered User
South Korea-Daegu-Gyeongbuk daily new cases (135),34,32,56,57,93,36,64,19,22
they did realise, how important it is to stop it early. They declared war on COVID Mar02, all agencies 24/7.
Remember how they managed the MERS outbreak in 2015
Why can't we do that in Europe,USA ? Won't it be cheaper in the end economically as well ? Even if we ignore
all the diseases and deaths. WHO recommends it. Not only for us, but also to reduce the worldwide spread,
to give an example to the rest of the world. Until vaccine or drugs are available
That we are as "good" as communist China ;-)
they did realise, how important it is to stop it early. They declared war on COVID Mar02, all agencies 24/7.
Remember how they managed the MERS outbreak in 2015
Why can't we do that in Europe,USA ? Won't it be cheaper in the end economically as well ? Even if we ignore
all the diseases and deaths. WHO recommends it. Not only for us, but also to reduce the worldwide spread,
to give an example to the rest of the world. Until vaccine or drugs are available
That we are as "good" as communist China ;-)
It is a special type of "challenging", when we watch the train crash in slow motion, as we are right now :/
We can see what needs to be done, we know what the next steps have to be, and yet, those in charge, continuously ignore them. Meanwhile, the world's most simplistic semi-living organism, a simple virus, marches forwards, unabated.
We can see what needs to be done, we know what the next steps have to be, and yet, those in charge, continuously ignore them. Meanwhile, the world's most simplistic semi-living organism, a simple virus, marches forwards, unabated.
It is the public health catch 22. Spend a fortune to be ready for a zoonotic epidemic (or on containment) and turn it into a non-event, you will get shot for wasting money on something that never happened anyway. Don't and get crucified for not preparing.
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Emily
Editor, Senior Moderator
I felt a lot of compassion for WA state/King County officials watching Wednesday's press conference. They are addressing the needs of patients and family at Life Care and juggling all the other issues as best as anyone can. The voluntary social distancing is a good plan, IMO.
Just hope that Pence brings some N-95's for the UW doctors.
***ETA - Yes, he did bring hundreds of thousands of masks and other PPE to WA state. Very happy to see that!
Just hope that Pence brings some N-95's for the UW doctors.
***ETA - Yes, he did bring hundreds of thousands of masks and other PPE to WA state. Very happy to see that!
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Pathfinder
Editor, Senior Moderator
I received this email from a friend:
From Dr. James Robb, UC San Diego
?€œWhat I am doing for the upcoming COVID-19 (coronavirus) pandemic?€?
Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.
The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.
Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.:
1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove.
3) Open doors with your closed fist or hip ?€“ do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.
4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.
5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
6) Keep a bottle of sanitizer available at each of your home?€™s entrances. AND in your car for use after getting gas or touching other contaminated objects when you can?€™t immediately wash your hands.
7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!
What I have stocked in preparation for the pandemic spread to the US:1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average ?€“ everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon.
This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.
2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you ?€“ it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth ?€“ it is only to keep you from touching your nose or mouth.
3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.
4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY ?€œcold-like?€? symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.
I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.
I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us!
From Dr. James Robb, UC San Diego
?€œWhat I am doing for the upcoming COVID-19 (coronavirus) pandemic?€?
Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.
The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.
Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.:
1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove.
3) Open doors with your closed fist or hip ?€“ do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.
4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.
5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
6) Keep a bottle of sanitizer available at each of your home?€™s entrances. AND in your car for use after getting gas or touching other contaminated objects when you can?€™t immediately wash your hands.
7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!
What I have stocked in preparation for the pandemic spread to the US:1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average ?€“ everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon.
This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.
2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you ?€“ it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth ?€“ it is only to keep you from touching your nose or mouth.
3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.
4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY ?€œcold-like?€? symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.
I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.
I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us!
mcphilbrick
Well-known member
China autopsies - irreversible lung damage
does other research support this finding?
https://www.news.com.au/lifestyle/h...e/news-story/f58f19c5eeae99b845c54e2d2b9305ca
does other research support this finding?
https://www.news.com.au/lifestyle/h...e/news-story/f58f19c5eeae99b845c54e2d2b9305ca
kiwibird
Editor, Senior Moderator
https://www.thelancet.com/journals/l...305-6/fulltextCommonground
Senior Moderator
- Join Date: May 2006
- Posts: 9476
#10
March 2nd, 2020, 08:47 AM
Originally posted by kiwibird View Post
https://twitter.com/i/status/1234387570320080896 Stated as an Iranian soldier. Not likely to be elderly or have co-morbidities then!
excerpt from Lancet published February 22, 2020
All three coronaviruses induce excessive and aberrant non-effective host immune responses that are associated with severe lung pathology, leading to death.
Similar to patients with SARS-CoV and MERS-CoV, some patients with 2019-nCoV develop acute respiratory distress syndrome (ARDS) with characteristic pulmonary ground glass changes on imaging. In most moribund patients, 2019-nCoV infection is also associated with a cytokine storm, which is characterised by increased plasma concentrations of interleukins 2, 7, and 10, granulocyte-colony stimulating factor, interferon-γ-inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1 alpha, and tumour necrosis factor α.
In those who survive intensive care, these aberrant and excessive immune responses lead to long-term lung damage and fibrosis, causing functional disability and reduced quality of life.
All three coronaviruses induce excessive and aberrant non-effective host immune responses that are associated with severe lung pathology, leading to death.
