On Topic Discussion 2019 Coronavirus (COVID-19/SARS-CoV-2)

[KaraBulut]

25-Mar-2020:

Global COVID-19 Mortality/Morbidity
- Cases reported: 436,159 (up from 392,331)
- Deaths: 19,648 (up from 17,156) - ** 2,492 people died yesterday

US COVID-19 Mortality/Morbidity
- Cases reported in the US - 55,238 cases (up from 46,450 yesterday, ‬ 8,788 new cases), 802 deaths

Across the globe:

• The case counts in Italy and Spain had been lower over the weekend. Unfortunately, both Italy and Spain are reporting more cases. Italy reported 5,249 new cases, up from 4,789 the day before. This is still lower that their high on 22-Mar of 6,557 cases. The daily death count also increased- 743 deaths which was up from 601 the day before. Their all time high was 793 deaths on 22-Mar.
• Spain hit a new high overnight. Spain reported 7,937 new cases. Yesterday their new cases were 6,584. The previous high was on 22-Mar - 7,001 new cases. Spain also hit a new daily high on deaths- 738 deaths, up from 514 the day before. Their previous daily high was 627 deaths on 22-Mar.
• The total deaths in Spain is 3,434, which exceeds China's death count of 3,285. Spain has so many dead that they are using an ice rink as a makeshift morgue.
• UK had a 21% increase in cases from 6,733 to 8,167. Yesterday, the UK started more aggressive public health measures to try to decrease the spread of the virus. They have also realized that the NHS will be overwhelmed by patients and have begun the process of setting up field hospitals and recalling retired doctors and nurses to duty.

Coronavirus cases/deaths in major countries:

• Italy - 69,176 cases (up from 63,927) - 6,820 deaths.
• Spain - 47,610 (up from 39,673 cases) - 3,434 deaths
• Germany - 34,009 cases (up from 30,150 cases), 172 deaths
• Iran - 27,017 cases (up from 24,811 Friday) - 2,077 deaths
• France - 22,637 cases (up from 20,149 cases), 1,102 deaths
• Switzerland - 10,456 cases (up from 9,117 cases), 145 deaths
• South Korea - 9,137 cases (from 9,037 cases) - 126 deaths
• UK - 8,167 cases (up from 6,733 cases), 423 deaths
• Netherlands - 5,585 cases (up from 4,767 cases), 277 deaths
• Canada - 2,792 cases (up from 2,088), 27 deaths
• Australia - 2,364 cases (up from 2,044 cases), 8 deaths
• Mexico - 405 cases, 5 deaths
• New Zealand - 205 cases, 0 deaths

United States updates:

• The US is on its way to exceeding the 81,661 cases in China. Yesterday, the US reported 8,788 (up 19%) new cases which is higher than any other country, including Italy and Spain.
• 38 states, Puerto Rico and Guam have at least 1 death.

Individual States with high case counts:

• New York - 25,665 (up from 20,875 cases), 210 deaths
• New Jersey - 3,675 (up from 2,844 case), 44 deaths
• Washington - 2,469 (up from 2,221 cases), 123 deaths
• California - 2,102 (up from 1,733 cases), 40 deaths
• Michigan - 1,791 (up from 1,328 cases), 24 deaths
• Illinois - 1,535 cases (up from 1,285 cases), 16 deaths
• Florida - 1,461 (up from 1,237 cases), 19 deaths
• Louisiana - 1,388 cases (up from 1,172 cases), 46 deaths
• Georgia - 1,097 (up from 800 cases), 38 deaths
• Massachusetts - 1,159 (up from 777 cases), 11 deaths
• Pennsylvania - 851 (up from 644 cases), 7 deaths
• Tennessee - 667 (up from 615 cases), 2 deaths
• Colorado - 912 (unchanged from 591), 11 deaths
• Texas - 715 (up from 352), 11 deaths
  

Canadian Province Stats:

