Coronavirus

[Swerd]

I hear you. There are no reported cases in my state, but we were in Costco yesterday and lots of people were buying several cases of bottled water and toilet paper. You would think this virus was a diarrhea bomb and not a respiratory illness. I suspect if Costco sold oxygen concentration machines those would sell like ice in hell too.

1. Never rule out the power of newly acquired mutations.
2. Cruise ships should be thankful that Covid-19 causes only respiratory illness and not diarrhea bombs.

 

[JerryLove]

I wonder if I should take the bait and respond to this. It's obvious to me that these comments are so vague that they can be read in a large number of different ways. Overall, they're meaningless.

Or – in the spirit of pouring cold water on posts that can inflame unwarranted fears of disease & death – should I respond?

See. I thought TLS Guy's dire warnings were quire specific and direct. But if you feel that his statements (which while far more detailed offer the same conclusions as mine) are unwarranted. GO ahead.

You cannot speak of Covid-19s mortality in older patients without comparing it to known mortalities of other infectious viral diseases such as influenza, viral pneumonia, etc. In the case of influenza, get mortality data for each season's flu, not a composite average of all seasons. They do vary significantly.

Of course that's true. One of the most accessable statistics to use here is the overall mortality.

Most flu's kill about 0.1% of those who are infected.

SARS-COV-2 kills about 2%.

Saying it's a pandemic is meaningless. How does that add anything to your claim of "millions dead"? Influenza is a known pandemic each season. It kills plenty of people each year. Yet, there is no widespread fear & loathing for the seasonal flu.

There really should be widespread fear and loathing of the flu.

"pandemic" most certainly has a well-defined meaning. Here's an at-layman article from a scholar on the topic as it relates to this disease: https://www.wired.com/story/whats-a-pandemic/

So is the common cold, so is Ebola, and so is the plague. So what?

So if the WHO, NIH, and CDC were anticipating huge outbreaks of Ebola, pre-vaccine in particular, in the US; I'd be quite worried.

All three points sound alarming, but add up to very little, or nothing. Why say them at all?

To counter the claim put forth to counter my claim put forth to counter someone else's claim. Why did you ask the question?

I feel compelled to point out that Trump has taken pains to make light of the Covid-19 pandemic. I emphatically do not agree with him on this matter, nor on any other matters. He seems to be more concerned over Wall Street & loan interest rates than he is about rates of disease transmission or mortality rates. His responses, and those of his flunkies, are primarily aimed at public relations, not fighting a public health threat.

I do however believe there is great harm in over-reacting because of the widespread fear of Covid-19. That's why I want to keep politics out of this. And that's why I want to stick with "just the facts".

I don't think I brought up politics. This seems to be the first mention.

 

[JerryLove]

Understand that it is still early in the game, and I may be proven wrong, but based on the current info, It seems like this is not the virus that will wipe out 10+% of the population!

Unless there's some drastic mutation; you can rest assured that this will not wipe out 10%. The actual mortality rate is 2% (some values are in the 3-something % range), and something less than 100% of the population will actually catch the disease.

So, assuming containment completely fails, realistic number seem more like 0.5%-1% of the population as a reasonable upper-bound (about 35-70 million worldwide).

Obviously the values will be lower if we manage more effective treatment, or if prevention methods are effective.

 

[Trell]

A good point. The less aggressive Covid-19 type S virus may be the dominant form for the present. But it is probably not the last sub-type we'll see. More mutations should be expected, as this newly emerged virus adapts to human hosts world wide. But, as always, natural selection will be at work. Any advantages offered by new mutations will be favored, but only in combination with the selective pressures created by medical & public health efforts from the human hosts of the infectious virus.

By selective pressures or evolutionary pressure I mean something specific.

