Coronavirus

[LC]

even if transmission is substantially slowed within the small area during the local partial lockdown.

 

But this is one of the most important thing we can do - to buy as much time for both research into treatment, and to ease the burden on the healthcare system.

[Read the Footnotes]

even if transmission is substantially slowed within the small area during the local partial lockdown.

 

But this is one of the most important thing we can do - to buy as much time for both research into treatment, and to ease the burden on the healthcare system.

 

In addition to treatments and vaccines, there are a couple of things that people have not mentioned:

 

1) Standard of care will likely improve over time and a delay could make a difference. In each new area doctors are being quoted saying "I didn't believe the reports were accurate" or "I've never seen anything like this" or "we have no idea what to do" or "it turns out ____ is true after all". None of those are things you want to hear a doctor say when that was so easily fixed through communication and time.

 

2) Healthcare providers are already getting infected and quarantined. Estimates are that without good management 40% of healthcare providers could be sick at the same time. At that point, ventilators and beds will no longer be the bottleneck in the system.

 

3) Temporary facilities can be erected, equipment repurposed, procedures rescheduled, etc.

 

4) If 40% are out sick (which is also a typical rule of thumb) then we would typically try to draft health workers out of retirement and issue them temporary licenses, which takes time. And given that they are likely in the high risk category for this virus (sometimes it is the young or the particularly fit instead who are at risk of death due to cytokine stormc) that may not be as good of an option.

[LC]

Additionally if the healthcare system does crack as you allude is a possibility, widespread self-care will be important.

 

The question may become, how to manage your own/your family's symptoms as best you can. This requires time for professionals to discover, and time to communicate the message.

[KJP]

even if transmission is substantially slowed within the small area during the local partial lockdown.

 

But this is one of the most important thing we can do - to buy as much time for both research into treatment, and to ease the burden on the healthcare system.

 

I understand.  My point is that if partial lockdowns are a good idea, why aren't they being more broadly imposed?  To take the Philadelphia region as an example, why not impose the same restrictions across the entire metropolitan region, or the tri-state region (I realize this would require multiple state governments)?  Montgomery County is full of commuters and has the busiest commuting train line in the area (it runs essentially along the old Main Line).  If you need to lockdown Montgomery County, then why don't you need to lockdown Philadelphia and every place that is closely connected to it?

 

I see the internal logic in "This is all overblown and lockdowns are an overreaction" and the internal logic in "We need widespread partial lockdowns to nip this in the bud before it gets out of hand."  I don't see the internal logic in partially locking down only Montgomery County, but, again, I'm not a medical professional; I've only watched ER on TV.

[alwaysdrawing]

I understand.  My point is that if partial lockdowns are a good idea, why aren't they being more broadly imposed?  To take the Philadelphia region as an example, why not impose the same restrictions across the entire metropolitan region, or the tri-state region (I realize this would require multiple state governments)?  Montgomery County is full of commuters and has the busiest commuting train line in the area (it runs essentially along the old Main Line).  If you need to lockdown Montgomery County, then why don't you need to lockdown Philadelphia and every place that is closely connected to it?

 

I see the internal logic in "This is all overblown and lockdowns are an overreaction" and the internal logic in "We need widespread partial lockdowns to nip this in the bud before it gets out of hand."  I don't see the internal logic in partially locking down only Montgomery County, but, again, I'm not a medical professional; I've only watched ER on TV.

 

I think being a medical professional is a red herring.  Physicians are not trained in population level health policy, they are trained to treat patients.  We need to listen to epidemiologists, who are saying to close down.  Hopefully we do so broadly soon.  There have been big changes this week in sentiment, and hopefully that leads to communities being more proactive.

[StubbleJumper]

even if transmission is substantially slowed within the small area during the local partial lockdown.

 

But this is one of the most important thing we can do - to buy as much time for both research into treatment, and to ease the burden on the healthcare system.

