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Post by drbill on Mar 16, 2020 14:31:18 GMT -6
That’ll show ‘em. We live in a gross time. Yup. Political hubris in the political market place knows no party-line. Both sides ought to man up and make a difference instead of taking cheap shots. Should I hold my breath??  |
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Post by ragan on Mar 16, 2020 14:37:55 GMT -6
That’ll show ‘em. We live in a gross time. Yup. Political hubris in the political market place knows no party-line. Both sides ought to man up and make a difference instead of taking cheap shots. Should I hold my breath?? I think the often-leaned-on claim of both-sides-ism is largely illusory in this particular chunk of history (this chunk being abnormal.... please, please let it prove to be abnormal) but in general I agree with you 100%. As for holding your breath, there's enough respiratory trauma in the world right now so I'd say please don't. |
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Post by drbill on Mar 16, 2020 14:41:35 GMT -6
Yup. Political hubris in the political market place knows no party-line. Both sides ought to man up and make a difference instead of taking cheap shots. Should I hold my breath?? I think the often-leaned-on claim of both-sides-ism is largely illusory in this particular chunk of history (this chunk being abnormal.... please, please let it prove to be abnormal) but in general I agree with you 100%. As for holding your breath, there's enough respiratory trauma in the world right now so I'd say please don't. It may be in your particular example, but overall, no, I don't think so. I'm afraid that each side is still out for maximizing their agenda with Corona opportunities at the public's expense - be it fear mongering, chest thumping or making money off of horrific human trauma. And I'll take your advice and not hold my breath. |
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Post by matt@IAA on Mar 16, 2020 14:50:15 GMT -6
ragan what a douche. Edit: the governor candidate I mean. POTUS presser today was good. All Americans of any flavor should watch. Don't filter through the news, you can go watch yourself.
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Post by matt@IAA on Mar 16, 2020 14:54:25 GMT -6
From the Task Force
15 Days to Slow the Spread
Listen and follow the directions of your state and local authorities.
If you feel sick, stay home. Do not go to work. Contact your medical provider.
If your children are sick, keep them at home. Do not send them to school. Contact your medical provider.
If someone in your household has tested positive for the coronavirus, keep the entire household at home. Do not go to work. Do not go to school. Contact your medical provider.
If you are an older person, stay home and away from other people.
If you are a person with a serious underlying health condition that can put you at increased risk (for example, a condition that impairs your lung or heart function or weakens your immune system), stay home and away from other people.
Even if you are young, or otherwise healthy, you are at risk and your activities can increase the risk for others. It is critical that you do your part to stop the spread of the coronavirus.
Work or engage in schooling from home whenever possible.
If you work in a critical infrastructure industry, as defined by the Department of Homeland Security, such as healthcare services and pharmaceutical and food supply, you have a special responsibility to maintain your normal work schedule. You and your employers should follow CDC guidance to protect your health at work.
Avoid social gatherings in groups of more than 10 people.
Avoid eating or drinking at bars, restaurants, and food courts - use drive-thru, pickup, or delivery options.
Avoid discretionary travel, shopping trips, and social visits.
Do not visit nursing homes or retirement or long-term care facilities unless to provide critical assistance.
Practice good hygiene:
Wash your hands, especially after touching any frequently used item or surface.
Avoid touching your face.
Sneeze or cough into a tissue, or the inside of your elbow.
Disinfect frequently used items and surfaces as much as possible.
*School operations can accelerate the spread of the coronavirus. Governors of states with evidence of community transmission should close schools in affected and surrounding areas. Governors should close schools in communities that are near areas of community transmission, even if those areas are in neighboring states. In addition, state and local officials should close schools where coronavirus has been identified in the population associated with the school. States and localities that close schools need to address childcare needs of critical responders, as well as the nutritional needs of children.
**Older people are particularly at risk from the coronavirus. All states should follow Federal guidance and halt social visits to nursing homes and retirement and long-term care facilities.
***In states with evidence of community transmission, bars, restaurants, food courts, gyms, and other indoor and outdoor venues where groups of people congregate should be closed.
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Post by ragan on Mar 16, 2020 14:58:05 GMT -6
I think the often-leaned-on claim of both-sides-ism is largely illusory in this particular chunk of history (this chunk being abnormal.... please, please let it prove to be abnormal) but in general I agree with you 100%. As for holding your breath, there's enough respiratory trauma in the world right now so I'd say please don't. It may be in your particular example, but overall, no, I don't think so. I'm afraid that each side is still out for maximizing their agenda with Corona opportunities at the public's expense - be it fear mongering, chest thumping or making money off of horrific human trauma. And I'll take your advice and not hold my breath. Agree to disagree on the equivalence. And I'm sure we can both agree that whoever distorts information for their own gain should be run out of town. |
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Post by matt@IAA on Mar 16, 2020 16:54:18 GMT -6
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Post by M57 on Mar 16, 2020 16:54:21 GMT -6
A little humor always helps to keep me sane..
