Just curious, anyone have a plan, or preps for global pandemic?

[Matt]

This study is not in humans but one of the ways the virus is killing people is by damaging the lungs and causing fluid build upi, and this is similar to what H1N1 did in humans. 

"Saccharomyces cerevisiae beta-glucan reduced the pulmonary lesion score and viral replication rate in SIV-infected pigs."

Antiviral effect of Saccharomyces cerevisiae beta-glucan to swine influenza virus by increased production of interferon-gamma and nitric oxide.

The aim of these experiments was to investigate the potential antiviral effect of Saccharomyces cerevisiae beta-glucan on the pneumonia induced by swine influenza virus (SIV). Forty colostrum-deprived 5-day-old piglets were randomly divided into four groups of 10. The 20 pigs in groups 1 and 2 were administered Saccharomyces cerevisiae beta-glucan orally (50 mg/day/pig; En-Bio Technology Co., Ltd) for 3 days before SIV infection and those in groups 3 and 4 were given culture medium/diluent alone. Groups 1 and 3 were inoculated intranasally with 3 ml of tissue culture fluid containing 2 x 10(6) tissue culture infective doses 50% (TCID(50))/ml of SIV and those in groups 2 and 4 were exposed in the same manner to uninfected cell culture supernatant. The microscopic lung lesions induced by SIV infection (group 1 pigs) were significantly more severe than those induced by infection in animals pre-administered beta-glucan (group 3) (P < 0.05). Significantly more SIV nucleic acid was detected in the lungs of pigs experimentally infected with SIV only (group 1) at 5, 7 and 10 days post-inoculation (dpi) compared with lungs from pigs pre-administered beta-glucan and infected with SIV (group 3) (P < 0.05). The concentrations of interferon-gamma (IFN-gamma) and nitric oxide (NO) in bronchoalveolar lavage fluid from pigs pre-administered beta-glucan and infected with SIV (group 3) were significantly higher than for any other group at 7 and 10 dpi for IFN-gamma, and at 5, 7 and 10 dpi for NO (P < 0.05). Saccharomyces cerevisiae beta-glucan reduced the pulmonary lesion score and viral replication rate in SIV-infected pigs. These findings support the potential application of beta-glucan as prophylactic/treatment agent in influenza virus infection.

Edited March 7, 2020 by Matt

[Gordo]

Yea, I think the best thing you can do is eat foods that are supportive of the immune system, wash hands obsessively, avoid crowds and make sure you are getting optimal sleep.

I'm still trying to wrap my head around what happens next... I see a lot of cognitive dissonance.  Every day the virus gets closer and closer to where I live and work, schools were closed today in the county that I work in due to an infection.  The stock market has been cratering, oil plunged nearly 10% today alone (what's that telling you about the prospects of near term recovery?), fed fund futures have already priced in THREE MORE rate cuts this year (signaling recession).  The markets are taking this seriously and yet only one person in my circle of friends and coworkers seems to be taking this seriously.  

The Gathering Storm: Could Covid-19 Overwhelm Us in the Months Ahead?

Either the science is wrong and the complacent will be proven correct, or the science is correct and the complacent will be wrong.

The present disconnect between the science of Covid-19 and the status quo's complacency is truly crazy-making, as we face a binary situation: either the science is correct and all the complacent are wrong, or the science is false and all the complacent are correct that the virus is no big deal and nothing to fret about.

Complacency is ubiquitous: readers on Facebook leave comments on my posts "this is silly." Correspondents report that people don't even cover their mouths when coughing, much less use a tissue. People keep repeating like a mantra that a bad flu season kills 35,000 in the U.S. alone, and so why worry about a couple thousand deaths globally?

Another common trope is "hepatitis kills far more people in the U.S., so why worry about the coronavirus?"

So let's look at some data and consider what science can tell us about the potential consequences of the Covid-19 virus spreading as widely as conventional flu viruses.

The fallacy made by the complacent is that the number of cases will remain small (in the dozens or hundreds) and so the number of deaths will also remain small.

Since the evidence suggests the Covid-19 virus is more contagious than conventional flu viruses, a reasonable assumption is that it will eventually infect more people than a conventional flu, which according to the CDC infects up to 45 million Americans annually.

According to the CDC, viral hepatitis B caused 5,600 deaths in the U.S. in 2017, and hepatitis C caused 19,000 deaths, for a total of 24,600. That certainly exceeds reported deaths of Covid-19, but since the statistics presented by the Chinese government are unreliable, we have no idea how many people have the virus and how many have died.

According to the CDC, influenza and pneumonia together caused 55,000 deaths in the U.S. in 2017.

Given the scientific evidence that Covid-19 is highly contagious, let's do a Pareto Distribution (80/20 rule) projection and estimate that 20% of the the U.S. population gets Covid-19. That's 66 million people, roughly 50% higher than the 45 million who catch a flu virus in a "bad flu" season.

Data suggests between 2% and 3.4% of all Covid-19 cases end in death, but the deaths are concentrated in the 20% of cases that become severe, and in the vulnerable populations within the 20% severe cases that require hospitalization.

Using the lower CFR (case-fatality rate) rate, 2% of 66 million is 1.3 million, so if Covid-19 infects only 20% of the U.S. populace, current data suggests 1.3 million people will die. This is considerably more than 24,600, or 55,000. (Total annual deaths in the U.S. are around 2.8 million.)

But these mortality data are drawn from small numbers of patients who have had access to intensive care. Anecdotal evidence from places where the healthcare system has been overwhelmed (Wuhan) so intensive care is unavailable to the majority of severely ill patients suggest much higher death rates around 15%, with worst-case scenarios going as high as 80% mortality for untreated severe cases in vulnerable populations (elderly and chronically ill).