 

In addition to treatments and vaccines, there are a couple of things that people have not mentioned:

 

1) Standard of care will likely improve over time and a delay could make a difference. In each new area doctors are being quoted saying "I didn't believe the reports were accurate" or "I've never seen anything like this" or "we have no idea what to do" or "it turns out ____ is true after all". None of those are things you want to hear a doctor say when that was so easily fixed through communication and time.

 

I'm not quite sure that I quite understand this one.  Are you positing that a better treatment might be developed (eg, the use of HIV antivirals), and therefore if you are forced to choose, you'd be better to catch Covid in October rather than April because you will benefit from cumulative learnings?

 

2) Healthcare providers are already getting infected and quarantined. Estimates are that without good management 40% of healthcare providers could be sick at the same time. At that point, ventilators and beds will no longer be the bottleneck in the system.

 

This is definitely a large threat.

 

3) Temporary facilities can be erected, equipment repurposed, procedures rescheduled, etc.

 

IMO, the focus should have shifted weeks ago towards developing contingency plans for temporary facilites.  I am really hoping that my province has some sort of plan to close down schools and convert them into temporary Covid clinics.  But is it happening?  Who knows.  We are banging away on the politicians about testing and travel restrictions, but I don't seem much banging being done about developing surge capacity.

 

 

4) If 40% are out sick (which is also a typical rule of thumb) then we would typically try to draft health workers out of retirement and issue them temporary licenses, which takes time. And given that they are likely in the high risk category for this virus (sometimes it is the young or the particularly fit instead who are at risk of death due to cytokine stormc) that may not be as good of an option.

 

If you were a 70 year-old retired doctor or nurse and you took the time to pull up the morbidity and mortality numbers by age group off of the WHO's website (or other websites) would you come out of retirement?  If I were 70 years old, I'd be trying desperately to dodge this one...  I am guessing that, as a group, retired health professionals are not in desperate need for an extra $10,000, so it's a bit hard to imagine that they would be motivated to expose themselves to a bunch of sick people.

[Dalal.Holdings]

I understand.  My point is that if partial lockdowns are a good idea, why aren't they being more broadly imposed?  To take the Philadelphia region as an example, why not impose the same restrictions across the entire metropolitan region, or the tri-state region (I realize this would require multiple state governments)?  Montgomery County is full of commuters and has the busiest commuting train line in the area (it runs essentially along the old Main Line).  If you need to lockdown Montgomery County, then why don't you need to lockdown Philadelphia and every place that is closely connected to it?

 

I see the internal logic in "This is all overblown and lockdowns are an overreaction" and the internal logic in "We need widespread partial lockdowns to nip this in the bud before it gets out of hand."  I don't see the internal logic in partially locking down only Montgomery County, but, again, I'm not a medical professional; I've only watched ER on TV.

 

I think being a medical professional is a red herring.  Physicians are not trained in population level health policy, they are trained to treat patients.  We need to listen to epidemiologists, who are saying to close down.  Hopefully we do so broadly soon.  There have been big changes this week in sentiment, and hopefully that leads to communities being more proactive.

 

Absolutely. Most physicians have no quantitative training. Med school is largely memorization exercise.

[Dalal.Holdings]

 

I'm not disagreeing that there is value to testing (probably only relevant to immediate treatment at this point). Testing is hindsight at this point. You're not skating to where the puck is going. You're not skating to where the puck is. You're skating to where the puck was.

 

Gretzky didn't play hockey with a blindfold on. You need to know where the puck is to know where it is going.

 

Testing is preferable to not testing. It really is that simple.

 

It's like saying that not telling sexually promiscuous individuals whether they are HIV positive or not will not impact future spread. This is categorically false and we do not need to go back to 20th century discoveries in medicine each time to address these points that have been shown decades ago.

 

There are some points being made (against testing, action) that can be easily dismissed, but they are brought up almost hourly on here.

[Dalal.Holdings]

https://www.npr.org/sections/goatsandsoda/2020/03/12/814522489/singapore-wins-praise-for-its-covid-19-strategy-the-u-s-does-not

 

Hong Kong and Singapore were hit early with the coronavirus. But each now has fewer than 200 cases, while France, Germany and Spain, which were hit late, all have more than 10 times that number.