• Alberta - 358 (up from 301 cases) 2 deaths
• British Columbia - 617 (up from 472 cases) 13 deaths
• Manitoba - 21 (up from 20 cases), 0 deaths
• New Brunswick - 18 (up from 17 cases), 0 deaths
• Newfoundland/Labrador - 18 (up from 24 cases), 0 deaths
• Nova Scotia - 51 (up from 41 cases), 0 deaths
• Ontario - 588 (up from 503 cases) 7 deaths
• Quebec - 1016 (up from 628 cases) 4 deaths
• Prince Edward Island - 3 (no change from 3 cases)
• Saskatchewan - 72 (up from 66 cases)

There were also 13 Canadians on the Grand Princess, one of whom died.

 

[Alistair]

The current tie-on masks are a paper/cotton blend and are designed to be disposable. They should be changed between patients.

The masks that healthcare workers are using when patients have coronoavirus have high-filtration factors (N95 masks- they filter 95% of airborne particles). Water and oil damages the mask and would lower the 95% effective rate.

Cloth masks made out of fabric can be used for the public, particularly for people who have colds, flu. The goal with these masks is to block virus from the mouth and nose from getting into the air, particularly coughing and sneezing. They do not have to fit airtight around the face, so they can be washed and reused.

I hope this isn't off topic, but you're in the know. Are the clothe masks that people are making at home to donate to hospitals usable? I can't see them actually being used because there's no way to prove they're sterile.

 

[KaraBulut]

I hope this isn't off topic, but you're in the know. Are the clothe masks that people are making at home to donate to hospitals usable? I can't see them actually being used because there's no way to prove they're sterile.

We've been trying to keep this thread for information (there's other threads in Hot Topics for memes and humor etc) and this is exactly the kind of question that fits into this thread.

The homemade cloth masks aren't recommended for healthcare workers who are high risk- particularly people in the emergency department and those who are doing direct patient care. What I'm hearing from people in the hospitals is that they're looking for solutions that reduce consumption of N95 masks because of the severe shortage. The CDC said as much last week when they said "bandanas" could be used if no disposable masks were available (to which a lot of healthcare workers said, "Are you fucking kidding me?").

By using cloth masks for volunteers, registration staff and other workers who aren't providing direct patient care, they are able to preserve the disposable masks (and in particular the N95 masks) for the staff who need them. There's also suggestions that an N95 mask could be "protected" and reused if a cloth mask is placed over it (although it's already hard enough to breathe with an N95 mask on). I think it also helps the public feel like they're contributing to the effort- a lot of people are at home with nothing to do, so sewing masks is a good way to occupy their time.

I'm also hearing that staff are using the same N95 masks all day (which is not recommended). In some cases, I've heard that they're putting the N95 masks in their lockers and using them again the next day (which is definitely not recommended because the masks are considered contaminated after they are used). There are some studies about how long coronavirus can survive on metal, plastic, cardboard, etc but I haven't seen reports on cloth but it's probably safe to assume that it falls into the 24-48 hour viability window that they're reported on other materials.

Earlier, I posted a link to an account by a doctor working in an emergency room in NYC. He is one of the healthcare workers who contracted Ebola during the 2013-2014 outbreak and he now works in a hospital seeing lots of COVID-19 cases. He talks about getting home and stripping naked in the entryway and immediately showering (something that a lot of us do when we care for a lot of sick patients). Hospitals don't provide the scrubs and uniforms for staff outside the OR. We put on our uniforms at home and wear them all day and then wear them home and we have to wash them. The assumption is for the cloth masks either they would be thrown away or bagged after use and washed.

 

[belamyi]

^ Medical staff has been asking people not to flood them with masks as if just anything covering your mouth could do: if we were in a fall-of-Atlanta scenario you might be reduced to accept anything with the triple cloth-film-gauze home-made mask, or even less than that, if anything but, so far, it is considered more a nuisance than help for medical workers.

I think we would have better help to them if all these past years we had pressure decisions makers to plan everything that is desperately being suggested now, because medical equipment is the known and controllable part in an emergency situation like this.