..and very cleanly performed, I might add.
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Post by swurveman on Mar 16, 2020 18:03:13 GMT -6
I'm going to post this, hoping it is informative and helpful. It is from an Emergency Room Doctor, who posted this on a forum I am a part of with other alumni of my university. Here's what he posted:
1. The cases of COVID are far, far more than are being reported. We are not testing the majority of people. We are sending them home with instructions to self quarantine, and what to watch for.
2. The reason for this is three fold
a. Tests are very a finite resource...not just tests but the viral medium needed to collect the sample. We need to conserve for the people who we really need to know
b. For most people, it won't change management. Results are taking 3-5 days. You look well, you don't have severe disease, and have few or no risk factors. You will be sent home to be on self-quarantine regardless.
***c. This is the big one. It is a huge burden to test. Why you ask? COVID is a droplet and contact disease. It is generally not airborne. So standard PPE (Personal Protective Equipment) is adequate (surgical mask, eye protection, gown, gloves) plus having the patient keep a mask on at all times. BUT it becomes airborne during aerosolizing procedures, which include collecting nasal and oral samples. At this point, airborne precautions must be taken to include N95 Respirator masks.
BUT we are on a massive shortage of all PPE nationally and worldwide...in many hospitals out west they are already bleaching and reusing N95s in between patients. Not ideal at all, but better than nothing at all. We are also on shortage of gloves and surgical masks. Also, in between any COVID patient the room needs to be terminally cleaned which takes time, but if an aerosolizing procedure (even test collection) the room is supposed to be given one hour to let any droplets settle onto the floor/surfaces before terminal cleaning. It is simply not practical
Although we can assign a nurse to our COVID wing (that is cordoned off with temporary barriers) there are still requirements after performing aerosolizing procedures with regard to PPE, what can be reworn, what can't
Simply put, routine testing right now is a burden and rightfully so
The only way to really do a lot of testing is outdoors, with a tent, where you have people outfitted in the proper PPE and just leave it on as cars drive through/people walk up. But we are finding it to be a big burden
Further, I'm sure people were sick of me, but for the first few days staff were taking masks off when they were sitting at computers or out in the doctor/nurse area. I was asking people to put masks on, but everyone said it wasn't required when not around patients. I said "Yeah, but what happens when one of us tests positive? We are all exposed". The purpose of me wearing a mask is to protect YOU from ME, not ME from YOU. Well, guess what, a couple staff have now tested positive. Which means that all staff that worked closely with them without masks and eye protection on are now on 14 day self-quarantine. So we are now down 1 doctor and 4 nurses in a small 14 bed ER. I am on "supervised self monitoring" because the very first day this was all starting to go down, I didn't have eye protection on with a patient that tested positive. Fortunately the patient was masked, so that means I can just be on self monitoring and not full self quarantine, but I still have to fill out a form with my temperature and any symptoms 3x/day
3. Speaking of aerosolizing procedures, some interesting things
a. BIPAP/Non-invasive ventilation is basically out. It is highly aerosolizing and associated with one of the highest rates of healthcare provider contamination. So while traditionally we use BIPAP as much as possible to avoid intubation, we are going to intubation much more quickly now
b. Nebulizers, a mainstay of respiratory disease/wheezing are verboten. As you can imagine, again highly aerosolizing. One person on a nebulizer in a non-negative pressure room with the door opens can shut down a whole wing. You are going to see a huge number of EMS providers start testing positive, because they've been following their protocols and giving nebulizers right and left to these folks. The protocols are changing, but I suspect that horse is already out of the barn. Instead, we are using serial Metered dose inhalers with spacer devices.
c. For intubation and other high risk procedures, I am donning PAPR (Powered Air Purifier Respirator) basically a positive pressure sealed head cover that doesn't allow any outside air in. It sucks because it's hard to hear whats going on, but intubations are too high risk otherwise.
