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Old 24 March 2020, 06:30 AM   #3511
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Not sure if this has been shared today yet. Found this on Reddit this morning. AMA thread with a critical care doctor working in a UK high consequence infectious diseases center.

The author obviously has his own political views on how his government has handled the matter. Beyond that though, there is some great content throughout the Q&A body of the thread:

https://www.reddit.com/r/Coronavirus..._in_a_uk_high/
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Old 24 March 2020, 06:36 AM   #3512
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U.K. just got locked down.


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Old 24 March 2020, 06:40 AM   #3513
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What do you mean this (coronavirus) is so far from "the flu"? In what ways?

Are symptoms so drastically different between coronavirus and seasonal flu that you can tell which patients have coronavirus without an actual coronavirus test?

Not trying to be confrontational. Genuinely curious.
I would say that with sicker patients, the answer to that is likely to be yes. It's not terribly common for patients with influenza to come into the ER so sick that they're in real respiratory distress, and often when they do, they've had a positive flu PCR in the community relatively recently (or will have a positive PCR or multiplex for flu in the ER). There seems to be sort of a common thread also that they were relatively OK--mild symptoms, low grade fevers, dry cough, pretty well appearing--for a few days, then they suddenly crashed. Getting a bolus of several patients in a few hours who either need to be intubated or look like they might soon from flu would also be unheard of in an ER like mine.

With milder disease, no, it's not obvious, particularly since the early symptoms of COVID are so insidious. On the other hand, mild disease isn't really what we're talking about, either.
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Old 24 March 2020, 06:40 AM   #3514
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I agree. But I do not think this negative possibility merits draconian restrictions imposed by the politicians. Judicious. rational measures based on facts should have been taken. For example, we should take extreme care to protect the elderly who are in most danger from the coronavirus.
I understand your view. But I am sorry but I just cannot agree.

The problem I have is that no one who advocates backing off without even trying containment for a real two weeks on a national level has introduced a science based study of doing so, with the testing and resources we have available on the ground, that may not result in tremendous loss of life and a breakdown of the system. Part of the problem is that countries such as the US were caught ill prepared as far as testing capabilities and medical equipment and supplies. And we have yet to catch up. Working on it yes. Remotely caught up on delivery to providers, no.

And I have seen no front line health providers who advocate this approach. This gives me great pause when I hear people say that this is being blown out of proportion. I have yet to hear someone working in an ER says this.

Aside from the loss of life, if this is allowed to spiral out of control I fear even worse damage to society and the economy. Neither citizens nor systems react well to mass carnage. And the shock of such an event may be far worse than a few weeks partial shutdown of the economy.

Italy was slow to impose measures. The reason was the economy. I understand the concern, but the result was disastrous.

The damage done to Norther Italy is beyond price tag. Thankfully it appears they are for now gaining ground in their fight. But the measures they had to impose to do so, and the loss of life and damage to the society, and yes damage to their economy make the attempts we are chafing at seem mild.

It may be that we lack the will to continue containment measures to flatten the curve. If so, I sincerely hope that nay sayers are correct and that the bulk of the medical providers are wrong.

Stay safe.
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Old 24 March 2020, 06:45 AM   #3515
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I would say that with sicker patients, the answer to that is yes. It's not terribly common for patients with influenza to come into the ER so sick that they're in real respiratory distress, and often when they do, they've had a positive flu PCR in the community relatively recently (or will have a positive PCR or multiplex for flu in the ER). There seems to be sort of a common thread also that they were relatively OK--mild symptoms, low grade fevers, dry cough, pretty well appearing--for a few days, then they suddenly crashed. Getting several patients in a few hours who either need to be intubated or look like they might soon from flu is unheard of in an ER like mine.

With milder disease, no, it's not obvious, particularly since the early symptoms of COVID are so insidious. On the other hand, mild disease isn't really what we're talking about, either.

Thanks for taking the time to explain from your well of experience. Extremely valuable contribution. Could you share with us what you’re experiencing first hand with these patients, over this next period, as you feel comfortable?


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Old 24 March 2020, 06:51 AM   #3516
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U.K. just got locked down.


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A good address I thought.

Absolutely clear guidance.

Don’t think it will be just for 3 weeks either.
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Old 24 March 2020, 06:58 AM   #3517
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A good address I thought.

Absolutely clear guidance.

Don’t think it will be just for 3 weeks either.
Agreed. I think the government are doing a pretty good job of it. Shudder to think what would be happening if Corbyn was handling this. I can see this lockdown being in place for 2 months at least. Pretty sure the US will follow and at that point the global economy is pretty much on ice. Crazy times.
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Old 24 March 2020, 06:59 AM   #3518
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I hear that the President wants to lift social distancing after 15 days

I live in the NYC area, where it is exploding. If the self quarantine ends, I suspect it will light the fuse of a second wave.
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Old 24 March 2020, 07:01 AM   #3519
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A good address I thought.

Absolutely clear guidance.

Don’t think it will be just for 3 weeks either.