If 20% of all cases can be expected to be severe and require hospitalization/intensive care (20% of 66 million is 13 million people), then intensive care will quickly become unavailable due to the low number of intensive care beds in the U.S. (94,000). The total number of all hospital beds in the U.S. is around 931,000. (Recall that the majority of these beds are already in use, so the number available to those severely ill with Covid-19 is a fraction of the total.)

If 15% of untreated severely ill patients die, that is 13 million X 15% = 1.95 million.

So let's cut all these numbers in half: let's assume only 10% of the U.S. populace gets the Covid-19 virus (33 million), so only 6.6 million people become severely ill. If 15% of untreated severely ill patients eventually die, that's 1 million deaths in the U.S. alone.

In other words, the death rate is only low if the number of severely ill patients remains very low. Once the number of patients needing hospitalization exceeds the number of ICU beds, the death rate leaps dramatically.

All this assumes there are not already more lethal variants in some human populations, and it also ignores the issue of re-infection: A tour guide in Japan tested positive for the coronavirus for a 2nd time, less than a month after recovering.

Authorities are well aware of the potential for the Covid-19 to spread rapidly and cause a great many deaths. But they're also concerned about the consequences of an economic crash as people avoid public places (i.e. "social distancing") as the most effective preventative measure to reduce the chances of contracting the virus.

The resulting layoffs and business closures will trigger financial and economic consequences that may not be recoverable if these trends self-reinforce (more layoffs cause consumption to decline, triggering more layoffs, etc.).

I wrote about this on February 11: China's Fatal Dilemma.

If authorities downplay the Covid-19 pandemic and encourage people to continue flying, gathering in public, etc. in order to keep the economy humming, that will accelerate the spread of the virus.

When people awaken to the dangers of the pandemic (for example, when ICU beds are all filled and severely ill patients are being turned away), they will panic and pursue "social distancing" regardless of what officials say. When complacency gives way to panic (yes, it can happen here and yes, it can happen to you), the economy will crash.

In other words, the economy will crash either way: if authorities force "social distancing" to limit the spread of the virus or if they downplay the pandemic and let the virus spread to the point that people panic and "socially distance" themselves regardless of official entreaties to get out there and buy, buy, buy.

Forcing "social distancing" won't stop the eventual spread of the virus, because as soon as restrictions are eased the virus will enter the newly open cities via asymptomatic carriers and a second wave of infections will spread. Forcing "social distancing" while thousands of airline flights and railway travel continue to spread asymptomatic carriers to every transportation node on the planet is not going to stop the spread of the virus.

The science suggests a significant percentage of the human populace will eventually get the Covid-19 virus. Estimates run from 40% to 70%; You're Likely to Get the Coronavirus (The Atlantic).

Common sense suggests complacency is misplaced, and efforts should be made to minimize the risk of getting the virus until a reliable vaccine is available, which those with experience in the field suggest might be a year or 18 months away.

The science is telling us that the global economy will experience a depression as these realities sink in. Authorities pushing complacency as a short-term financial panacea are doing an enormous disservice to the people who entrusted them with power. The more effective strategy would be to prepare to deal with a global depression while limiting the spread of the virus by whatever means are available, which at present boils down to social distancing and increased hygiene.

Here is an example of status quo complacency in the U.S.: the person returns from Japan with symptoms of Covid-19, tests negative for conventional flu and other viruses, CDC refuses to test for Covid-19, no special protocols despite the obvious risk of Covid-19, staff tells the patient to go home by whatever transport he/she normally uses. My COVID-19 Story. Brooklyn. (via Maoxian)

So either the science is wrong and the complacent will be proven correct, or the science is correct and the complacent will be wrong.

My COVID-19 Pandemic Posts

 

[Sibiriak]

Italy:

L’età media dei decessi, ecco lo Studio dell’Istituto Superiore di Sanità su Covid-19  6 Marzo 2020

(Google translation:  The average age of deaths, here is the Study of the Istituto Superiore di Sanità on Covid-19)

Quote

Nello studio riportata l’età media dei pazienti deceduti al 4 marzo 2020 per Covid-19 e le diverse patologie da cui erano affetti.  L’età media dei pazienti deceduti e positivi a Covid-2019 è 81 anni, sono in maggioranza uomini. Essi, in più dei due terzi dei casi, hanno tre o più patologie preesistenti. Ad affermarlo un’analisi condotta dall’Istituto Superiore di Sanità su 105 pazienti italiani deceduti al 4 marzo.

Lo studio sottolinea come vi siano ben 20 anni di differenza tra l’età media dei deceduti e quella dei positivi al virus.

Il report, stando a quanto riportato sul sito del Ministero della Salute, riguarda i pazienti deceduti. Esso è basato sui dati ottenuti tramite la compilazione di un questionario. Quest’ultimo è stato sviluppato ad hoc ai fini della rilevazione dei casi di morte.

L’età media dei pazienti presi in esame è 81 anni, circa 20 anni superiore a quella dei pazienti che hanno contratto l’infezione. Le donne sono 28 (26.7%).

I Dati

La maggior parte dei decessi 42.2% si riscontra, secondo i dati dell’ISS, nella fascia di età tra 80 e 89 anni. Il 32.4% erano tra 70 e 79, mentre l’8.4% tra 60 e 69, 2.8% tra 50 e 59 e 14.1% sopra i 90 anni.  Le donne decedute per aver contratto l’infezione da Covid-19 hanno un età più alta degli uomini.