I want to reiterate: THIS IS NOT THE FLU. I will freely say it, I was wrong. I downplayed this months ago, and cited how many people die of the flu every year, etc. I have had more critically ill patients this week than I had all flu season. I have personally had 2 patients die already, both in their late 60s/early 70s but otherwise actually very healthy with no significant medical problems. Yes, most people will be fine, but for the subset that get very ill, it's a bit stunning how quickly and dramatically they go downhill. There are already 2 ER doctors barely hanging onto life, one in Washington (healthy male in his early 40s) and one in New Jersey (also healthy but 70 years old, coincidentally he is in charge of Emergency Preparedness for a large health system). Most people don't have anything to worry about with COVID-19, but if you are one of the people who it hits harder, it's frightening how fast you go downhill.
But I really want to emphasize to everyone, do not be lulled into a false sense of security by the number of positive tests. The number of people infected is orders of magnitude more than reported, because we simply aren't test most people. As more tests become available hopefully that will change.
Practice social distancing, flatten the curve...yes they seem like overused buzzwords but it's the only way we're going to survive this thing.
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Post by swurveman on Mar 16, 2020 18:16:35 GMT -6
*redundant*
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Post by swurveman on Mar 16, 2020 18:17:06 GMT -6
...and more information that hopefully is helpful: "I think by now enough people have heard about steroids and NSAIDS. If not, while it has not been prospectively studied, there is clearly association with use of steroids and NSAIDS to control the inflammation and worse outcomes/progression. From what I have read, we're not sure why, but it has been the case. So if there is any chance that you're feeling ill and it could be COVID, avoid ibuprofen/aleve and don't let your doctor prescribe steroids Also, this is fascinating, and it may not end up being as big a deal, but also in China there was clear association with hypertension and rapid worsening...hypertension was a clearly identifiable risk factor for rapid worsening. Of particular concern are those taking ACE inhibitors or ARBs, like lisinopril and losartan, which are some of the most commonly prescribed anti-hypertensives out there. The reason is COV-19 binds preferentially to the ACE2 enzymes, and in patients taking ACE-i and ARBs ACE2 expression is increased. So the thought is that perhaps this is providing additional attachment points resulting a higher viral load from the outset The European Cardiology Society has downplayed that association, but some other groups that I know are questioning that. We have one cardiologist in our hospital group who thinks physiologically about everything like I do, and his analysis of it is much more cautious than ECS. While he's not willing to say there's a definite association, he thinks ultimately there will be So if you're on an ACE-i or ARB, and get COVID or are at higher risk, consider discussing this with your cardiologist." |
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Post by matt@IAA on Mar 16, 2020 20:48:26 GMT -6
Some quick nerd talk.
R0 is how many people each sick person infects. It directly changes how fast the disease spreads per day as well. Some is based on the disease itself (measles is higher than flu) but you can control it with hygiene and behavior. This disease has a do-nothing R0 of around 2.2, maybe higher.
The amount of people who don't get an illness during an epidemic in a population is straight up related to R0. If R0 doesn't change - if we don't do this social distancing stuff - 85% of a "well mixed" population get a disease with an R0 of 2.2.
Seasonal flu has an R0 of around 1.3. That means around 55% of a "well mixed" population get it. 2009 H1N1 infected around 60,000,000 Americans over a year - 19% - and 12,000 deaths.
That's where the 30-70% of Americans getting COVID19 is coming from, from guys like Dr Fauci. That's where the 480,000 - 2.2 million fatalities is coming from (30% spread and 0.5% fatality low end, 70% spread and 1% fatality high end).
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Post by rowmat on Mar 16, 2020 23:20:19 GMT -6
Italy's crematoriums now cannot keep up with the body count.
Just announced here in Australia we are heading towards the current Italian scenario within three weeks unless we lockdown IMMEDIATELY.
I would think the US, UK and elsewhere are on a similar trajectory.
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Post by bricejchandler on Mar 17, 2020 2:53:36 GMT -6
We here in France are in Lockdown starting today.
You need special authorization to go out.
I don't think there's any way around it. The sooner countries lock down the better.
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Post by matt@IAA on Mar 17, 2020 8:06:26 GMT -6
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Post by rowmat on Mar 17, 2020 12:36:11 GMT -6
Bergamo Newspaper obituaries showing the dramatic increase in deaths from February 9th to March 13th. Bergamo ObituariesUnless you have already been officially told to go into lock-down I would just do it anyway. Every additional day politicians and officials spend playing with their dicks is a crucial day lost. Over 4000 health professionals here in Australia signed a petition appealing to the government to take immediate action to lock the entire country down while the government continues to say it is "monitoring the situation" and "taking advice" from its own appointed 'Yes Men' and cronies.