In the lab, if someone is studying the function of a particular gene in bacteria, they alter that gene to see what happens to the bacteria when it can't work. What if that mutated gene makes the bacterial grow slowly or not at all? Would you be able to find it growing among many other bacteria that didn't have the mutation? You physically attach that mutated gene to another gene that creates resistance to an antibiotic such as penicillin. When you grow the bacteria on nutrient plates containing penicillin, only the ones with the penicillin resistance gene can grow. Among them will be the interesting mutations of the gene you're interested in studying. That's only one commonly used selection method. There are many others.

We can't do that with humans, but we can still talk about selective pressures. The efforts at containing contagious viral diseases by public health measures such as quarantine, or by medical interventions, can affect whether new mutations thrive or fail. That also qualifies as selective pressure.

A very nice post, but when you decry politics and then softly step around the crazy "Christians" with respect to ungodly evolution (you'll burn in hell for this, unless you believe in asbestos), I think you step too softly!

I'll show myself out the door, thank you!

 

[Trell]

@NINaudio You marked my tongue-in-cheek post as dumb, but read his post again and you'll see he is very careful in his phrasing.

 

[pewternhrata]

Anyone see SXSW is cancelled. That ones crazy.

 

[Irvrobinson]

Anyone see SXSW is cancelled. That ones crazy.

Austin declared a local emergency. The organizers had no choice, but a couple of days ago when some big companies pulled out, like Apple, Netflix, WarnerMedia, Facebook, Intel, and Twitter, I figured the event was doomed.

 

[TLS Guy]

Italian critical care physicians have sent a letter to the independent newspaper to warn UK doctors of the whirlwind they are about to face. We will also face this whirlwind.

Please read this article. The Independent by the way is a heavily left leaning newspaper. That is not really relevant as this speaks for itself.

This is exactly what I have been worried about and warning you about these past few weeks.

Please read this article and please do not be afraid to ask questions.

Of the individuals who present ill, 10% require intensive care. The overall death rate in Italy has been kept to 2% in Italy. However I can be certain that ICU resources in the UK, USA and elsewhere will become exhausted and heart wrenching decisions have to be made about individual cases. Those that need, but who can not get ICU care will go into the mortality column.

I'm sorry to have to tell you guys that this is going to take a truly horrific turn. I don't want to hear anymore about this being no worse than flu. This is nothing like flu, or anything we have experienced in our lifetimes.

Chinese physicians are reporting an upswing of more serous cases now also involving children unfortunately.

 

[Mr._Clark]

for some reason it’s sparing children from dying from it and they don’t know why m

I've been wondering why that is. My first thought was that it might have something to do with their immune systems but this seems unlikely to me. My rudimentary understanding is that the virus accesses (not sure what the proper term is) cells in the lungs via specific receptors. This made me wonder if there might be something different about the receptors in the cells in children that makes them less vulnerable to the virus.

Perhaps one of the people pos

Italian critical care physicians have sent a letter to the independent newspaper to warn UK doctors of the whirlwind they are about to face. We will also face this whirlwind.

Please read this article. The Independent by the way is a heavily left leaning newspaper. That is not really relevant as this speaks for itself.

This is exactly what I have been worried about and warning you about these past few weeks.

Please read this article and please do not be afraid to ask questions.

Of the individuals who present ill, 10% require intensive care. The overall death rate in Italy has been kept to 2% in Italy. However I can be certain that ICU resources in the UK, USA and elsewhere will become exhausted and heart wrenching decisions have to be made about individual cases. Those that need, but who can not get ICU care will go into the mortality column.

I'm sorry to have to tell you guys that this is going to take a truly horrific turn. I don't want to hear anymore about this being no worse than flu. This is nothing like flu, or anything we have experienced in our lifetimes.

Chinese physicians are reporting an upswing of more serous cases now also involving children unfortunately.

TLS Guy, thanks for posting.

Roughly speaking, in your estimation, what is our capacity here in the U.S. (basically, the number of respirators relative to the population) compared to Italy?