Gli esperti dell’Istuto Superiore di Sanità hanno scoperto, inoltre, il numero medio di patologie osservate nella popolazione in considerazione è di 3,4.  Complessivamente, l’15.5% del campione presentavano 0 o 1 patologie, il 18.3% presentavano 2 patologie e 67.2% presentavano 3 o più patologie. [...]

Google:

Quote

In the study, the average age of patients who died [on] 4 March 2020 for Covid-19 and the various pathologies from which they were affected were reported.

The average age of deceased and positive patients in Covid-2019 is 81 years, mostly men. They, in more than two thirds of cases, have three or more pre-existing pathologies.

This was confirmed by an analysis conducted by the Istituto Superiore di Sanità on 105 Italian patients who died on 4 March. 
The study highlights that there are as many as 20 years of difference between the average age of the deceased and that of the virus positive.

The report, according to what reported on the website of the Ministry of Health, concerns deceased patients. It is based on the data obtained by filling in a questionnaire. The latter was developed ad hoc for the purpose of detecting death cases.

The average age of the patients examined is 81 years, about 20 years higher than that of the patients who contracted the infection. There are 28 women (26.7%).
 

The data

According to ISS data, most of the 42.2% deaths are in the age group between 80 and 89 years. 32.4% were between 70 and 79, while 8.4% between 60 and 69, 2.8% between 50 and 59 and 14.1% over 90 years.  Women who died of Covid-19 infection are older than men.

Furthermore, the experts of the Istituto Superiore di Sanità discovered the average number of pathologies observed in the population under consideration is 3.4.

Overall, 15.5% of the sample had 0 or 1 pathologies, 18.3% had 2 pathologies and 67.2% had 3 or more pathologies.  [...]

 

Edited March 7, 2020 by Sibiriak

[mccoy]

Mmmm, there was a 3% individuals in the sample who belonged to the 50-59 age interval, but as noted, they probably had one or more patologies ongoing.

Also, 'mostly men' confirms the Chinese observation and denies the hypothesis that the gender difference might be due to smoke, prevalent in male Chinese.

Latest news in Italy:

• Schools are probably going to be closed one more month
• Private hospitals, hotels, any real estate, can be requisitioned by the government if necessary
• Courtrooms will treat only the most serious offenses, will suspend other cases. In Italy, where an administrative procedure lasts 10 years on average, that's not good news.
• Soccer matches will take place with closed doors (extreme measure in Italy!). Other public events are canceled.
• The whole region of Lumbardy may be locked down.
• Many government offices may be closed down.

It really seems like a war situation! The social disruption is already there, in the sense that social activities have been minimized. Social animals will definitely suffer.

 

Edited March 7, 2020 by mccoy

[Matt]

I recommend checking out this channel below. The person giving out the information is Roger D. Seheult, MD. He works in Pulmonology.

 

[Sibiriak]

FWIW,  an optimistic view:

Coronavirus: nine reasons to be reassured

[Sibiriak]

Thanks Matt!

[Gordo]

US hospitals are preparing for 96 MILLION coronavirus infections and nearly HALF A MILLION deaths, leaked documents reveal

[TomBAvoider]

Isn't the mortality rate vs infection rate still below SARS and MERS? This panic is very strange. I wonder why the reaction is so much stronger. Maybe the infectiousness of COVID-19 is much greater than SARS accounting for the reaction, even if the mortality is not very high. I wonder if the virus is mutating, that might be a whole other can of worms. 

[Sibiriak]

It’s a ‘false hope’ coronavirus will disappear in the summer like the flu, WHO says

Quote

World leaders should not assume COVID-19 will be seasonal and subside in the summer, like the flu, the World Health Organization said Friday.  “We have to assume that the virus will continue to have the capacity to spread,” Dr. Mike Ryan, executive director of WHO’s health emergencies program, said at the agency’s headquarters in Geneva. “It’s a false hope to say, yes, that it will disappear like the flu.”  “We hope it does. That would be a godsend,” he added. “But we can’t make that assumption. And there is no evidence.

Coronavirus ‘highly sensitive’ to high temperatures, but don’t bank on summer killing it off, studies say

Quote

Pathogen appears to spread fastest at 8.72 degrees Celsius...

Edited March 8, 2020 by Sibiriak

[Sibiriak]

Stop the Patriarchal Pandemic!

 

Activists of the women’s movement FEMEN lead an action on the ‘Place de la Concorde’ and show slogans reading ‘Stop the Patriarchal Pandemic’ during the International Women’s Day in Paris.

[Gordo]

On 3/7/2020 at 4:48 AM, Matt said:

I recommend checking out this channel below

I like the channel!  He also has one on the role of vitamin D (TLDW: make sure you are getting your vit D)

 

[Sibiriak]

Danger of healthcare system overload:

Liz Specht, PhD Associate Director of Science & Technology, The Good Food Institute

Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.

https://twitter.com/LizSpecht/status/1236095180459003909

(see criticisms of this analysis in the twitter thread.  Eg. Sebastián Miralles  Replying to @LizSpecht

Those exponential numbers simply cannot materialize. Viruses are like brush fire. They run out of susceptible hosts and transmission ceases. China to be virus free by month end.   //  China has the disease very well contained at this time. And disease spread slowing after running out of hosts is basic science. But we live in a world were society prefers to believe self-proclaimed Twitter experts.  // Outbreaks tend to be self-limiting. If you assume that diseases spread exponentially unabated, you may know math, but you don't know epidemiology.   //  The disease is behaving remarkably like the flu. If that is a guide you can expect a max of 10% of the population getting it with about a 0.5% mortality rate for that group. If it is seasonal (unknown) we are at the tail end so divide that by 2 o 4. Bad but do not panic.)

Quote

I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math.