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Post by chessparov on Mar 17, 2020 14:27:15 GMT -6
Following this thread. Honestly, relatively recently-Thought the closing of the schools I work at (I teach afterschool chess)... Was overboard. In retrospect, I think it was the right thing to do. I have a strong immune system (even at 60). Set the record at work, for not missing work. Over 12 years (!) without a sick day/missing teaching. But... My room mate is 70 years old, so staying very careful. Washing hand/Social distance/etc. Chris P.S. Wishing all my RGO "Extended Family" well-Literally and figuratively! |
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Post by ericn on Mar 17, 2020 22:09:29 GMT -6
Not music related but they just shut down the schools here until early April. I have a teenager I need to find things to do. Other than video games. Ugh. Cheers, Geoff Good luck with that, as a the father of a teen who is in the exact same boat I do feel the pain. I’m just telling myself thank god Im not living 4 miles away in KS where the Governor closed schools for the rest of the school year. |
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Post by rowmat on Mar 17, 2020 22:15:28 GMT -6
Although a variation on other 'Exponential Growth' demonstrations this example highlights just how rapidly something can become overwhelming.
“The greatest shortcoming of the human race is our inability to understand the exponential function.” - Dr Albert Bartlett
Follow the link...
Compounding is THE Problem |
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Post by ericn on Mar 17, 2020 22:24:35 GMT -6
Re: gov response, refusing test kits offered early by the WHO and bellowing from crowded campaign rallies that it’s “a hoax” and that “in a couple of days there will be close to zero cases” is certainly not an effective strategy, to put it extremely charitably. Know I love you dude but that whole hoax thing is totally and completely out of context. The only thing more frustrating for me than the lead-footed test kit rollout is the partisan spin on both sides...BOTH SIDES. Rush and Hannity acting like this is a Democrat ploy is just as bad as the junk coming from the left. They can’t give it a rest for a minute even when it’s serious. Gets old. Matt from what I have heard, not in the Media but from people I know with the CDC, a couple of reference labs. Health related CO. It wasn’t that they REFUSED, they never asked for the WHO kit. Now the fact that the WHO was not FDA is true, BUT the only reason the CDC kit is because it was seed of light fast tracked. Now the funny thing is guess where the reagents are made? Fitchburg WI, ProMega ( old client trying to save the world). Now nobody is sure where the CDC kit reagents are being made. |
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Post by ragan on Mar 17, 2020 22:38:39 GMT -6
Know I love you dude but that whole hoax thing is totally and completely out of context. The only thing more frustrating for me than the lead-footed test kit rollout is the partisan spin on both sides...BOTH SIDES. Rush and Hannity acting like this is a Democrat ploy is just as bad as the junk coming from the left. They can’t give it a rest for a minute even when it’s serious. Gets old. Matt from what I have heard, not in the Media but from people I know with the CDC, a couple of reference labs. Health related CO. It wasn’t that they REFUSED, they never asked for the WHO kit. Now the fact that the WHO was not FDA is true, BUT the only reason the CDC kit is because it was seed of light fast tracked. Now the funny thing is guess where the reagents are made? Fitchburg WI, ProMega ( old client trying to save the world). Now nobody is sure where the CDC kit reagents are being made. I'm the one who made that accusation and your post just motivated me to look it up again and I see a couple of fact-checking orgs posting articles today calling that claim misleading or at least partially false. While it doesn't look like there is official comment from CDC or WHO on it, the people they have gotten comment from characterize it more as 'declining' to use the WHO test kits, not actively refusing an offer. So I'll freely admit that my characterization of it wasn't right. New info, new opinion. I'm thoroughly disloyal to views I've had if they turn out to be wrong or incomplete (as looks to be the case with that one). There have been a bevy of screw-ups in the handling of this, some of them almost certainly politically motivated. And they're gonna turn out to have cost lives. Not the point right now, as I see it. Let's just get through this as focused and purposeful as possible. |
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Post by the other mark williams on Mar 18, 2020 3:00:51 GMT -6
Thanks for that PDF. One of the conclusions I draw from it and other articles I've read: We're going to need a lot more ventilators and hospital beds. While I know it's not this simple, it seems we should be spending money building both like crazy. |
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Post by ericn on Mar 18, 2020 5:56:09 GMT -6