Tweetand
NawtyBits
Registered User
- Join Date: May 2006
- Posts: 62
#125
February 1st, 2020, 03:43 PM
Originally posted by hawkeye View Post
Thanks LA - reading what you've written, do we know if reinfection is not possible (I'm sure there are always exceptions, but I'm asking with regards to the general population)? I hadn't thought about it until now.
https://translate.googleusercontent....oEAnmDpR8cUHSQ
Expert: Wuhan pneumonia is still at risk of reinfection or pulmonary fibrosis sequelae after healing
Experts point out that patients who have recovered from the new type of coronavirus pneumonia still have the risk of reinfection, and they should strengthen their protection.
The new coronavirus pneumonia epidemic is raging, and many cases have been recovered so far. However, at the press conference of the National Health Commission on Friday (31st), experts pointed out that patients who are cured still have the risk of reinfection, so protection should be strengthened.
In addition, experts also mentioned that generally mild patients have no sequelae after recovery, and very severe patients may have pulmonary fibrosis for a period of time.
Zhan Qingyuan, director of the fourth and fifth department of Respiratory Medicine of the Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, pointed out that the general rule of viral infection, patients will produce certain antibodies after viral infection, which has a protective effect on the human body. But in fact, antibodies may not last long, so patients who have recovered from new coronavirus pneumonia still have the risk of reinfection, and they should strengthen their protection.
Regarding the question of whether the cured patients will have sequelae, Zhan Qingyuan pointed out that after clinically found that the new type of coronavirus infection, the patients were mainly damaged lungs, but mild patients should have no sequelae, and severe patients may have a residual for a period of time Lung damage repairs changes, such as fibrosis. But Zhan Qingyuan emphasized that the lung's repairing ability is very strong, and most of the fibrosis can be repaired. "But for very heavy, very, very, very few patients, they may leave a little lung for a long time. Fibrosis, we need to strengthen the follow-up. "
I have a question. I saw a press briefing where one of the reporters asked about testing and if the uninsured could get tested in the US. The question was not answered. What is the correct situation? Because if this is the case, then the US will be in for a very rough ride with this virus. You cannot contain or mitigate if a large sector of your population is not being tested, and therefore isolated or treated. If, on the other hand this is correct, then does this mean that insurers will be required to foot the bill for care? Because if so, are they financially resilient enough to cope with millions of ventilation / ICU cases or will it make them go bust?
Missouriwatcher
Editor, Senior Moderator
Relayed to me:
Source was in meeting at a small healthcare firm near Boston yesterday. Woman from firm was coughing, sneezing and blowing nose. Source in meeting had to then go to other clients at different firms throughout Boston. Since not enough test kits available, was this just a cold? Could source potentially be a carrier to additional firms in the area? Where is the point that a company steps in and sends person home? Where is the point that source should have stopped working, if feeling no symptoms yet possibly exposed?
In Boston, another source working in large government office overheard a coworker saying she was feeling unwell and coughing, yet still at work. Source went to boss who immediately removed worker. How does this worker get home? Uber or mass transit, since few personally drive to work? No mask available to give to worker who was sent home.
Business as usual.
Source was in meeting at a small healthcare firm near Boston yesterday. Woman from firm was coughing, sneezing and blowing nose. Source in meeting had to then go to other clients at different firms throughout Boston. Since not enough test kits available, was this just a cold? Could source potentially be a carrier to additional firms in the area? Where is the point that a company steps in and sends person home? Where is the point that source should have stopped working, if feeling no symptoms yet possibly exposed?
In Boston, another source working in large government office overheard a coworker saying she was feeling unwell and coughing, yet still at work. Source went to boss who immediately removed worker. How does this worker get home? Uber or mass transit, since few personally drive to work? No mask available to give to worker who was sent home.
Business as usual.
Missouriwatcher
Editor, Senior Moderator
KCTV5: (Mar5) ...For Missouri, the Jackson County Health Department just got their five kits today.
The Kansas City Health Department said they’ll be receiving their five very soon...
https://www.kctv5.com/coronavirus/a-...db08d1eb2.html
Clarification: Each test kit can test 700-800 specimens.
The Kansas City Health Department said they’ll be receiving their five very soon...
https://www.kctv5.com/coronavirus/a-...db08d1eb2.html
Clarification: Each test kit can test 700-800 specimens.
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Niko
Editor, Senior Moderator
Snipped: "This is still a developing situation. As new U.S. cases emerge, states will likely roll out new policies. Vice President Mike Pence announced Tuesday that Medicare and Medicaid would cover COVID-19 testing.
In New York state, Gov. Andrew Cuomo has extended emergency measures for insurers there to waive cost-sharing and charge no co-pays to those on Medicaid.
Perhaps other states won’t need to: On Monday, U.S. Rep. Ruben Gallego, D-Ariz., announced a bill that would provide Medicaid coverage of COVID-19 testing for all Americans."
https://www.google.com/amp/s/whyy.o...d-19-test-but-dont-have-health-insurance/amp/
In New York state, Gov. Andrew Cuomo has extended emergency measures for insurers there to waive cost-sharing and charge no co-pays to those on Medicaid.
Perhaps other states won’t need to: On Monday, U.S. Rep. Ruben Gallego, D-Ariz., announced a bill that would provide Medicaid coverage of COVID-19 testing for all Americans."
https://www.google.com/amp/s/whyy.o...d-19-test-but-dont-have-health-insurance/amp/
Emily
Editor, Senior Moderator
I believe WA state can and will set their own mandates for insurance coverage of the test. Not sure about coverage for uninsured. Also remember many insured avoid going to the doctor because deductibles are so large. Promised insurance coverage can be merely lipstick on a pig. Even Medicare with no private supplement has a $450 deductible. Yes, this is low compared to the huge insurance deductibles but many on Medicare are poor.
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