Let’s conservatively assume that there are 2,000 current cases in the US today, March 6th. This is about 8x the number of confirmed (lab-diagnosed) cases. We know there is substantial under-Dx due to lack of test kits; I’ll address implications later of under-/over-estimate.

We can expect that we’ll continue to see a doubling of cases every 6 days (this is a typical doubling time across several epidemiological studies). Here I mean *actual* cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts. We’re looking at about 1M US cases by the end of April, 2M by ~May 5, 4M by ~May 11, and so on. Exponentials are hard to grasp, but this is how they go.

As the healthcare system begins to saturate under this case load, it will become increasingly hard to detect, track, and contain new transmission chains. In absence of extreme interventions, this likely won’t slow significantly until hitting >>1% of susceptible population.

What does a case load of this size mean for healthcare system? We’ll examine just two factors — hospital beds and masks — among many, many other things that will be impacted. The US has about 2.8 hospital beds per 1000 people. With a population of 330M, this is ~1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc).

Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for *weeks* — in other words, turnover will be *very* slow as beds fill with COVID19 patients).

By this estimate, by about May 8th, all open hospital beds in the US will be filled. (This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus.) If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by ~May 2nd. If only 5% of cases require it, we can make it until ~May 14th. 2.5% gets us to May 20th. This, of course, assumes that there is no uptick in demand for beds from *other* (non-COVID19) causes, which seems like a dubious assumption.

 As healthcare system becomes increasingly burdened, Rx shortages, etc, people w/ chronic conditions that are normally well-managed may find themselves slipping into severe states of medical distress requiring intensive care & hospitalization. But let’s ignore that for now.

Alright, so that’s beds. Now masks. Feds say we have a national stockpile of 12M N95 masks and 30M surgical masks (which are not ideal, but better than nothing). There are about 18M healthcare workers in the US. Let’s assume only 6M HCW are working on any given day. (This is likely an underestimate as most people work most days of the week, but again, I’m playing conservative at every turn.) As COVID19 cases saturate virtually every state and county, which seems likely to happen any day now, it will soon be irresponsible for all HCWs to not wear a mask. These HCWs would burn through N95 stockpile in 2 days if each HCW only got ONE mask per day. One per day would be neither sanitary nor pragmatic, though this is indeed what we saw in Wuhan, with HCWs collapsing on their shift from dehydration because they were trying to avoid changing their PPE suits as they cannot be reused. How quickly could we ramp up production of new masks? Not very fast at all. The vast majority are manufactured overseas, almost all in China. Even when manufactured here in US, the raw materials are predominantly from overseas... again, predominantly from China. Keep in mind that all countries globally will be going through the exact same crises and shortages simultaneously. We can’t force trade in our favor.

Now consider how these 2 factors – bed and mask shortages – compound each other’s severity. Full hospitals + few masks + HCWs running around between beds without proper PPE = very bad mix. HCWs are already getting infected even w/ access to full PPE. In the face of PPE limitations this severe, it’s only a matter of time. HCWs will start dropping from the workforce for weeks at a time, leading to a shortage of HCWs that then further compounds both issues above.

We could go on and on about thousands of factors – # of ventilators, or even simple things like saline drip bags. You see where this is going.

Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.

Undeserved panic does no one any good. But neither does ill-informed complacency. It’s wrong to assuage the public by saying “only 2% will die.” People aren’t adequately grasping the national and global systemic burden wrought by this swift-moving of a disease.

I’m an engineer. This is what my mind does all day: I run back-of-the-envelope calculations to try to estimate order-of-magnitude impacts. I’ve been on high alarm about this disease since ~Jan 19 after reading clinical indicators in the first papers emerging from Wuhan. Nothing in the last 6 weeks has dampened my alarm in the slightest.

To the contrary, we’re seeing abject refusal of many countries to adequately respond or prepare. Of course some of these estimates will be wrong, even substantially wrong. But I have no reason to think they’ll be orders-of-magnitude wrong.

Even if your personal risk of death is very, very low, don’t mock decisions like canceling events or closing workplaces as undue “panic”. These measures are the bare minimum we should be doing to try to shift the peak – to slow the rise in cases so that healthcare systems are less overwhelmed. Each day that we can delay an extra case is a big win for the HC system.

And yes, you really should prepare to buckle down for a bit. All services and supply chains will be impacted. Why risk the stress of being ill-prepared? Worst case, I’m massively wrong and you now have a huge bag of rice and black beans to burn through over the next few months and enough Robitussin to trip out.

One more thought: you’ve probably seen multiple respected epidemiologists have estimated that 20-70% of world will be infected within the next year. If you use 6-day doubling rate I mentioned above, we land at ~2-6 billion infected by sometime in July of this year.

Obviously I think the doubling time will start to slow once a sizeable fraction of the population has been infected, simply because of herd immunity and a smaller susceptible population. But take the scenarios above (full beds, no PPE, etc, at just 1% of the US population infected) and stretch them out over just a couple extra months.

That timeline roughly fits with consensus end-game numbers from these highly esteemed epidemiologists. Again, we’re talking about discrepancies of mere days or weeks one direction or another, but not disagreements in the overall magnitude of the challenge.

This is not some hypothetical, fear-mongering, worst-case scenario. This is reality, as far as anyone can tell with the current available data.

That’s all for now. Standard disclaimers apply: I’m a PhD biologist but *not* an epidemiologist. Thoughts my own. Yadda yadda. Stay safe out there.

 

Edited March 8, 2020 by Sibiriak

[Clinton]

 

16 hours ago, TomBAvoider said:

Isn't the mortality rate vs infection rate still below SARS and MERS? This panic is very strange.

This has been my perspective.