 

[sixthson]

60% of the new cases in the US are coming from New York alone.

Unless I'm missing it, you are neglecting to post how many have actually recovered from the virus. Last I heard it was over 110,000. Imagine how many have recovered from it while thinking they only had the seasonal flu or bad cold. We'll never know. Let's include the good news with the bad.

 

[KaraBulut]

^ Medical staff has been asking people not to flood them with masks as if just anything covering your mouth could do: if we were in a fall-of-Atlanta scenario you might be reduced to accept anything with the triple cloth-film-gauze home-made mask, or even less than that, if anything but, so far, it is considered more a nuisance than help for medical workers.

I think we would have better help to them if all these past years we had pressure decisions makers to plan everything that is desperately being suggested now, because medical equipment is the known and controllable part in an emergency situation like this.

It's pathetic and I'm embarrassed to say this, but believe it or not, several large healthcare organizations have asked Americans to sew and donate masks. Here's an example:
https://www.providence.org/lp/100m-masks

The US made some strategic mistakes recently that have created shortages, including shortages of PPE.

• Manufacturing has been outsourced to other countries that make things for less labor cost (although prices didn't decrease). This is the issue with masks and gowns and other PPE. It will probably become an issue with other things like medications.
• Efficiencies of the supply chain means that they're able to buy as they consume stocked supplies. The hospitals don't maintain large stores of supply items like they did in the past. Just like what we're seeing with toilet paper in grocery stores, efficiency doesn't account for sudden increases in demand and it takes a long time to ramp up production when we're used to making it only as it is ordered.
• Because hospitals have consolidated, they don't maintain individual stores and they have centralized purchasing. This is the issue with ventilators- they only maintain enough for typical usage and keep a central backup store.
• Because the US healthcare system tries to run on a profit (even though for tax purposes, they are not-for-profit), they try to stay "lean and mean", so keeping extra PPE and ventilators doesn't maximize profits.

Back in the 1970s, President Carter created a Strategic Petroleum Reserve to store oil in the event of an emergency or nationwide shortage. We haven't been as strategic with medical supplies. Instead, we have a group of bozos in our government who waste millions of dollars on legislating what Americans can or can't do with their body and trying to figure out ways to reduce taxes for people who have plenty of money. It takes an emergency like this to show how pathetic our political system has become on the subject of planning and saving for a rainy day.

 

[belamyi]

^ Medical staff has been asking people not to flood them with masks as if just anything covering your mouth could do: if we were in a fall-of-Atlanta scenario you might be reduced to accept anything with the triple cloth-film-gauze home-made mask, or even less than that, if anything but, so far, it is considered more a nuisance than help for medical workers.

I think we would have better help to them if all these past years we had pressure decisions makers to plan everything that is desperately being suggested now, because medical equipment is the known and controllable part in an emergency situation like this.

Well, I should have edited better than that

 

[KaraBulut]

60% of the new cases in the US are coming from New York alone.

Unless I'm missing it, you are neglecting to post how many have actually recovered from the virus. Last I heard it was over 110,000. Imagine how many have recovered from it while thinking they only had the seasonal flu or bad cold. We'll never know. Let's include the good news with the bad.

The recovered cases is accounted for in the Johns Hopkins epidemiological tracking website. They show 111,933 total recovered cases - 73,773 of which are in China.

The problem with recovered cases at the moment is that we have so many people testing positive or getting sick, they public health people are not able to report accurately on resolved cases. The definition of a recovered case is that it is someone who is not actively being treated, no longer has the virus and did not die.

One thing that we're not talking much about is that the surveillance efforts aren't able to really figure out what the true scope of the problem is at the moment. For example, Italy's numbers don't make sense. Italy is reporting 69,176 cases, 6,820 deaths and 8,326 recovered. That means that they have 54,030 active cases. None of that makes sense. What I think we're going to find is that Italy's death rate is probably about 3-4% and they actually had something like 200,000 cases with a lot more recovered people who were never counted in their case numbers.