 

Three weeks ago, Italy had only three cases. Now it has more than 10,000.

 

These dramatic differences show that how governments respond to this virus matters, says Mike Ryan, the World Health Organization's head of emergencies.

 

"Hope is not a strategy," says Ryan, who is an epidemiologist. "We are still very much in the up cycle of this epidemic."

 

Which group would you rather your country be a part of? Maybe the comparison to HK and Singapore is a stretch for U.S., but what about Korea? Japan?

[Read the Footnotes]

even if transmission is substantially slowed within the small area during the local partial lockdown.

 

But this is one of the most important thing we can do - to buy as much time for both research into treatment, and to ease the burden on the healthcare system.

 

In addition to treatments and vaccines, there are a couple of things that people have not mentioned:

 

1) Standard of care will likely improve over time and a delay could make a difference. In each new area doctors are being quoted saying "I didn't believe the reports were accurate" or "I've never seen anything like this" or "we have no idea what to do" or "it turns out ____ is true after all". None of those are things you want to hear a doctor say when that was so easily fixed through communication and time.

 

I'm not quite sure that I quite understand this one.  Are you positing that a better treatment might be developed (eg, the use of HIV antivirals), and therefore if you are forced to choose, you'd be better to catch Covid in October rather than April because you will benefit from cumulative learnings?

 

2) Healthcare providers are already getting infected and quarantined. Estimates are that without good management 40% of healthcare providers could be sick at the same time. At that point, ventilators and beds will no longer be the bottleneck in the system.

 

This is definitely a large threat.

 

3) Temporary facilities can be erected, equipment repurposed, procedures rescheduled, etc.

 

IMO, the focus should have shifted weeks ago towards developing contingency plans for temporary facilites.  I am really hoping that my province has some sort of plan to close down schools and convert them into temporary Covid clinics.  But is it happening?  Who knows.  We are banging away on the politicians about testing and travel restrictions, but I don't seem much banging being done about developing surge capacity.

 

 

4) If 40% are out sick (which is also a typical rule of thumb) then we would typically try to draft health workers out of retirement and issue them temporary licenses, which takes time. And given that they are likely in the high risk category for this virus (sometimes it is the young or the particularly fit instead who are at risk of death due to cytokine stormc) that may not be as good of an option.

 

If you were a 70 year-old retired doctor or nurse and you took the time to pull up the morbidity and mortality numbers by age group off of the WHO's website (or other websites) would you come out of retirement?  If I were 70 years old, I'd be trying desperately to dodge this one...  I am guessing that, as a group, retired health professionals are not in desperate need for an extra $10,000, so it's a bit hard to imagine that they would be motivated to expose themselves to a bunch of sick people.

 

Responding to your responses:

1)  Exactly:

a) I would hope to do everything I can for myself and anyone I can tell to delay getting it. Especially if you're in a risk group. Remember some of us might not realize we have underlying commodities.

b) Also, check the probabilities of risks other than age. Statistically, hypertension, diabetes, smoking is about as bad statistically as being 70+ years old.

c) If you smoke, quit immediately. Smoking kills your cilia, which appears to be the same primary method of action on COVID-19.

d) Also, eliminate all risk during periods you suspect your local services will be overwhelmed.

 

2) Agreed

 

3) I have heard from many people in North America that their hospital colleagues were oblivious, or actively denying the threat. We are just seeing tents put up in many cases. I haven't spoken to anyone that is starting to reorganize their hospital or change schedules. Most have already had protocol discussions, some specialty hospitals haven't even done that. I am not speaking about backwater locations. Some backwater places have discovered they are more connected than they realized and were completely unprepared.

 

4) Yes, that could be an issue, but:

a) unlike finance the psychopaths are usually concentrated in a limited number of specialties. Volunteers and conscripts will probably be more common in other countries that are showing a more coordinated response and preparation. At risk workers can be assigned to low risk duties. Remember, there are still going to be people getting in car wrecks and chronic conditions aren't going away either.

b) There will be heroes all over the world. China doesn't have a monopoly on heroes.