Personally I’m operating on the assumption that I’ll be infected sooner or later, but I’m hoping to avoid being part of the first wave in case I’m one of the people who has more severe problems.

 

[mtrycrafts]

... I don't want to hear anymore about this being no worse than flu. ....

Dead id dead.

 

[mtrycrafts]

...

Of the individuals who present ill, 10% require intensive care. The overall death rate in Italy has been kept to 2% in Italy. ...

That is interesting. The paper stated
the scale of the impact on hospitals in Italy where 5,883 patients have been infected with the virus and 233 people have died as of 6pm on Saturday.
Which is 3.9% There must be others out there?

 

[Swerd]

Italian critical care physicians have sent a letter to the independent newspaper to warn UK doctors of the whirlwind they are about to face. We will also face this whirlwind.

Please read this article. This is exactly what I have been worried about and warning you about these past few weeks.

Wow, that's sobering. Thanks for posting this. Because too many people won't actually read the article you linked, I've summarized it. Please let me know if I left out anything important.

• Italian doctors have warned medics across Europe to “get ready” for coronavirus in a letter revealing up to 10% of all those infected with coronavirus need intensive care with ventilators. Hospitals became overwhelmed. These patients were admitted “almost entirely” for severe lung failure caused by the virus, needed ventilators to help them breathe.
  
  As of 6 pm Saturday:
• 5,883 patients in Italy have been infected by Covid-19.
• 10% of them, ~590 patients, needed intensive care with ventilators.
• 233, 4% of those 5,883 patients, have died
  
  
• It's vital that hospitals have equipment to protect staff and that staff be trained in wearing the kit.
• Increase your total ICU capacity. Identify early hospitals that can manage the initial surge in a safe way. Get ready to prepare ICU areas where to cohort Covid-19 patients – in every hospital if necessary.
• Latest figures show the UK National Health Service (NHS) intensive care units were running at around 80% capacity at the start of March. Overall the NHS has one of the lowest ratios of hospital beds per head of population in Europe. UK hospitals are already discussing how they will need to ration care to those most likely to survive in the event there are not enough beds, ventilators or staff to care for the numbers infected if the worst case scenario predictions prove accurate.
  
  
• In a separate note, Italian intensive care doctor Giuseppe Nattino, from the Lecco province in northern Italy, shared a clinical summary of the patients his unit has been treating, which doctors described as “frightening” in terms of what it could mean for the UK.
• The technical note spells out how patients with coronavirus experience a severe infection in all of their lungs, requiring major ventilation support. It also reveals the effect of the virus, which affects blood pressure, the heart, kidneys and liver with patients needing sustained treatment.
• Dr Nattino said: “A week ago we opened a 6-bed ICU for Covid-19 critically ill patients. In two days our unit filled up and we extended it to 10 beds on 3 March which filled up during the same afternoon. Now we’re planning to merge the cardio and general ICUS to use the general ICU beds for 10 more Covid-19 patients.”
  
  
• In an alarming development, Dr Nattino said younger patients were being affected, saying the ages of patients ranged from 46 to 83 with only a small number having important underlying conditions. He added: “The last days are showing a younger population involved as if the elderly and weaker part of the population crashed early and now younger patients, having exhausted their physiological reserves, come to overcrowded, overwhelmed hospitals with little resources left.”
• One UK doctor said this latter point needed careful consideration by NHS hospitals, adding: “We need to be careful to have some ICU capacity for younger patients. This is where important difficult decisions need to be made.”

 

[Irvrobinson]

Thanks, Swerd.

I read the article, and the question I came away with: is the mortality rate really about 10%?

 

[TLS Guy]

I've been wondering why that is. My first thought was that it might have something to do with their immune systems but this seems unlikely to me. My rudimentary understanding is that the virus accesses (not sure what the proper term is) cells in the lungs via specific receptors. This made me wonder if there might be something different about the receptors in the cells in children that makes them less vulnerable to the virus.