You can also get to the individual states (and for Canada, the provinces) by selecting the country on the list on the left, then clicking the right arrow at the bottom of the left panel. Then if you click on the name of the state on the left panel, you'll get the case count, deaths and recoveries for that individual state.

For example, NY state has 26,395 cases, 271 deaths and has reported no recoveries.

 

[rareboy]

It's pathetic and I'm embarrassed to say this, but believe it or not, several large healthcare organizations have asked Americans to sew and donate masks. Here's an example:
https://www.providence.org/lp/100m-masks

The US made some strategic mistakes recently that have created shortages, including shortages of PPE.

• Manufacturing has been outsourced to other countries that make things for less labor cost (although prices didn't decrease). This is the issue with masks and gowns and other PPE. It will probably become an issue with other things like medications.
• Efficiencies of the supply chain means that they're able to buy as they consume stocked supplies. The hospitals don't maintain large stores of supply items like they did in the past. Just like what we're seeing with toilet paper in grocery stores, efficiency doesn't account for sudden increases in demand and it takes a long time to ramp up production when we're used to making it only as it is ordered.
• Because hospitals have consolidated, they don't maintain individual stores and they have centralized purchasing. This is the issue with ventilators- they only maintain enough for typical usage and keep a central backup store.
• Because the US healthcare system tries to run on a profit (even though for tax purposes, they are not-for-profit), they try to stay "lean and mean", so keeping extra PPE and ventilators doesn't maximize profits.

Back in the 1970s, President Carter created a Strategic Petroleum Reserve to store oil in the event of an emergency or nationwide shortage. We haven't been as strategic with medical supplies. Instead, we have a group of bozos in our government who waste millions of dollars on legislating what Americans can or can't do with their body and trying to figure out ways to reduce taxes for people who have plenty of money. It takes an emergency like this to show how pathetic our political system has become on the subject of planning and saving for a rainy day.

In Ontario, after SARS, all health care institutions started carrying a back-up stock for disasters such as this. It is hard to say if some became complacent and let their stocks diminish, but I know that all the regional hospitals in our area are sitting on enough PPE supplies to deal with this crisis as long as we all try to keep the numbers as low as is possible. Our shortage, of course, will be ventilators, like all the other areas hit by large numbers of cases. At the moment though, the cases are able to be managed with the numbers of ventilators and ICU beds available.....but that could literally change overnight as we've seen in Europe and Asia.

 

[cityboy-stl]

This seems promising and it is available, but I have not seen any media attention about it.

This-vaccine-may-provide-immune-boost-against-coronavirus-herpes-and-other-viral-infections [Knowridge.com]

In recent studies, researchers found that a vaccine VPM1002 originally developed against tuberculosis may be effective against infection with SARS-CoV-2.

The research was conducted by a team at the Max Planck Institute.

VPM1002 is based on a vaccine called BCG, which was developed at the beginning of the 20th century.

Studies on mice show that the BCG vaccine can protect not only against tuberculosis but also against viral infections of the respiratory tract.

 

[KaraBulut]

This seems promising and it is available, but I have not seen any media attention about it.

This will be interesting to see... there has been a bunch of social media stuff talking about a block of countries around Turkey that have somehow had lower than usual case counts. The social media posts have been in the line of "Turks are immune!".

These same countries also use BCG vaccines in childhood. It's too early to know, but it is worth studying their populations to see why the case counts have been low, in particular because Tehran, Qom and the cluster of cases in Iran are very close by.

 

[metta]

Re: Coronavirus. Are you buying the hype?