Thanks for that PDF. One of the conclusions I draw from it and other articles I've read: We're going to need a lot more ventilators and hospital beds. While I know it's not this simple, it seems we should be spending money building both like crazy. What your going to find is even if we somehow manage to get the vents through the supply chain shutdowns and slow downs is we need more people who can maintain them. The skill set of in house bio-electronic departments is not what it once was. |
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Post by Tbone81 on Mar 18, 2020 10:29:49 GMT -6
Thanks for that PDF. One of the conclusions I draw from it and other articles I've read: We're going to need a lot more ventilators and hospital beds. While I know it's not this simple, it seems we should be spending money building both like crazy. What your going to find is even if we somehow manage to get the vents through the supply chain shutdowns and slow downs is we need more people who can maintain them. The skill set of in house bio-electronic departments is not what it once was. This is a generalization because some ventilators are a PITA to maintain, but most ventilators are very easy to maintain. Its having the Respiratory Therapists (like myself) to run them when we're all being exposed and forced into 14 day quarantine that is the bigger issue. Critical Care staffing is a huge issue right now. |
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Post by drbill on Mar 18, 2020 17:49:45 GMT -6
With all the gloom and doom, I thought I'd share this news with you guys. I haven't had a chance to check out all the links, but it looks like there may be some promising developments on the horizon. Vaccines, treatments, trends.... Crap, the links wouldn't transfer over. Oh well. I'll at least leave up the news points.... UPDATE : I went the extra mile for you guys and manually found the links for you.....You're worth it!! haha!! Good news!! (1) Vaccine development: An experimental vaccine developed by Moderna Inc. began the first stage of a clinical trial on Monday, with testing on 45 healthy adults in Seattle. www.nytimes.com/2020/03/16/health/coronavirus-vaccine.html?utm_campaign=Tech%20Blog&utm_source=hs_email&utm_medium=email&utm_content=84918252&_hsenc=p2ANqtz-8RHzv980K1CJ3hGO5afVtQ84nuQpdMyNCJ5VrVWpnN1yquILD6bJEaTwjhlARIKiAFNmKBwf3i5_q_HQHfq8pdtdLBPg&_hsmi=84918252(2) China's new cases plummet: China has now closed down its last temporary hospital built to handle COVID-19. Not enough new cases to warrant them. link(3) Drugs that work: Doctors in India have successfully treated two Italian patients with COVID-19, administering a combination of drugs — principally Lopinavir and Ritonavir, alongside Oseltamivir and Chloroquine. Several are now suggesting the same medical treatment, on a case-by-case basis, globally. link(4) Antibodies to the rescue: Researchers at the Erasmus Medical Center claim to have found an antibody that can fend off infection by COVID-19. link(5) 103-year-old recovery: A 103-year-old Chinese woman has made a full recovery from COVID-19 after being treated for 6 days in Wuhan, China, becoming the oldest patient to beat the disease. link(6) Stores re-opening: Apple has reopened all 42 of its Apple retail stores in China. link(7) Test results in 2 hours: Cleveland’s MetroHealth Medical Center has developed a COVID-19 test that can now deliver results in just two hours, rather than in a matter of days. link(8) South Korea's dramatic drop in new cases: After its peak of 909 newly reported COVID-19 cases on February 29th, South Korea has now seen a dramatic drop in the number of new cases reported daily. link(9) Mortality rates inflated? Experts predict that Italy has seen a higher mortality rate of COVID-19 given its significant aging population, as well as its higher percentage of COVID-19 patients with pre-existing health conditions. This might suggest that COVID-19’s fatality rate may have been slightly more inflated than previously thought for the general population. link(10) Israeli vaccine development: More than 50 scientists in Israel are now working to develop a vaccine and antibody for COVID-19, having reported significant breakthroughs in understanding the biological mechanism and characteristics of the novel coronavirus. link(11) Full recoveries: Three patients in Maryland who tested positive for COVID-19 have now been reported to have “fully recovered.” link(12) Isolated virus: A network of Canadian scientists isolated the COVID-19 virus, which can now be replicated to test diagnostics, treatments, and vaccines. link(13) Yet another vaccine in the works: San Diego biotech company Arcturus Therapeutics is developing a COVID-19 vaccine in collaboration with Duke University and National University of Singapore. link(14) Treatment protocols: Seven patients who were treated for COVID-19 at Jaipur’s Sawai Man Singh (SFS) Hospital and Delhi’s Safdarjung Hospital in India have recovered. The treatment protocol will be widely scaled to other hospitals. link(15) Another treatment: Plasma from newly recovered COVID-19 patients (involving the harvesting of virus-fighting antibodies) holds promise for treating others infected by the virus. linkSome of COVID-19’s hardest hit nation victims are already emerging strong after peak infection, and biomedical innovators are tackling the virus at unprecedented speeds. We will find out more as large scale-testing comes reliably online. |
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