Covid 19 SANITY

I finally dedoosed it, right before your post! (Actually I knew Immeeediately being a House fan too) Hmm... Maybe I ought to cover some good old Slade stuff now!

I always appreciated how House's character, was based  on Doyle's inspirartion (Dr. Bell) for the greatest literary detective AKA Sherlock Holmes. Not to be confused with Larry Holmes, who also had the habit of completing his rounds too.
Chris

i just had to look that up on Twitter to see if it was real. Wow!

I realize this could change, But the UK model predicted us to be at 100,000 hospitalized cases today (3/30)... we were less than 1/4 of that. We are tracking exactly where the Stanford and Oxford models predicted...here’s hoping it stays that way.

I know the media butchered this, but that is not correct. The Imperial study said in the unlikely event we do nothing, we'd be at x cases or whatever. We're tracking right on the original range of their model with the social distancing intervention.

This study is kind of like the government coming to someone and saying, we have to jump off of this building, what should we do? The guy says, well if you jump off of this building without a parachute you'll die, here are five different parachute sizes you can pick, and here's some outcomes depending on which one you pick based off what we know about gravity.
The media says "SCIENTIST SAYS NATION WILL FALL TO DEATH"


The government says, we'll pick this parachute. They check in again as they're coasting down, and say - hey are we going to die? and he says no, looks like we're good.
The media says, "SCIENTIST REVISES HIS PREDICTION: GRAVITY WAS A LIE"



Imperial released a new study yesterday estimating the impact of the intervention.

www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-Europe-estimates-and-NPI-impact-30-03-2020.pdf


And that Lancet article CNN is talking about was written by Verity and others...at Imperial...same people who were involved in the original study. It was actually the basis for the severity estimate in the original study.

svart that number isn't a revision. That same severity was what was cited by the original study by Imperial, it just was pre-print before, and published by the Lancet today.

The biggest problem is CNN and other reporters are either agenda-driven or not able to understand what they're reporting on. Or both. And that's not really on them, when I have been interviewed for articles for gas turbines or whatever we go through 3-4 rounds of editing to make sure reporters don't mess up details. It isn't their job to know details and get things just right...but in these situations, those details are HUGELY relevant.

Here's an update from the doctor who is posting on my university forum:

"Just finished 5 long shifts in a row. A few random thoughts

1. We are seeing a lot of typical COVID patients now. Fever, cough, body aches. They describe the pain with coughing like being stabbed by 1000 knives. Most get short of breath just walking around the house or up and down stairs.
2. We are also unfortunately seeing more of the "typical" patient that needs to be admitted. The symptoms above as well as bilateral patchy infiltrates on chest xray (looks like little cotton balls all over the place), hypoxia, and overwhelming fatigue. About a third of these patients end up getting moved to the ICU, and most of those end up getting intubated. Our 8 bed ICU has 7 COVID patients on vents right now, and we've transferred 5 to our main hospital that has opened up a full COVID wing. I intubated three yesterday (during nights and weekends, the ER physician does all intubations/central lines and other resuscitative procedures in our hospital). This is in TWO WEEKS. I've never seen anything like this. I shudder to think what this will be like in a few weeks. We only have 9 vents total for our hospital.
3. I think the hardest conversation that I have over and over is that "there is really nothing we can do" for patients that have COVID. So many come in, they clearly feel terrible, and just want some relief or something that will help them get better. We screen them to see if they need admission, look for other potential causes (ie the flu), but then we have to explain that there really isn't much of anything. I've prescribed a lot of Hydrocodone-based cough medicine, with the hopes that it will at least help them get some sleep and ease the pain of coughing
4. BUT, the good news is that those we send home, we follow up on, and most are slowly but steadily recovering. So be assured that a) most will only get mild symptoms, b) even those who have more severe symptoms will likely not need to be admitted, and will recover
5. Testing: We are trying to follow CDC testing guidelines as much as possible. All admitted patients get tested. Select non-admitted patients I am able to test too. I can test through a commercial lab anyone that I want, but we have to conserve resources because the hospital has limited numbers of testing kits (the viral medium we use to obtain and store the sample). Those results also take about a week to come back (testing for patients that meet testing criteria go to the state labs with about 36 hour turnaround). I am commercially testing those who are older, have a number of comorbidities etc. If I can find any reason to test someone, I am. My thought is that if the healthcare systems feel the strain of possibly running out of tests, there will be continued sense of urgency to source new ones.
6. We are still not testing the majority of patients. Total numbers of confirmed cases will be dramatically lower than actual cases
7. Antibody testing will help considerably at some point, to determine who actually had it. That will be one of the keys to reopening society...if you are immune there really is no reason why you need to be quarantined
8. As the impact of social distancing and shelter in place restrictions begin to take hold, we will continue to see case/death estimates go down. I really hope people don't interpret that as meaning the restrictions were unnecessary. This is going to be bad, worse than anything our country has seen in the last 100 years, but would have been catastrophic without the restrictions.

I want to point out some of the individual patients. I had a guy in his mid 60s who I admitted yesterday, super fit, tell me that this is the worst thing he's ever been through. He's a retired Army infantry general with multiple combat deployments and a purple heart. He said the worst things he has been through in his life paled compared to how he felt now.

I intubated three patients yesterday (all inpatients, on the medical floor but decompensating and needing moved to the ICU). All three were similar...increasing oxygen requirements, they were getting tired from working to breathe, worsening chest xrays. While all three were with it enough to consent to intubation, all three were, simply put, tired. You could see it in their eyes. There was no argument, no discussion, no push back. Just a tear in their eye and saying "Yes, do it". Right now we haven't had a person go on the vent yet and come off. All have died or are still on vents.

Two of the three that I intubated are sisters in their late 50s. Their xrays look horrible. Their mom is also admitted and is on comfort care (she is in her low 80s...relatively healthy for an 80 year old) but she was adamant that she did not want to go on a vent that someone else might need. She will likely die in the next day or two. Two husbands and a dozen kids and grandkids are going to lose their wives, mothers, and grandmother all within 2 weeks of each other."

Here’s a likely way forward.

www.aei.org/research-products/report/national-coronavirus-response-a-road-map-to-reopening/

Unfortunately it's mostly compiled from self-reported adherence to quarantine.  Most self-reported datasets are heavily biased towards compliance but rarely supported by verification of compliance.  AKA, people claim to be doing what they're supposed to be doing but rarely comply as much as they report, in real life.