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Discussion thread III - Covid-19 (new coronavirus)

Good Lord - this sounds awful. - Ro

‘I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.

First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.

The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity

We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.

Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.

My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.

We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern:

1)A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick
2)Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great

3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2.
4)Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly.

Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe,

f governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to.

Another typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe.

We have seen it, you won’t be if you don’t take it seriously. I really hope it won’t be as bad as here but prepare.
https://twitter.com/jasonvanschoor/...0mGUswy-_rsonaHJWtuKvwzcKlM1Resg-zVUhwEO8z8-w
 
I have no medical training or anything atall, I'm just very interested in epidemics etc. I'd like to ask those who know more what happens after the first wave - if we stay isolated up here (which we can do) then what? Will the virus die back suring summer and re- emerge in winter? Or is it more random? Or does nobody know because this is all new?
And thank you all for a very interesting debate in here :applause:
 
gsgs said:
Emily, just luck. Also German cases are more recent, consider the delay to death. 5 days until confirmation, 4 days until
death in Italy so far , I read
Click to expand...

That could certainly be the case, gsgs. I saw that 2 deaths are reported now in Germany. I did wonder if they might have a milder strain there. I hope the numbers stay better there for whatever reason. The initial cases in Germany seemed very mild, including the visitor from China and her parents' cases, if I have that right. The initial case in the Seattle area seemed rough for a non-smoker in his 30's with just a history of hypertriglyceridemia.

The earliest case in Italy also sounds like it was rough for a person that was only 38. So maybe there are strain differences.
 
B.C. said:
Numbers are possibly up in Italy as they have had to make decisions

https://www.ilfattoquotidiano.it/20...-ha-piu-probabilita-di-sopravvivenza/5729020/
Click to expand...

I wondered about that going on in the Life Care situation in Kirkland. From what I see so far, everyone is being treated as needed since the regional hospital system has had beds. Though there is this from an article Treyfish posted:
"In Bellevue, officials at Overlake said a man in his 80s passed away after he tested positive for COVID-19. The man had also been a resident of Life Care Center before he was admitted to the hospital for comfort care."
 
Emily said:
That could certainly be the case, gsgs. I saw that 2 deaths are reported now in Germany. I did wonder if they might have a milder strain there. I hope the numbers stay better there for whatever reason. The initial cases in Germany seemed very mild, including the visitor from China and her parents' cases, if I have that right. The initial case in the Seattle area seemed rough for a non-smoker in his 30's with just a history of hypertriglyceridemia.

The earliest case in Italy also sounds like it was rough for a person that was only 38. So maybe there are strain differences.
Click to expand...

It seems to be the demographics of the earliest cases in Germany. The earliest points of entry seem to have been two festivals and then people returning from ski holidays in Northern Italy. A significant number of these were younger people. There were very few aged in the at risk category 70+. It is likely that once the initial "seeding" is over, Germany will start to exhibit the same patterns that we've seen elsewhere.
 
I've seen data from Italy that includes the number of COVID-19 patients who are hospitalized and the number of patients needing critical care.

Is there any data for the United States detailing how many of those who tested positive are hospitalized? What about ICU patients?

Also, is there data available about the total number of ICU beds across the country?
 
I don't think there are any important differences in circulating strains. All very similar, no critical mutations, corona does proofreading
--------------------------------------------
South Korea is unusual because of all this Shincheonji (or such) sect testing
 
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Please help us.

@RonDeSantisFL @SenRickScott @marcorubio

"Our research indicates that, as of 03/01/2020., it is likely that there are already thousands of individuals in the US infected with SARS-CoV-2." https://medrxiv.org/content/10.1101/2020.03.06.20031880v1…

#coronavius #COVIDー19 #SARSCoV2 #iloveflorida
 
I find it surprising that the median age is 65 in Lombardy...Does anyone recall what is in Wuhan? Could be that Lombardy is very much like Wuhan...it was flying under the radar then took off and deaths began mounting up. The fact that there is a high percentage of elderly in Lombardy could be a factor in the death rate. But I'm wondering if there is more too it...particularly given the median age. In China, there were 2 strands of Covid...one milder, the other aggressive, Could this be at work there?
 
Pathfinder said:
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!
Click to expand...

Worth noting here that Dr. James Robb did not intend this to be widely disseminated and did not mean this as an endorsement for a specific product (zinc lozenges). Zinc's role as an antiviral is disputed at best and may be harmful (some of the manufacturers of these zinc lozenges have faced lawsuits for causing anosmia -- loss of smell -- in consumers). https://www.snopes.com/fact-check/zinc-lozenges-coronavirus/

I would caution against jumping to zinc as a magic bullet on this advice alone.
 
Something else to share, here (reproduced exactly as I received it):

3/8/2020

Notes from the front lines:

I attended the Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7. 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. Erin Epson, 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 MCHD 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. Presumably, this would only affect inpatients though since we (CHOMP) have decided not to collect specimens ordered by outpatient physicians.
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 (CDPH and OCHD) 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.

Feel free to share. All PUIs in Monterey Country so far have been negative.

Martha.

Martha L. Blum, MD, PhD
 
Hi guys, just a few questions I was hoping someone might have some leads on for me. I'm wondering if anyone has seen any recent data on the routes of spread of the virus? I know in the WHO conference last week they said they were working on studies for this, I'm just wondering if it is out and I just haven't seen it yet. (I saw one of the early ones out of China, but it sounded like the studies they were doing were far more extensive). Also has anyone heard anything about the follow up antibody testing(probably called something else)? When the surveillance team came back from China they mentioned that this will be an important follow up to see if there was truly more people infected than what was caught in testing (although if I recall correctly they did not find this very likely due to the number of people being tested in the country at that time). Not sure if anyone has seen when they might start that work. With Xi going into Wuhan this week I figured things must have calmed down to a level where they might be doing this work now.

I'm just stumped right now on the spread we have been seeing, as I know many of you have commented on as well. When you look back at the early cases in the US I would have expected more cases from those original ones. I get the thought that maybe there is greater unknown spread, but don't you think we would have seen at least more severe cases pop up in those unknown groups? Probability wise it seems pretty lucky that more have not sprouted. You had infected people on airplanes, taking transportation, etc. and yet it appears that no one in their path was infected and I have not seen any of the groups being watched due to those cases come up positive (except the husband in Chicago). Just seems odd and doesn't add up to what we saw in Wuhan or now Italy.
 
Thank you, Dexxy. Just to clarify, the lawsuits were not directed towards lozenges but rather towards products sprayed or applied into the nose.
https://www.aboutlawsuits.com/zicam-settlement-loss-smell-taste-lawsuits-14952/
The experiments on children in the 1930's should have dissuaded that manufacturer from using zinc in the nose. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2086354/

Some cautions below about too much zinc in general:
https://www.mayoclinic.org/diseases...ld/expert-answers/zinc-for-colds/faq-20057769

(Note the Mayo article is talking about rhinovirus, not coronavirus.)
 
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