Perhaps one of the people pos


TLS Guy, thanks for posting.

Roughly speaking, in your estimation, what is our capacity here in the U.S. (basically, the number of respirators relative to the population) compared to Italy?

Personally I’m operating on the assumption that I’ll be infected sooner or later, but I’m hoping to avoid being part of the first wave in case I’m one of the people who has more severe problems.

My personal view is that the US health system is very badly prepared for an event like this. The US health care system is very fragmented, with poor central command so to speak. There is no rigid central control. In good times this is a strength and helps innovation. In a crisis like this it can lead to lack of control and organization, which can mean duplication and inefficient use of resources. There have already been very serious missteps in the US and elsewhere. Singapore and Taiwan look to be models we should look at first.

As an example my brother and my nephew were here last weekend and left Wednesday. My nephew's wife had spent the previous week in Venice. I wanted guidance form the state health department. The department was closed and not staffed. I have had no reply from and Email, and I used the physician portal. I could only contact the CDC on their physician hot line and had a useless generic response two days later.

No screening was done when they entered MSP even after they identified the problem at passport control. This is so far from what is required it is truly worrying. So to answer your question, I do not think we are prepared. I understand that the State Health Department will be staffed this weekend.

As far as when it is best to get it. I would say certainly before we run out of ICU, ventilators and dialysis machines. I personally think that is bound to happen.

From a personal standpoint I would say that we actually never save lives we just prolong them. All of us are destined to die. The manner of our death is not known until sometimes near the end. But as I used to tell patients on hearing they had a potentially fatal disease, "everybody gets something". The key to emotional stability at any time and especially now is to really understand and accept that fact. I have not lost sleep over my recent cancer diagnosis. Certainly I will investigate and consider my options and try and choose the most appropriate for my situation. I accept that this whole crisis may greatly limit my options and very likely lead to treatment delay. That is just another slice of life on my journey from birth to death. One thing I do accept is that as someone who has had a good life for 73 years and has a significant past history, I may have to accept that this situation could present a case were I might have to give way to someone with a better chance of survival and I'm prepared to accept that. Resources have to be expended were they will likely do the most good, and that may well not be you or me.

 

[TLS Guy]

Thanks, Swerd.

I read the article, and the question I came away with: is the mortality rate really about 10%?

No, but based on this report from respected ICU physicians in Italy, the mortality of IDENTIFIED cases is 2% in their hands so far. However when there are no ICU beds, ventilators and dialysis machines available it will be 10%. That is pretty consistent with reports from WuHan. Their overall mortality is running at 3.4% currently. That is pretty consistent elsewhere and the point where WHO says it is.

I would stress that we can only work with identified cases. You can not make statistics from cases you do not know about. How many of those there are is totally a wild guess and not useful to talk about. As physicians we can only draw conclusions from definite cases. That is what you need to make decisions and advise patients and families when confronted with a new known case.

I will say this, that it is crucial to delay spread. No matter how intrusive and disruptive forceful measures have to be taken. Lives will be shortened if we let everyone get sick at once. This is professors Chis Witty's point. By the way we really do need to have a respected eminent physician like professor Whitty to talk on behalf of the Federal government and fast.

I now think this will be a watershed event for the world. In its wake there will have to be a totally new world order emerge. The current world order plays right into the hands of infectious organisms. I have seen infectious organisms steadily get the upper hand throughout my career. Things need to change drastically.

 

[Verdinut]

My personal view is that the US health system is very badly prepared for an event like this. The US health care system is very fragmented, with poor central command so to speak. There is no rigid central control. In good times this is a strength and helps innovation. In a crisis like this it can lead to lack of control and organization, which can mean duplication and inefficient use of resources. There have already been very serious missteps in the US and elsewhere. Singapore and Taiwan look to be models we should look at first.