Costco in Edmonton and Calgary Alberta reportedly had sold out of toilet paper, eggs and tissues, white rice and canned tomatoes were all nearly gone.  People are really panicking and there is not a single confirmed case yet (afaik) in Alberta.  Are these guys smart and 'ahead of the curve' stockpiling NOW before the sh- really hits the fan??

Perhaps right now is the opportune time at the very least I don’t want to run out of toilet paper.

Edit: I'm not too worried 'yet' since the area I'm in has zero cases, however I also don't want to be in the position that by the time the cases start, the shelves are empty.

 

 

Edited March 8, 2020 by Clinton

[TomBAvoider]

This Liz Specht thing strikes me as a load of rubbish. First, I don't believe that rates of infection are anything like she projects - that's true of almost all bacterial and viral infections, even such devastating ones as AIDS - there are some people who just don't get infected, or whose ability to resis the virus is much stronger (there's an SNP variant, which I apparently have, that makes you less likely to get infected with AIDS upon exposure to the HIV virus). We have no idea what percentage of the population would get infected upon exposure. Second, tons and tons of people who would be infected would exhibit zero symptoms - their bodies are just not susceptible to developing such symptoms. I have not had a cold for like, years - but it's entirely possible that I DID have a cold, just that I exhibited no symptoms. Third, even if you do exhibit symptoms, there's got to be a spectrum - it's not like everyone lands in the hospital any more than everyone lands in the hospital the second they catch a cold. So this panic about hospital beds seems premature.

It's just like with the Y2K bug that was supposed to bring civilization to its knees. It struck me then as a load of rubbish panic, and what happened - nothing. Of course, those who think it was a legit fear immediately turn around and say that it was all those hours engineers spent reprogramming that narrowly by the skin of our teeth averted a holocaust. I'm sure the same thing will obtain here - there will be no world-wide collapse of healthcare systems, but the panic mongers will claim that it was this measure or that measure that averted the end of civilization and we came "this" close, blah, blah. Well that's like one of those "tiger repelling" rocks - you have one those rocks, and look, you still have not been eaten by a tiger, ergo, it's thanks to the tiger-repelling rock that you're safe from tigers. 

[Sibiriak]

2 hours ago, TomBAvoider said:

...this panic about hospital beds seems premature.

Panic is bad, practically by definition.    But reasonable concern seems to be in order.  Hope for the best, prepare for the worst.  Learn from what's happening elsewhere:

Italy

Quote

In his overnight news conference, [Italian Prime Minister] Conte said the health-care system risked becoming “overwhelmed” and that Italians should not leave the house unless absolutely necessary in order to be mindful of the health of their “grandparents,” given that older people are at greater risk of infection.

The issue isn’t just the number of people who’ve tested positive or even the death rate, it’s the number of beds available in intensive-care units. The head of Lombardy’s intensive-care crisis unit, Antonio Pesenti, told Corriere Della Sera, Italy’s leading daily newspaper, that his region’s health-care system, the best in the country, was “on the brink of collapse” and that they had had to set up intensive care in hallways.

https://www.theatlantic.com/international/archive/2020/03/italy-coronavirus-covid19-west-europe-future/607660/

 

Quote

LODI, Italy —One infectious-disease doctor said coronavirus had hit "like a tsunami" at his hospital, where more than 100 out of 120 people admitted with the virus have also developed pneumonia. 

Another hospital nearby is facing staff shortages as doctors have become patients.

Doctors, virologists and health-care officials on the front line of Italy’s battle against coronavirus, in more than a dozen interviews, described a health-care system stretched to its limits — a situation other countries may face as the virus spreads.

In an effort to cope, Italy is graduating nurses early and calling medical workers out of retirement. Hospitals in the hardest-hit regions are delaying nonessential surgeries and scrambling to add 50 percent more intensive-care beds. 

“This is the worst scenario I’ve seen,” said Angelo Pan, the head of the infectious-disease unit at the hospital in Cremona, noting the prevalence of pneumonia complications. He said 35 patients in his hospital required intubation or mechanical ventilation to breathe.

[…]Once covid-19 took hold, hospitals in the region were quickly overwhelmed with cases. And, by that time, dozens of doctors and other health-care workers had become infected.

“The lesson is that you have to intervene very, very fast and in a very tough manner,” Rezza said. “Otherwise, you’ll have a high burden of disease that will jeopardize the health system. We cannot compromise.”

https://www.msn.com/en-us/news/world/coronavirus-in-italy-fills-hospital-beds-and-turns-doctors-into-patients/ar-BB10HIRn

 

Thousands wait for hospital beds in South Korea as coronavirus cases surge

Quote

Hospitals in South Korea’s hardest hit areas were scrambling to accommodate the surge in new patients.

In Daegu, 2,300 people were waiting to be admitted to hospitals and temporary medical facilities, Vice Health Minister Kim Gang-lip said. A 100-bed military hospital that had been handling many of the most serious cases was due to have 200 additional beds available by Thursday, he added.

South Korean President Moon Jae-in on Tuesday declared “war” on the virus, apologized for shortages of face masks and promised support for virus-hit small businesses in Asia’s fourth-biggest economy.

https://www.japantimes.co.jp/news/2020/03/04/asia-pacific/thousands-wait-hospital-beds-south-korea-coronavirus-cases-surge/

 

Growing Coronavirus Epidemic Is Straining Europe’s Health-Care System

 

Quote

Doctors say the continent is ill prepared to face a worsening coronavirus outbreak, with shortages of equipment including protective gear and hospital beds

BERLIN—Doctors in European countries where the coronavirus has just begun to spread are warning that their health-care systems aren’t prepared for an outbreak on the scale seen in China, South Korea or Italy.

https://www.wsj.com/articles/growing-coronavirus-epidemic-is-straining-europes-health-care-system-11583670904

 

I’m an ICU doctor. The NHS isn’t ready for the coronavirus crisis

 

Quote

ICU is a precious and scarce resource in terms of beds, staff and equipment. This is especially so in the UK. In 2012 the UK had about 4,100 critical care beds including ICU beds and “high dependency” beds which are a step down from full ICU care. Compared with other European countries the UK ranked 23rd of 31 in terms of ICU beds per head of population and 29th of 31 for all hospital beds.