Not particularly clear I didn’t think and not particularly fair.

I can’t exercise due to disability so a drive in the car was my release to maintain my mental health. So effectively completely locked down. I’m sensing a lot of police stops for me!

What’s essential work? Hopefully not crap morning TV shows so celebs can lockdown also. But as usual that won’t happen.


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Old 24 March 2020, 07:03 AM   #3520
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Agreed. I think the government are doing a pretty good job of it. Shudder to think what would be happening if Corbyn was handling this. I can see this lockdown being in place for 2 months at least. Pretty sure the US will follow and at that point the global economy is pretty much on ice. Crazy times.

2 months, I get the seriousness of this but that is going to seriously damage a lot of people’s health also.


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Old 24 March 2020, 07:15 AM   #3521
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2 months, I get the seriousness of this but that is going to seriously damage a lot of people’s health also.


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Agree and it’s terrible. Can’t argue that.

I wonder what the metrics will me after all the dust settles.

Damage from health issues vs damage by a total economic collapse.

It’s all heartbreaking.
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Old 24 March 2020, 07:21 AM   #3522
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My wife inquired about test kits about a week ago.She is a doctor ,as well ..

The company responded with the following :

The kits are from China ,but the virus strain has changed so much that the kits are not usable anymore.

This is of great concern .
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Old 24 March 2020, 07:22 AM   #3523
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Agree and it’s terrible. Can’t argue that.

I wonder what the metrics will me after all the dust settles.

Damage from health issues vs damage by a total economic collapse.

It’s all heartbreaking.

Agree totally.

I don’t even recognise the world anymore.


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Old 24 March 2020, 07:25 AM   #3524
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My wife inquired about test kits about a week ago.She is a doctor ,as well ..

The company responded with the following :

The kits are from China ,but the virus strain has changed so much that the kits are not usable anymore.

This is of great concern .
Fauci said the exact opposite yesterday, I’ll go by what he said, it has not mutated

steve
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Old 24 March 2020, 07:26 AM   #3525
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How do all the small businesses in NYC re-open if they are shut for two months? The closures may be medically advisable, I really do not think anyone knows the real answers to all of this. But, no question the economic devastation to the economy will be long lasting and painful. The notion we will bounce back quickly as many have said suggests to me these people have no idea how thinly capitalized most people in business really are making it impossible to be out of business so long and re-open.
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Old 24 March 2020, 07:31 AM   #3526
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Fauci said the exact opposite yesterday, I’ll go by what he said, it has not mutated

steve
Fauci is highly respected .

I am reporting what the feedback was from the company .
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Old 24 March 2020, 07:42 AM   #3527
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How do all the small businesses in NYC re-open if they are shut for two months? The closures may be medically advisable, I really do not think anyone knows the real answers to all of this. But, no question the economic devastation to the economy will be long lasting and painful. The notion we will bounce back quickly as many have said suggests to me these people have no idea how thinly capitalized most people in business really are making it impossible to be out of business so long and re-open.
Correct.

I have your answer. They won’t reopen. Most of them anyway.
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Old 24 March 2020, 07:43 AM   #3528
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I expect a fast rebound if closures are for 1,2 or 3 months.

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How do all the small businesses in NYC re-open if they are shut for two months? The closures may be medically advisable, I really do not think anyone knows the real answers to all of this. But, no question the economic devastation to the economy will be long lasting and painful. The notion we will bounce back quickly as many have said suggests to me these people have no idea how thinly capitalized most people in business really are making it impossible to be out of business so long and re-open.
Lots of pent up demand. People want to shop, go to restaurants and travel.
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Old 24 March 2020, 07:45 AM   #3529
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I think there will be debates about US federal response - and the States, too. Now that England has issued their new order, it will also be debated.

Each will have different views perhaps.

Back to the actual virus and COVID-19 disease, one thing I’ve been seeing is the change in testing results. For example, reductions of positive results in some areas and increases in others.

Some questions for the physicians...and you thought internship was tough

Have we reached a point where counting the number of coronavirus instances is fairly useless in treatment?

On an individual basis is it still useful to inform you on choice of therapies?

What I have read is a PCR test can detect the virus only if the person is currently sick. It’s looking for a couple of coronavirus genes.

A serological test looks for specific antibodies that the body has produced to fight the virus. It’s looking for coronavirus antibodies.

However, both tests might miss cases if samples are taken too early, when the viral load is too low or if the person's body hasn't produced enough antibodies against the virus yet.

So creating a screening process had two benefits - first, conserving test kits while there was an insufficient supply. - second, to actually give time for the PUI to express viral load or antibodies. Thoughts?

Separately, if a PUI tests negative on PCR, is it possible they have had a mild case and recovered. So won’t be counted as positive. Do you then pull a blood sample for a serological test because it can detect antibodies even if a patient has recovered?

For the serologic test, I understand it can take about a week after coronavirus exposure before the body produces enough antibodies to code positive. So should a negative PCR actually trigger a future (say one week later) serological test?