[Castanza]

 

I'm not disagreeing that there is value to testing (probably only relevant to immediate treatment at this point). Testing is hindsight at this point. You're not skating to where the puck is going. You're not skating to where the puck is. You're skating to where the puck was.

 

Gretzky didn't play hockey with a blindfold on. You need to know where the puck is to know where it is going.

 

Testing is preferable to not testing. It really is that simple.

 

It's like saying that not telling sexually promiscuous individuals whether they are HIV positive or not will not impact future spread. This is categorically false and we do not need to go back to 20th century discoveries in medicine each time to address these points that have been shown decades ago.

 

There are some points being made (against testing, action) that can be easily dismissed, but they are brought up almost hourly on here.

 

You both conveniently glossed over the "I'm not disagreeing that there is value to testing (probably only relevant to immediate treatment at this point). Testing is hindsight at this point." (testing for spread containment)

 

Testing to prevent spread is hindsight. I think it's already all over the US. There is probably one or two clusters brewing in every state. By the time someone responds to this comment there is probably a few dozen asymptomatic individuals who just left each cluster zone spreading it further.

 

Targeted testing would be more effective. Testing by risk profile is the only way to get ahead of the spread. Gets tests to high risk individuals and lock down senior care facilities. (the puck is everywhere and it's going to senior homes)

 

Telling people in the 80% that they have covid-19 is a sure fire way to flood hospitals with people who probably don't need any type of significant treatment. I'd rather see the beds we have available left for those who have a high chance of death.

 

 

 

 

[Read the Footnotes]

I haven't listened to the whole thing because I'm not that in to podcasts, but this podcast supposedly does a good job of explaining how China and Korea's successes depended on testing.

 

https://www.nytimes.com/2020/03/12/podcasts/the-daily/coronavirus-pandemic.html

[Dalal.Holdings]

 

You both conveniently glossed over the "I'm not disagreeing that there is value to testing (probably only relevant to immediate treatment at this point). Testing is hindsight at this point." (testing for spread containment)

 

Testing to prevent spread is hindsight. I think it's already all over the US. There is probably one or two clusters brewing in every state. By the time someone responds to this comment there is probably a few dozen asymptomatic individuals who just left each cluster zone spreading it further.

 

Targeted testing would be more effective. Testing by risk profile is the only way to get ahead of the spread. Gets tests to high risk individuals and lock down senior care facilities. (the puck is everywhere and it's going to senior homes)

 

Telling people in the 80% that they have covid-19 is a sure fire way to flood hospitals with people who probably don't need any type of significant treatment. I'd rather see the beds we have available left for those who have a high chance of death.

 

Well then as long as you agree that testing helps reduce further spread, we are on the same page. The "hindsight" remark didn't make it seem that way.

 

Right now, we are only testing those with travel Hx or known contact a.k.a. "high risk individuals", likely due to shortage of tests. This after we know there is community spread. There are patients with flu like symptoms who are flu negative who do not have travel or known contact who are denied testing, in many cases given a mask, and sent back out into the community without diagnosis. Is that acceptable?

 

And no, we would not overburden hospitals with asymptomatic cases--we can do tests in clinics, urgent care, etc. Asymptomatic individuals who are positive would merely be told to go home and quarantine. It would not burden hospitals. Moreover, you can do what is more innovative which is drive thru testing in Korea which would 1) prevent spread to others in clinic/hospital and 2) not burden hospitals.

[JRM]

I work for Fortune 500 utility.  We operate a nuclear power plant, which I worked at for 9 years.  The company is taking some very serious actions, specifically at the nuke plant.  They are receiving temporary trailers with sleeping quarters, MREs, temperature scanners, etc.  They were told that, based on CDC models, the peak will be in May.  They are slowly coming off of their current work schedules and switching to a rotating 5 days on, 10 days off schedule.

 

I think the CDC has information that is not being shared publicly to avoid mass panic. Most people in my circles think this is a joke.

[Read the Footnotes]

I think the CDC has information that is not being shared publicly to avoid mass panic.

Bingo.