PSA Safe Grocery Shopping in COVID-19 Pandemic

 

[KaraBulut]

In Ontario, after SARS, all health care institutions started carrying a back-up stock for disasters such as this. It is hard to say if some became complacent and let their stocks diminish, but I know that all the regional hospitals in our area are sitting on enough PPE supplies to deal with this crisis as long as we all try to keep the numbers as low as is possible. Our shortage, of course, will be ventilators, like all the other areas hit by large numbers of cases. At the moment though, the cases are able to be managed with the numbers of ventilators and ICU beds available.....but that could literally change overnight as we've seen in Europe and Asia.

There's a certain arrogance that the US has about listening to wisdom from other countries, even when they are (or were) close allies.

There's some good news coming out of Italy on how to deal with ventilator shortages. There is a population of patients who do not need intubation for mechanical assistance or high measures of positive pressure (PEEP) ventilation. For these patients, they are able to allow them to breathe on their own with a different form of positive pressure (CPAP- same CPAP as those nighttime machines that people with sleep apnea use).

Italy has reached a point where they are taking scuba masks and hooking them to home CPAP machines with supplemental oxygen. This at least buys some time until a ventilator becomes available.

 

[rareboy]

^ I was really captivated by the McGyver scuba mask idea.....and hopefully for many patients who do not require intubation, this will be the solution.

 

[KaraBulut]

Updates from Cuomo's briefing this morning:

• New York expects that their peak case load will be 21 days from now.
• The state has tested 103,000 people (this is 28% of all people who have been tested in the US). New York has drive-through testing in population dense areas like the NYC area.
• Of the the 103,000 tested, there has been 30,811 positives (30%). Yesterday, they had 5,146 new confirmed cases.
• A big surprise: of those people that New York has tested who were positive, 46% are age 18-44. This is the first time that we've gotten a picture of how many asymptomatic carriers might be in the population.
• Most patients (~80%) who test positive do not need hospitalization. Their cases can be managed with self-isolation at home.
• About 15% require hospitalization - this is higher than projection models has anticipated. Of the 15% requiring hospitalization, 12% are in regular hospital beds and 3% are in ICU beds.
• New York is still anticipating that they will need 140,000 hospital beds (they currently only have 53,000 beds currently). They anticipate needed 40,000 ICU beds (they have 3,000 ICU beds today).
• They currently have 4,000 ventilators, they anticipate needing 30,000 ventilators. The Trump Administration has promised them an additional 4,000 ventilators and they have ordered another 7,000. This leaves them 15,000 ventilators short of what they would need.
• 40K retired MDs/APRNs/RNS have signed up to help out.

 

[luckynumbah7]

There's a certain arrogance that the US has about listening to wisdom from other countries, even when they are (or were) close allies.

There's some good news coming out of Italy on how to deal with ventilator shortages. There is a population of patients who do not need intubation for mechanical assistance or high measures of positive pressure (PEEP) ventilation. For these patients, they are able to allow them to breathe on their own with a different form of positive pressure (CPAP- same CPAP as those nighttime machines that people with sleep apnea use).

Italy has reached a point where they are taking scuba masks and hooking them to home CPAP machines with supplemental oxygen. This at least buys some time until a ventilator becomes available.

shit, I could've suggested that - cpap was how I got through my last bedridden bout. Minus the canister of oxygen, I didn't have that. Ended up sitting up the entire time with a pillow wedged under my neck and my head tilted at a ridiculous angle so my airway felt more open. I do not recommend the sensation - have to focus as much as possible on the air temperature to keep panic under control.

 

[KaraBulut]

A video interview with Craig Spencer, a NYC ER doc who contracted Ebola in West Africa:

 

[rareboy]

Interactive model on the impact of intervention on the number of cases of COVID from the New York Times.

https://www.nytimes.com/interactive...DTYc5R9v3_h3KdAFiE-0fVCvAGcG5xzuN07JNYXY81DU0

 

[belamyi]

I love it when items for adults are presented in a Sesame Street way.

 

[belamyi]

If got into the habit of browsing it every morning, it's as funny as ever, but not as disgusting a tabloid as usual... (ok, maybe I do not scroll down enough

- - - Updated - - -

"Ireland: pubs shut", "US: Europe ban".