[…]Most UK ICUs therefore run at or above 90% occupancy and often can only admit new patients only by discharging others – even when workload is normal. Covid-19 will increase pressures not only because of weight of numbers but because intermediate treatments for pneumonia and lung failure are “aerosol-generating” (ie they risk spreading the disease) so cannot be used and early recourse to ICU is required.

Increased ICU demands equate to each ICU bed being needed for approximately 100 more patients than on average in the epidemic period – at least 10 times the normal throughput and equivalent to needing at least another 10 ICUs in the hospital during the epidemic. Of course, this demand will be in addition to, rather than instead of, normal workload as the illnesses that usually require ICU admission will not go away during the epidemic. In Wuhan, ICU capacity was increased by over 1,000 beds in two weeks by building a new hospital, but this is not possible in the UK.

Managing an ICU patient with Covid-19 is more complex than normal ICU care. Patients must be individually isolated. All staff must wear “personal protective equipment” (PPE), which consists of, as a minimum, a tight-fitting face mask, an extra gown, gloves, goggles and visor. PPE must be put on and taken off before and after patient contact and checked by a “buddy” colleague. Despite this scrupulous process in China two in every five early infections were acquired in hospital and two-thirds of these were healthcare workers, a significant number of whom then died. These demands slow down care, increase the number of staff needed and expose staff (and perhaps their families) to significant risk.

Patients in ICU have constant one-to-one nursing. Medical interventions are frequent, invasive and performed at extremely close proximity. Contact with body fluids is inevitable and common. But it is not only nurses and doctors who are at risk. Hospital cleaners will be required to be on hand at all times and rigorous cleaning is required between patients and after many procedures. Physiotherapists, dietitians, laboratory technicians and other medical specialists involved in care are also at risk. Keeping staff safe has implications beyond their welfare: skilled staff are a limited resource and if sickness rates are even moderate there will be major gaps in service.

The challenge from Covid-19 to ICU services in the UK is enormous and pressing. Throughout the UK, ICUs are preparing exceptional plans and training all staff to manage these patients with skill and safety, for the patient and themselves. Hospitals are acting to expand ICU care outside its existing footprint and double or even treble ICU capacity, most likely by taking over operating theatres. This expansion will involve engaging anaesthetists and others to provide ICU medical care and nurses from elsewhere in the hospital to work as ICU staff. To facilitate this, much or all routine surgery will need to stop. Many patients with Covid-19 will also be hospitalised outside ICU and care of these patients and those in ICU will have major consequences for caring for other patients who do not have Covid-19.

Whether these extreme precautions will be needed is unknown. If they are, whether even these measures will be sufficient is also unknown. We will find out over the next few weeks and months. In the meantime, preparations need to be accelerated and coordinated and we need to be honest and transparent about the potential impact of a Wuhan-type epidemic here in the UK, which no doubt will pose a major challenge to everyone working in the NHS.

https://www.theguardian.com/commentisfree/2020/mar/03/icu-doctor-nhs-coronavirus-pandemic-hospitals

Edited March 8, 2020 by Sibiriak

[mccoy]

Italy is now second worldwide for total cases and deaths. The death ratio is still 5%, news are not talking about this anomalously high rate. Germany has a thousand confirmed cases, officially zero deaths. Outside the emergency areas, life is almost as ever, some people are in near terror, others could not mind  less.

More news:

• Panic: the news that a locked-down area would have been implemented in the top industrial region (Lombardy) leaked out. During the night prior to the implementation, hundreds or maybe thousands of people hurried to the bus and train stations to run away from the area. 
• Riots have erupted in many prisons after the announcement that relatives were no more allowed to visit the inmates. some of the riots are still on.
• All crowdings, including church rituals, funerals and marriages, are forbidden.

[Gordo]

4 hours ago, Clinton said:

Perhaps right now is the opportune time at the very least I don’t want to run out of toilet paper.

For what its worth, I HIGHLY recommend a bidet!  You won't have to worry about running out of toilet paper, it gets you squeaky clean without having to shove your hand up your butt.  After buying one, my family liked it so much I put one of those on every toilet in the house.  Now when we travel my kids say "I really miss the bidet", haha.  Best bathroom purchase I ever made, the reviews on amazon speak for themselves.

 

 

[TomBAvoider]

OMG Gordo, I agree 100%! Absolutely bidets! Now, the following might be TMI, so read at your own discretion.

I personally regard the use of toilet paper as unhygienic - and I have not used TP for close to 20 years. Instead, when at home, I just wash with soap and running water - and feel much, much cleaner, and confident that it's much more comprehensive than the use of TP. When outside, one thing I always have with me are individually wrapped wipes you can buy in any drug store, so on the occasions when I need to have a BM, I just use the wipes. TP is kind of an abomination as I see it, but of course YMMV and I absolutely do not judge or criticize anyone who has different practices or opinions - that said, I do think it's instructive for those who travel to Japan and are familiar with the comparison of their bathrooms to what passes for bathroom hygiene solutions in most of the rest of the world; it is my suspicion that with time the rest of the world will catch up and we'll regard contemporary practices that rely on TP as something out of the middle ages. Again, IMHO, and YMMV.