 

They have to work to maintain critical infrastructure including secret service, military preparedness, etc.

 

None of that will be telegraphed to us.

 

Thank you for your comments. The timing of May makes sense. Some areas of the country have more time to prepare than others. There will be major geographic differences.

[LC]

Testing is not just hindsight. Right now there are thousands, ten thousands, hundreds of thousands, millions (https://www.news5cleveland.com/news/continuing-coverage/coronavirus/ohio-department-of-health-says-100-000-ohioans-are-carrying-coronavirus)

 

Of people in the US with a variety of symptoms. Perhaps people who had coronavirus and are recovering. Testing confirms whether they have coronavirus or not, whether they are recovering, how long those periods last, and a bunch of other information that a viral professional is probably more aware of than I am. Essentially, it builds a more robust dataset of infected individuals.

 

Right now we just have the worst-case groups being tested so your sample set it biased.

[Castanza]

Testing is not just hindsight. Right now there are thousands, ten thousands, hundreds of thousands, millions (https://www.news5cleveland.com/news/continuing-coverage/coronavirus/ohio-department-of-health-says-100-000-ohioans-are-carrying-coronavirus)

 

Of people in the US with a variety of symptoms. Perhaps people who had coronavirus and are recovering. Testing confirms whether they have coronavirus or not, whether they are recovering, how long those periods last, and a bunch of other information that a viral professional is probably more aware of than I am. Essentially, it builds a more robust dataset of infected individuals.

 

Right now we just have the worst-case groups being tested so your sample set it biased.

 

That's all fine and dandy. But we don't exactly have an oversupply of tests....so wouldn't it be best to put them to the most efficient use? High risk individuals.

[Dalal.Holdings]

Testing is not just hindsight. Right now there are thousands, ten thousands, hundreds of thousands, millions (https://www.news5cleveland.com/news/continuing-coverage/coronavirus/ohio-department-of-health-says-100-000-ohioans-are-carrying-coronavirus)

 

Of people in the US with a variety of symptoms. Perhaps people who had coronavirus and are recovering. Testing confirms whether they have coronavirus or not, whether they are recovering, how long those periods last, and a bunch of other information that a viral professional is probably more aware of than I am. Essentially, it builds a more robust dataset of infected individuals.

 

Right now we just have the worst-case groups being tested so your sample set it biased.

 

That's all fine and dandy. But we don't exactly have an oversupply of tests....so wouldn't it be best to put them to the most efficient use? High risk individuals.

 

Yes, we have an undersupply. That is the problem we are saying needs to be addressed urgently. We need more tests. That's what we are saying. CDC is responsible for that and extending approval to states/labs for testing on their own.

 

We are already limiting testing due to undersupply to only those with travel history to known places or known contact with positive individual. It is already only going to "high risk" individuals and we are missing large swaths of other people who have this and are spreading it.

 

For some reason, the United States, among the last places to get significant cases, appears to be among the most unprepared nations and we continue to fiddle while Rome burns and this is very very alarming.

 

EDIT: here is the evaluation algorithm for COVID-19 that healthcare providers follow:

 

https://www.cdc.gov/coronavirus/2019-ncov/downloads/public-health-management-decision-making.pdf

 

As you can see, only someone who went to China or known contact with positive individual is deemed a risk. This is categorically false and asinine as a Europe travel ban at this point because we have community spread.

 

I can assure you that the cost vs benefit of widespread testing is MUCH more favorable than a 30 day Euro travel ban or even payroll tax holidays--think about the economic costs of these other things

[Hoodlum]

Testing is not just hindsight. Right now there are thousands, ten thousands, hundreds of thousands, millions (https://www.news5cleveland.com/news/continuing-coverage/coronavirus/ohio-department-of-health-says-100-000-ohioans-are-carrying-coronavirus)

 

Of people in the US with a variety of symptoms. Perhaps people who had coronavirus and are recovering. Testing confirms whether they have coronavirus or not, whether they are recovering, how long those periods last, and a bunch of other information that a viral professional is probably more aware of than I am. Essentially, it builds a more robust dataset of infected individuals.