As an example my brother and my nephew were here last weekend and left Wednesday. My nephew's wife had spent the previous week in Venice. I wanted guidance form the state health department. The department was closed and not staffed. I have had no reply from and Email, and I used the physician portal. I could only contact the CDC on their physician hot line and had a useless generic response two days later.

No screening was done when they entered MSP even after they identified the problem at passport control. This is so far from what is required it is truly worrying. So to answer your question, I do not think we are prepared. I understand that the State Health Department will be staffed this weekend.

As far as when it is best to get it. I would say certainly before we run out of ICU, ventilators and dialysis machines. I personally think that is bound to happen.

From a personal standpoint I would say that we actually never save lives we just prolong them. All of us are destined to die. The manner of our death is not known until sometimes near the end. But as I used to tell patients on hearing they had a potentially fatal disease, "everybody gets something". The key to emotional stability at any time and especially now is to really understand and accept that fact. I have not lost sleep over my recent cancer diagnosis. Certainly I will investigate and consider my options and try and choose the most appropriate for my situation. I accept that this whole crisis may greatly limit my options and very likely lead to treatment delay. That is just another slice of life on my journey from birth to death. One thing I do accept is that as someone who has had a good life for 73 years and has a significant past history, I may have to accept that this situation could present a case were I might have to give way to someone with a better chance of survival and I'm prepared to accept that. Resources have to be expended were they will likely do the most good, and that may well not be you or me.

Sorry to hear about your condition. There are things which we have no control on and unfortunately, we depend on our surrounding situation as well.
It's good to have you sharing your time, your passion for high fidelity reproduction and your knowledge on this site.
In any case, I wish a good outcome without too much suffering for you and your family.

 

[davidscott]

My personal view is that the US health system is very badly prepared for an event like this. The US health care system is very fragmented, with poor central command so to speak. There is no rigid central control. In good times this is a strength and helps innovation. In a crisis like this it can lead to lack of control and organization, which can mean duplication and inefficient use of resources. There have already been very serious missteps in the US and elsewhere. Singapore and Taiwan look to be models we should look at first.

As an example my brother and my nephew were here last weekend and left Wednesday. My nephew's wife had spent the previous week in Venice. I wanted guidance form the state health department. The department was closed and not staffed. I have had no reply from and Email, and I used the physician portal. I could only contact the CDC on their physician hot line and had a useless generic response two days later.

No screening was done when they entered MSP even after they identified the problem at passport control. This is so far from what is required it is truly worrying. So to answer your question, I do not think we are prepared. I understand that the State Health Department will be staffed this weekend.

As far as when it is best to get it. I would say certainly before we run out of ICU, ventilators and dialysis machines. I personally think that is bound to happen.

From a personal standpoint I would say that we actually never save lives we just prolong them. All of us are destined to die. The manner of our death is not known until sometimes near the end. But as I used to tell patients on hearing they had a potentially fatal disease, "everybody gets something". The key to emotional stability at any time and especially now is to really understand and accept that fact. I have not lost sleep over my recent cancer diagnosis. Certainly I will investigate and consider my options and try and choose the most appropriate for my situation. I accept that this whole crisis may greatly limit my options and very likely lead to treatment delay. That is just another slice of life on my journey from birth to death. One thing I do accept is that as someone who has had a good life for 73 years and has a significant past history, I may have to accept that this situation could present a case were I might have to give way to someone with a better chance of survival and I'm prepared to accept that. Resources have to be expended were they will likely do the most good, and that may well not be you or me.

Well said sir.

 

[TLS Guy]

Wow, that's sobering. Thanks for posting this. Because too many people won't actually read the article you linked, I've summarized it. Please let me know if I left out anything important.

• Italian doctors have warned medics across Europe to “get ready” for coronavirus in a letter revealing up to 10% of all those infected with coronavirus need intensive care with ventilators. Hospitals became overwhelmed. These patients were admitted “almost entirely” for severe lung failure caused by the virus, needed ventilators to help them breathe.
  