[Clinton]

Thanks for the input guys- I will discuss with upper management (my wife) changing out 1 toilet with a bidet.

[Gordo]

Potential drug to block coronavirus identified

[Sibiriak]

Testimony of a surgeon working in Bergamo, in the heart of Italy's coronavirus outbreak

https://www.reddit.com/r/medicine/comments/ff8hns/testimony_of_a_surgeon_working_in_bergamo_in_the/

 

https://bergamo.corriere.it/notizie/cronaca/20_marzo_07/coronavirus-bergamo-medico-humanitas-facebook-situazione-drammatica-altro-che-normale-influenza-4fdf6866-6088-11ea-8d61-438e0a276fc4.shtml?refresh_ce-cp

«In one of the non-stop e-mails that I receive from my hospital administration on a more than daily basis, there was a paragraph on "how to be responsible on social media", with some recommendations that we all can agree on. After thinking for a long time if and what to write about what's happening here, I felt that silence was not responsible. I will therefore try to convey to lay-people, those who are more distant from our reality, what we are experiencing in Bergamo during these Covid-19 pandemic days.

I understand the need not to panic, but when the message of the danger of what is happening is not out, and I still see people ignoring the recommendations and people who gather together complaining that they cannot go to the gym or play soccer tournaments, I shiver. I also understand the economic damage and I am also worried about that. After this epidemic, it will be hard to start over.

Still, beside the fact that we are also devastating our national health system from an economic point of view, I want to point out that the public health damage that is going to invest the country is more important and I find it nothing short of "chilling" that new quarantine areas requested by the Region has not yet been established for the municipalities of Alzano Lombardo and Nembro (I would like to clarify that this is purely personal opinion).

I myself looked with some amazement at the reorganization of the entire hospital in the previous week, when our current enemy was still in the shadows: the wards slowly "emptied", elective activities interrupted, intensive care unit freed to create as many beds as possible. Containers arriving in front of the emergency room to create diversified routes and avoid infections. All this rapid transformation brought in the hallways of the hospital an atmosphere of surreal silence and emptiness that we did not understand, waiting for a war that had yet to begin and that many (including me) were not so sure would never come with such ferocity (I open a parenthesis: all this was done in the shadows, and without publicity, while several newspapers had the courage to say that private health care was not doing anything).

I still remember my night shift a week ago spent without any rest, waiting for a call from the microbiology department. I was waiting for the results of a swab taken from the first suspect case in our hospital, thinking about what consequences it would have for us and the hospital. If I think about it, my agitation for one possible case seems almost ridiculous and unjustified, now that I have seen what is happening. Well, the situation is now nothing short of dramatic. No other words come to mind. The war has literally exploded and battles are uninterrupted day and night.

One after the other, these unfortunate people come to the emergency room. They have far from the complications of a flu. Let's stop saying it's a bad flu. In my two years working in Bergamo, I have learned that the people here do not come to the emergency room for no reason. They did well this time too. They followed all the recommendations given: a week or ten days at home with a fever without going out to prevent contagion, but now they can't take it anymore. They don't breathe enough, they need oxygen. Drug therapies for this virus are few.

The course mainly depends on our organism. We can only support it when it can't take it anymore. It is mainly hoped that our body will eradicate the virus on its own, let's face it. Antiviral therapies are experimental on this virus and we learn its behavior day after day. Staying at home until the symptoms worsen does not change the prognosis of the disease.

Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sicks, of different colors depending on the department they belong to, are now all red and instead of the surgical procedure, there is the diagnosis, which is always the same: bilateral interstitial pneumonia. Now, tell me which flu virus causes such a rapid tragedy.

Because that's the difference (now I get a little technical): in classical flu, besides that it infects much less population over several months, cases are complicated less frequently: only when the virus has destroyed the protective barriers of our airways and as such it allows bacteria (which normally resident in the upper airways) to invade the bronchi and lungs, causing a more serious disease. Covid 19 causes a banal flu in many young people, but in many elderly people (and not only) a real SARS because it invades the alveoli of the lungs directly, and it infects them making them unable to perform their function. The resulting respiratory failure is often serious and after a few days of hospitalization, the simple oxygen that can be administered in a ward may not be enough.

Sorry, but to me, as a doctor, it's not reassuring that the most serious are mainly elderly people with other pathologies. The elderly population is the most represented in our country and it is difficult to find someone who, above 65 years of age, does not take at least a pill for high blood pressure or diabetes.

I can also assure you that when you see young people who end up intubated in the ICU, pronated or worse, in ECMO (a machine for the worst cases, which extracts the blood, re-oxygenates it and returns it to the body, waiting for the lungs to hopefully heal), all this confidence for your young age goes away. And while there are still people on social media who boast of not being afraid by ignoring the recommendations, protesting that their normal lifestyle habits have "temporarily" halted, the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.

The cases multiply, up to a rate of 15-20 hospitalizations a day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the emergency room is collapsing. Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the to use to emergency room EHR and a few minutes later I'm already downstairs, next to the warriors on the war front. The screen of the PC with the chief complaint is always the same: fever and respiratory difficulty, fever and cough, respiratory insufficiency etc ... Exams, radiology always with the same sentence: bilateral interstitial pneumonia. All needs to be hospitalized. Some already needs to be intubated, and goes to the ICU.

For others, however, it is late. ICU is full, and when ICUs are full, more are created. Each ventilator is like gold: those in the operating rooms that have now suspended their non-urgent activity are used and the OR become a an ICU that did not exist before. I found it amazing, or at least I can speak for Humanitas Gavazzeni (where I work), how it was possible to put in place in such a short time a deployment and a reorganization of resources so finely designed to prepare for a disaster of this magnitude. And every reorganization of beds, wards, staff, work shifts and tasks is constantly reviewed day after day to try to give everything and even more. Those wards that previously looked like ghosts are now saturated, ready to try to give their best for the sick, but exhausted.