 

Right now we just have the worst-case groups being tested so your sample set it biased.

 

That's all fine and dandy. But we don't exactly have an oversupply of tests....so wouldn't it be best to put them to the most efficient use? High risk individuals.

 

 

It all starts from the top.  Trump has decided he doesn't need to be tested or go into self-quarantine after being in contact with someone who now has the virus.  I believe actions speak louder than words and Trump is not considering this as a serious threat.  So you will see large segments of the US that won't take it seriously since the government is providing the leadership.  This is not going to end well in the US.

 

[Spekulatius]

Just got back from work (yes I am still going to my office) and hat a chat with our supply chain manager who was back at the office too (he was off Office out last week).

 

He told me that Trump‘s speach last night caused a lot of trouble that he has been working last evening too fix, because of confusion that the ban on flight might also affect trademark good. It seems that our POTUS stated that all  to Europe are halted, but what he really meant and apparently later clarified in tweet is that it only affects people traveling and not the trade of goods of course, but many didn’t get that part of the message.

 

Life goes on (he was a lot on the phone this AM), but of course none of this is helping. Tomorrow we have a visitor from France (no idea how we got there ) with a full room of people bd there were some haphazard safeguards (signing a form that you don’t have fever) which seem more like legalese BS, but doesn’t really do anything to make anyone safer.

 

Interesting times.

[orthopa]

I would invite everyone to go back and read my first post in this thread. I dont have time look now, then read the yahoo article gregmal posted.

 

That being said realize in this thread I have been called "ignorant", a "cabbage brain", "blind", and have had very little offer.

 

Orthopa, the problem is that what you're saying doesn't seem to align with evidence.

 

It seems fairly clear that a bunch of people have died in Italy, Iran, and China as a result of COVID-19.  You seem to be claim is that millions in the USA have been infected a long enough time ago that we'd already be seeing lots of deaths if COVID-19 were a big deal.  But USA has not seen lots of deaths.

 

So, to be credible, you need to make it simple for us to understand this disconnect.  Are Americans just more robust than the Italians, Iran, or Chinese? Do Americans have some sort of herd immunity that makes them less likely to die?  Are Italy, Iran, and China simply pretending to have all these deaths, when really, they don't?  Is there something about American culture that allows millions to catch COVID-19, but nobody to die?

 

If you don't have some explanation for this disconnect between your hypothesis of millions infected but nobody dying, the most reasonable thing for people to believe is that your hypothesis is wrong.  Particularly considering that there doesn't actually appear to be any evidence for your hypothesis except "some people got sick this flu season and didn't die, and it's conceivable that those people had COVID-19".

 

(That said, I don't think you're ignorant.  I think you've got the "I'm smart and know a lot about the topic, so my hypothesis unsupported by evidence must be right, and I'll defend it unto death" thing going.  Pretty well all smart people make that mistake occasionally.)

 

I guess you certainly to posit that I am anchored. But its hard to argue with my own experience, my own 2 eyes and my medical knowledge. If I'm wrong in the end I'm certainly willing to eat crow.

[orthopa]

For every disease I can think of, outcomes are improved if you actually know what disease you have as opposed to just treating symptoms. I don't understand not wanting to know the diagnosis.

 

It's possible we are all talking about different things when we say "testing".

 

Maybe Orthopa thinks I mean test every person everyday. All I'm saying is more broad testing for anyone with symptoms or that has been in contact with someone sick/traveled is probably more prudent than the current "have you been in contact with someone with CV or do you have severe symptoms + travel to an affected country". I truly do appreciate that testing does not prevent illnesses in many cases when many don't have immunity. What I am saying is that we can easily improve outcomes. We should do it.

 

Men and woman get colonoscopys and mammograms all the time as preventative screening. It's good to know early what you have. As Orthopa has pointed out, some are asymptomatic early on. If you know you have CV but without symptoms, you would know to escalate care quickly if they appear. Common sense stuff.

 

Your first statement would be true if there was a treatment. As Im sure we all know there isnt, and wont be by the time this is mostly done and over with.