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Old 24 March 2020, 07:46 AM   #3530
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Lots of pent up demand. People want to shop, go to restaurants and travel.
My friend. The point is that most, or at least many, will be closed by that point.

There will be minimal places to go. At best.
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Old 24 March 2020, 07:48 AM   #3531
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How do all the small businesses in NYC re-open if they are shut for two months? The closures may be medically advisable, I really do not think anyone knows the real answers to all of this. But, no question the economic devastation to the economy will be long lasting and painful. The notion we will bounce back quickly as many have said suggests to me these people have no idea how thinly capitalized most people in business really are making it impossible to be out of business so long and re-open.
At the end of the day its really up to who is more responsible with their money and has reserves. Those that can ride through this will re-open with less competition on the market. Those that spend all their profits without thinking of the long term are in for a rude awakening. Unfortunately while the government will bail out big names like Boeing, the mom and pop shops will be overlooked. I definitely would feel bad for newly open businesses though, they have no chance to even recoup their investments and have been thrown under the bus in this situation but as such is life. Things aren't always fair
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Old 24 March 2020, 07:54 AM   #3532
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At the end of the day its really up to who is more responsible with their money and has reserves. Those that can ride through this will re-open with less competition on the market. Those that spend all their profits without thinking of the long term are in for a rude awakening. Unfortunately while the government will bail out big names like Boeing, the mom and pop shops will be overlooked. I definitely would feel bad for newly open businesses though, they have no chance to even recoup their investments and have been thrown under the bus in this situation but as such is life. Things aren't always fair
Another train of thought:

Those that lay off their staff and don’t send out payables will last longer than those that don’t.
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Old 24 March 2020, 07:55 AM   #3533
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On an individual basis is it still useful to inform you on choice of therapies?
Choice of therapies ..what choice ??

I think the only thing that can be offered with 100% certainty is ventilation.
Per defenition,not really in practice ,due to the lack of equipment .
Oh and parasetamol in oral or IV form .
The rest "may work "

I dont sleep at night .
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Old 24 March 2020, 07:55 AM   #3534
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My mood is fairly dark today. We just got word that our girls' school will be closed through the end of the school year. With "summer break" we are now looking at a minimum of five months without school, which is absolutely tragic and terrible for a number of reasons. I realize everyone is dealing with this together and my wife and I should personally feel fortunate for having jobs we can work from home and a stable financial situation. I'm going to do my best to get a good night's sleep tonight and hopefully have a better outlook tomorrow. This is just a brutal time.

Best wishes to everyone here - please take care of yourselves and your families. We have a long road ahead of us but all things come to an end eventually.
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Old 24 March 2020, 08:05 AM   #3535
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Choice of therapies ..what choice ??



You’re right in some quarters if off-label isn’t permitted. Also, choice to enter a trial cohort.

For example, remdesivir, hydroxychloroquine w/plaquenil, favilavir, TJM2, rhSP-D, and others.

The list was long so didn’t know if the PCR test was informative in choosing a route.
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Old 24 March 2020, 08:08 AM   #3536
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2 months, I get the seriousness of this but that is going to seriously damage a lot of people’s health also.
Yes. The question now is whether the measures being taken to stop the virus will cause more long term death and misery than the virus itself. I'm not hearing any answers to that one.
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Old 24 March 2020, 08:11 AM   #3537
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You’re right in some quarters if off-label isn’t permitted. Also, choice to enter a trial cohort.

For example, remdesivir, hydroxychloroquine w/plaquenil, favilavir, TJM2, rhSP-D, and others.

The list was long so didn’t know if the PCR test was informative in choosing a route.
WHO reports the rate of infection accelerating ...

The patient is deteriorating rapidly ,you going to try the chloroquine or wait for the trial result in a few weeks ? Its obvious
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Old 24 March 2020, 08:12 AM   #3538
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Another train of thought:



Those that lay off their staff and don’t send out payables will last longer than those that don’t.


Yes, Seth, it’s a tough choice.
For most small firms, business interruption insurance was too expensive - and many policies might not cover force majeure.


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Old 24 March 2020, 08:13 AM   #3539
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My mood is fairly dark today. We just got word that our girls' school will be closed through the end of the school year. With "summer break" we are now looking at a minimum of five months without school, which is absolutely tragic and terrible for a number of reasons. I realize everyone is dealing with this together and my wife and I should personally feel fortunate for having jobs we can work from home and a stable financial situation. I'm going to do my best to get a good night's sleep tonight and hopefully have a better outlook tomorrow. This is just a brutal time.

Best wishes to everyone here - please take care of yourselves and your families. We have a long road ahead of us but all things come to an end eventually.
I posted about this when Kansas cancelled the rest of the school year.

I was told it wasn’t a big deal because we are in March.
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Old 24 March 2020, 08:14 AM   #3540
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WHO reports the rate of infection accelerating ...



The patient is deteriorating rapidly ,you going to try the chloroquine or wait for the trial result in a few weeks ? Its obvious

Without other choices, I think you try the off-label use if you have permission. Is that what you meant?


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