  As of 6 pm Saturday:
• 5,883 patients in Italy have been infected.
• 10%, ~590 patients, needed intensive care with ventilators.
• 233 have died.
  
  
• It's vital that hospitals have equipment to protect staff and that staff be trained in wearing the kit.
• Increase your total ICU capacity. Identify early hospitals that can manage the initial surge in a safe way. Get ready to prepare ICU areas where to cohort Covid-19 patients – in every hospital if necessary.
• Latest figures show the UK National Health Service (NHS) intensive care units were running at around 80% capacity at the start of March. Overall the NHS has one of the lowest ratios of hospital beds per head of population in Europe. UK hospitals are already discussing how they will need to ration care to those most likely to survive in the event there are not enough beds, ventilators or staff to care for the numbers infected if the worst case scenario predictions prove accurate.
  
  
• In a separate note, Italian intensive care doctor Giuseppe Nattino, from the Lecco province in northern Italy, shared a clinical summary of the patients his unit has been treating, which doctors described as “frightening” in terms of what it could mean for the UK.
• The technical note spells out how patients with coronavirus experience a severe infection in all of their lungs, requiring major ventilation support. It also reveals the effect of the virus, which affects blood pressure, the heart, kidneys and liver with patients needing sustained treatment.
• Dr Nattino said: “A week ago we opened a 6-bed ICU for Covid-19 critically ill patients. In two days our unit filled up and we extended it to 10 beds on 3 March which filled up during the same afternoon. Now we’re planning to merge the cardio and general ICUS to use the general ICU beds for 10 more Covid-19 patients.”
  
  
• In an alarming development, Dr Nattino said younger patients were being affected, saying the ages of patients ranged from 46 to 83 with only a small number having important underlying conditions. He added: “The last days are showing a younger population involved as if the elderly and weaker part of the population crashed early and now younger patients, having exhausted their physiological reserves, come to overcrowded, overwhelmed hospitals with little resources left.”
• One UK doctor said this latter point needed careful consideration by NHS hospitals, adding: “We need to be careful to have some ICU capacity for younger patients. This is where important difficult decisions need to be made.”

As usual you have got it right SWERD!

 

[Irvrobinson]

No, but based on this report from respected ICU physicians in Italy, the mortality of IDENTIFIED cases is 2% in their hands so far. However when there are no ICU beds, ventilators and dialysis machines available it will be 10%. That is pretty consistent with reports from WuHan. Their overall mortality is running at 3.4% currently. That is pretty consistent elsewhere and the point where WHO says it is.

Okay, let me rephrase. If the Italian experience will be typical, 10% of people testing positive end up in an ICU. Is the ICU only postponing the inevitable at great cost? Or put another way, what percentage of COVID-19 patients come out of the ICU alive and capable of independent living? It seems to this layman like the answer is a very small percentage.

 

[Swerd]

Thanks, Swerd.

I read the article, and the question I came away with: is the mortality rate really about 10%?

No, that 10% number refers to the number of patients who required intensive care with ventilation. They were 10% out of a total of 5,883 patients infected with Covid-19.

233 patients died, out of a total of 5,883 patients infected with Covid-19. That becomes a 4% rate of mortality – bad enough.

I'll fix my earlier post to make it unambiguous.

Okay, let me rephrase. If the Italian experience will be typical, 10% of people testing positive end up in an ICU. Is the ICU only postponing the inevitable at great cost? Or put another way, what percentage of COVID-19 patients come out of the ICU alive and capable of independent living? It seems to this layman like the answer is a very small percentage.

We only know 233 patients died out of a total of 5,883. We don't know if all those 233 dead were only from the patients who received intensive care with ventilation. The way the news article was written, I couldn't tell.

If we ASSUME all 233 dead came from the ~590 intensive care with ventilation patients, their short term survival rate was ~60%. That would be a worst case estimate. But that would also be a general rate, for all patients, regardless of age or other underlying medical conditions.