 

Im not saying test everyone my point is in general it is too late from a containment standpoint to 1. meaningfully contain the disease by testing. 2. As I mentioned before to be effective in this type of situation you either test everyone or no one. What utility is there now in testing the entire Utah Jazz team? Its been passed on, Donovan Mitchell, and Gobert picked it up or gave it to one another and while playing likely exposed while symptomatic the most recent teams they were playing, training staff, crowd behind them during game, family, etc. Wheres the utility in that? Especially when there is no treatment! I guess you get closure of a diagnosis but thats about it.

 

And those 2 will recover just fine and will end up on ESPN talking about it or writing a memior.

 

What I think will really change the attitude about the virus is mass testing and a slow realization by the media, normal everyday people, and the market that it isnt a death sentence and nothing to fear unless your at risk. No question testing will help expose this. But no emergency treatment will be needed.

 

If your in need of an ICU bed you will get to the hospital without the diagnosis of covid-19. For those that haven't seen it someone needing a respirator or intensive care is quite obvious.  These people will get treatment without testing, its not like your positive test is your ticket in the door.

[Dalal.Holdings]

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/

This is what we have to fear:

 

Today, Italy has 10,149 cases of the coronavirus. There are now simply too many patients for each one of them to receive adequate care. Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air.

 

Now the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines ...The document begins by likening the moral choices facing Italian doctors to the forms of wartime triage that are required in the field of “catastrophe medicine.” Instead of providing intensive care to all patients who need it, its authors suggest, it may become necessary to follow “the most widely shared criteria regarding distributive justice and the appropriate allocation of limited health resources.”

 

“the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.”

 

So much more than just a Flu outbreak. If testing were done early and extensively, it would have decreased the probability of infected individuals from spreading it--just like TESTING of a few NBA players has led to definitive actions that will prevent the virus from spreading throughout the League (see what benefit early testing can have? Wow, testing and positive result in two players causes quarantine and prevents further spread! Guess it's hard for some to see benefits of prophylactic measures). At the very least, it would have shifted infections rightward in time and not led to sudden, overwhelming demand of critical care resources.

 

Just wait the median 2 week time from symptom onset to severe pulmonary symptoms and you will see the demand for ICU beds/vents overwhelm supply. Better hope Americans have some kind of innate immunity to this thing, because the clock is ticking.

 

For the record, I hope I am very, very wrong.

[orthopa]

I can give you some perspective from the front lines. I work in an urgent care and for the last couple of weeks have been seeing many cases of pts that present with symptoms way worse then common cold but test negative for flu A/B. Our flu test is 94% sensitive and source from Mckesson. Our current protocol is unless the pt has travel outside of the US within the last 30 days to not call  local DOH. So you guys tell me. What virus is going around that presents like the flu, fever, chills, some have body aches, cough, some sore throat that presents way more severe then rhinosinusitis (common cold) but is flu negative. Being thorough I have done chest x rays on all of these patients, no pneumonia or source of infection otherwise and complaint obviously is upper/lower respiratory.

 

I have worked in urgent care/ER for 12 years and maybe its recency bias but cannot remember ordering so many flu tests on people I would bet have the flu, but they come back negative.  H1N1 was a different story of course, "everyone" had the flu.

 

I was talking about this with other providers who have noticed the same and honestly it didn't dawn on me till I was thinking about this thread a couple days back that maybe....it could be....the corona virus? What gives though how come no one in my city has come on freaking out or freaks out when I tell them, listen "you have viral symptoms not consistent/way more severe then common cold but your flu is negative." Not one patient has questioned me yet about corona virus yet, but at the same time there are no confirmed cases in my city/area.

 

What blows my mind though is that there are only 400-500 (or whatever the latest figure is) of cases in a city such as NYC. There is no way IMO. How the hell does a virus so contagious with an incubation period of 2-4-14 days only infect that many people in one of the most densely populated cities in the world?

 

My uneducated opinion is that the virus has been in the US for months, the vast, vast, vast majority are people that I describe above and there have been hundreds of thousands of cases on tested/recovered in the US.