The staff is exhausted. I saw fatigue on faces that didn't know what it was despite the already grueling workloads they had. I have seen people still stop beyond the times they used to stop already, for overtime that was now habitual. I saw solidarity from all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?" or "leave that admission to me, i will take care of it." Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we are unable to save everyone and the vital signs of several patients at the same time reveal an already marked destiny. There are no more shifts, schedules.

Social life is suspended for us. I have been separated for a few months, and I assure you that I have always done my best to constantly see my son even on the day after a night shift, without sleeping and postponing sleep until when I am without him, but for almost 2 weeks I have voluntarily not seen neither my son nor my family members for fear of infecting them and in turn infecting an elderly grandmother or relatives with other health problems. I'm happy with some photos of my son that I look at between tears and a few video calls. So you should be patient too, you can't go to the theater, museums or gym.

Try to have mercy on that myriad of older people you could exterminate. It is not your fault, I know, but of those who put it in your head that you are exaggerating and even this testimony may seem just an exaggeration for those who are far from the epidemic, but please, listen to us, try to leave the house only to indispensable things.

Do not go en masse to make stocks in supermarkets: it is the worst thing because you concentrate and the risk of contacts with infected people who do not know they are infected. You can go there without a rush. Maybe if you have a normal mask (even those that are used to do certain manual work), put it on. Don't look for ffp2 or ffp3. Those should serve us and we are beginning to struggle to find them. By now we have had to optimize their use only in certain circumstances, as the WHO recently recommended in view of their almost ubiquitous running low.

Oh yes, thanks to the shortage of certain protection devices, many colleagues and I are certainly exposed despite all the other means of protection we have. Some of us have already become infected despite the protocols. Some infected colleagues also have infected relatives and some of their family members are already struggling between life and death. We are where your fears could make you stay away. Try to make sure you stay away.

Tell your family members who are elderly or with other illnesses to stay indoors. Bring him the groceries please. We have no alternative. It's our job. Indeed what I do these days is not really the job I'm used to, but I do it anyway and I will like it as long as it responds to the same principles: try to make some sick people feel better and heal, or even just alleviate the suffering and the pain to those who unfortunately cannot heal.

I don't spend a lot of words about the people who define us heroes these days and who until yesterday were ready to insult and report us. Both will return to insult and report as soon as everything is over. People forget everything quickly. And we're not even heroes these days. It's our job. We risked something bad every day before: when we put our hands in a belly full of someone's blood we don't even know if they have HIV or hepatitis C; when we do it even though we know they have HIV or hepatitis C; when we stick ourselves during an operation on a patient with HIV and take the drugs that make us vomit all day long for a month. When we read with anguish the results of the blood tests after an accidental needlestick, hoping not to be infected. We simply earn our living with something that gives us emotions. It doesn't matter if they are beautiful or ugly, we just take them home. In the end we only try to make ourselves useful for everyone. Now try to do it too, though: with our actions we influence the life and death of a few dozen people. You with yours, many more.

Please share and share the message. We need to spread the word to prevent what is happening here from happening all over Italy.»

[mccoy]

RE toilet paper: In Italy, I remember having a bidet since when I was 6: 53 years ago. I didn't know it's not so common in the USA. And the best way to clean oneself is probably:

1. Use TP first
2. Use the bidet afterward, with lots of liquid soap.
3. Clean your hands accurately with abundant soap and water at the end of the procedure.

Edited March 9, 2020 by mccoy

[mccoy]

Italy has reached 1st place, world champion of # total cases per million people

[Gordo]

3 hours ago, mccoy said:

RE toilet paper: In Italy, I remember having a bidet since when I was 6: 53 years ago. I didn't know it's not so common in the USA. And the best way to clean oneself is probably:

1. Use TP first
2. Use the bidet afterward, with lots of liquid soap.
3. Clean your hands accurately with abundant soap and water at the end of the procedure.

The modern (or U.S.) version is much different from what you know.  Its more like a thing you just install on any regular toilet, hook it up to your water supply line (installation only takes 15 to 20 minutes), then you turn a dial after your BM, and just blast yourself clean.  It's highly effective, water pressure is variable as you turn the dial.  You might think that would shoot stuff all over the place but it doesn't.  Its way more hygienic than using TP.

 

Siberiak, I saw the same message and came here to post it.  Now is definitely not the time for complacency.  As recently as this weekend, when I refused to shake hands with some guy I had just met (elbow bump only for me), I got the "its just the flu bro" speech.  Rolling eyes.  

Admittedly, I've been wavering back and forth on how bad I thought this would get, when I saw the leveling off of cases in China I thought there was actually a good chance this thing WOULD kill fewer people than the flu (its still possible, but doesn't seem likely).  Looking at the current trajectory and more recent videos from China and Italy, makes one at least glimpse how bad things could get.  We probably don't need a "war on panic", we need some panic to keep people alert and to help slow this thing down as much as possible.  We need people working from home more, and canceling face to face meetings (use skype or any other technology), we need obsessive hand washing, and covering mouths.  Most of us on this forum will be just fine, the elderly or people with health problems, not so much.  We can all give it to others, and in some way end up being partly responsible if not taking as many precautions as we can.  The economic impact is being priced into markets now after a very delayed reaction.  Many experts are still expecting something like 30 to 40% of the world to eventually get this thing, possibly >100 million infections in the U.S.  by year end.   No one really knows if warm weather will help, its in the mid 60's today where I live.  Hoping for the best.

Good luck all.