 

https://www.yahoo.com/news/dont-panic-says-us-woman-recovered-coronavirus-055155667.html

 

Was I a bit early maybe? This was about a week ago. We will see.  Ill be sure to check back and quote this when we get a similar narrative above in the media.  8)

 

For an uneducated opinion, this is reasonable. But how do you reconcile with what is happening in Italy? And given how quickly things went out of control in Italy, why don't you think the same thing will happen in the US?

 

Thats a good question, and I think this is alot of the reason for concern that it will spiral out of control in US. To be honest I don't know why Italy when to shit so fast. I have never worked there, don't know their facilities, protocols, patient populations, medications available,  etc.

 

Stuff that I would throw at a wall to see if it sticks?

 

1. Older population or population centers where disease has hit, we know it affects older people more, like nursing home in Washington.

2. More smokers? Covid 19 would be murder on someone with COPD, severe asthma, smoker etc.

3. Lower admission threshold? I dont know their protocols but medicine and treatment is not universal town to town, state to state, and certainly not country to country

 

I would argue it has nothing to do with testing vs Korea though why?

 

Latest updates are Italy 12462 positive, 827 deaths, Korea 7869 positive 66 deaths. How do you explain the difference?

 

Again there is no cure for Covid 19 so its not like Korea is curing people and Italy isnt. Again whether you are tested or not if you are to the point that you need a respirator (think dying) you will go in and be treated. Even if you test positive on day 1 you can do down hill quick if your old and immuno compromised so drive through testing would be great but your ass would still be in the ICU if you body couldn't handle the disease. Is it the case that S. Koreans are healthier? Maybe. Less lung disease? Maybe

 

So to summarize testing is not a cure, its a diagnosis, a label. Treatment for those positive is fluids, rest, tylenol for fever, steriods/breathing treatments for breathing issues. If you go down hill, its happening regardless of your test results as there is nothing to decrease the viral load.  My assumption is S. Koreas actually hands on treatment isnt much better in this day and age then Italy's so that leaves the pts.

 

I have read some believe S. Korea have been giving super super high doses of vitamin C IV with success. Maybe they are having success and never picked up the phone to call Lombardy. Idk.

 

[orthopa]

I would invite everyone to go back and read my first post in this thread. I dont have time look now, then read the yahoo article gregmal posted.

 

That being said realize in this thread I have been called "ignorant", a "cabbage brain", "blind", and have had very little offer.

 

Orthopa, the problem is that what you're saying doesn't seem to align with evidence.

 

It seems fairly clear that a bunch of people have died in Italy, Iran, and China as a result of COVID-19.  You seem to be claim is that millions in the USA have been infected a long enough time ago that we'd already be seeing lots of deaths if COVID-19 were a big deal.  But USA has not seen lots of deaths.

 

So, to be credible, you need to make it simple for us to understand this disconnect.  Are Americans just more robust than the Italians, Iran, or Chinese? Do Americans have some sort of herd immunity that makes them less likely to die?  Are Italy, Iran, and China simply pretending to have all these deaths, when really, they don't?  Is there something about American culture that allows millions to catch COVID-19, but nobody to die?

 

If you don't have some explanation for this disconnect between your hypothesis of millions infected but nobody dying, the most reasonable thing for people to believe is that your hypothesis is wrong.  Particularly considering that there doesn't actually appear to be any evidence for your hypothesis except "some people got sick this flu season and didn't die, and it's conceivable that those people had COVID-19".

 

(That said, I don't think you're ignorant.  I think you've got the "I'm smart and know a lot about the topic, so my hypothesis unsupported by evidence must be right, and I'll defend it unto death" thing going.  Pretty well all smart people make that mistake occasionally.)

 

Im glad you dont think Im ignorant, I dont either.

 

Maybe read this article? Title says Ohio department of health says 100,000 ohians carrying corona virus.  8)

 

https://www.news5cleveland.com/news/continuing-coverage/coronavirus/ohio-department-of-health-says-100-000-ohioans-are-carrying-coronavirus