the Coronavirus outbreak thread

[fastmd]

Originally Posted by 77T

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


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FYI- MDs don't need to permission to write off label. The consequence is if the patient suffers an SAE and if insurance picks up the bill.

I got a case report today of a couple who self medicated with chloroquine today, 60yo M died, wife in CCU- not sure of the validity of the case.

It goes to show how concerned and vulnerable some members of our society are right now.

As, CC MD, and head of a large pharma company we are in muddy waters.

But, everyone I know is trying to bring this to an end.

[statsman]

There are a couple of unhelpful things in play. First, there is a bit of “to a carpenter, every problem looks like a nail”, to the extent that medical advisors to political leaders all reccomend more quarantine, all the time. The other issue is the “crabpot syndrome”, so called because crabs, in a boiling pot, will gang up to stop one crab from getting out. You see this in age as where mayors of major cities are urging a state wide shelter in place, even in locales with no known. Ovid-19 cases, because they can’t stand the possibility of losing business was to the other county.

There are alternatives to several weeks of shelter in place, for typical regions (not NYC). If you have thorough testing, you can do like the Koreans are doing now and have positives self quarantine with fines for not adhering. You can direct the oldest people to shelter in place longer than the others.

[scarlet knight]

Originally Posted by statsman

There are a couple of unhelpful things in play. First, there is a bit of “to a carpenter, every problem looks like a nail”, to the extent that medical advisors to political leaders all reccomend more quarantine, all the time. The other issue is the “crabpot syndrome”, so called because crabs, in a boiling pot, will gang up to stop one crab from getting out. You see this in age as where mayors of major cities are urging a state wide shelter in place, even in locales with no known. Ovid-19 cases, because they can’t stand the possibility of losing business was to the other county.

There are alternatives to several weeks of shelter in place, for typical regions (not NYC). If you have thorough testing, you can do like the Koreans are doing now and have positives self quarantine with fines for not adhering. You can direct the oldest people to shelter in place longer than the others.

Sounds like our tests are in the thousands, not the millions that were predicted a week or two ago.

[statsman]

Yes. We have tested about 100,000. Supposedly, we are ramping up. We need to. Iran has tested more than us.

The WSJ did an article about it. Evidently, early on, the CDC insisted on developing and controlling the testing, through their office and state agencies. They could never do better than 209 tests per day. The administration had to pressure them to enlist private industry into the effort.

https://www.google.com/amp/s/www.wsj...em-11584552147

[RNHC]

Originally Posted by statsman

There are a couple of unhelpful things in play. First, there is a bit of “to a carpenter, every problem looks like a nail”, to the extent that medical advisors to political leaders all reccomend more quarantine, all the time. The other issue is the “crabpot syndrome”, so called because crabs, in a boiling pot, will gang up to stop one crab from getting out. You see this in age as where mayors of major cities are urging a state wide shelter in place, even in locales with no known. Ovid-19 cases, because they can’t stand the possibility of losing business was to the other county.

There are alternatives to several weeks of shelter in place, for typical regions (not NYC). If you have thorough testing, you can do like the Koreans are doing now and have positives self quarantine with fines for not adhering. You can direct the oldest people to shelter in place longer than the others.

Hear, hear! Well explained, sir.

[gnuyork]

Originally Posted by Brenngun

The only thing moving faster than Covid 19 is this thread. Trying to keep up with all thought processes is making my head spin. After reading every post I have a couple of random comments.

When it comes to health related issues in this circumstance and knowing when I should follow the suggested actions I always keep in mind the Bomb Squad T-Shirt that reads "If you see me running .. you should keep up". In this case I'll follow the advice of our front line health care professionals over any other professional group because they're the Bomb Squad in this case. They're not running away but they're trying to help us run.

As for the "economic sky is going to fall" if we close it down for a few weeks or a month. Well if we don't get a hold of this pandemic the economy will be the least of our concerns and will ultimately fail anyway. I'm not saying its not an important component to our well being I'm just saying we need to prioritize the most concerning issue and deal with it first. You can rebuild an economy as the great depression shows but you can't bring people back from the grave. Of the 2 evils I would rather fight off the fallout of massive unemployment versus an out of control Pandemic that may start to circle around again and again. I believe we can get past the economic problems faster. There are financial strategies that can help unlike the virus issue.

Regardless of what you believe to be the best course of action we all must stay positive and work together to defend against this unfolding tragedy while we still can.

I agree.

[superstarmar]

Originally Posted by Brenngun

The only thing moving faster than Covid 19 is this thread.
Regardless of what you believe to be the best course of action we all must stay positive and work together to defend against this unfolding tragedy while we still can.

Totally agree...

I would look to history and to those that have impacted history
for personal motives and gain through the ages on the
world platform .
Some have long awaited for the ( this) perfect
storm to unfold and bring about a new era ...
Let us be vigilant and not be overtaken by the element
of fear and surprise by the current undertaking.
I speak in parables for those that have the understanding .
.

[Yoda_Eating_Pizza]

Originally Posted by Blansky

Hawaii has instituted a 14 day quarantine for all people, tourists and residents coming home, starting this Thursday.

Go to Hawaii on vacation, you get to spend the two weeks in quarantine. Granted it's self quarantine, but essentially "house arrest".

https://abcnews.go.com/US/wireStory/...-days-69732399

I saw that press conference. I don't know how it's going to be enforced, though. Arriving passengers fill out a questionnaire. You could conceivably write any bogus info, and authorities just take your word that you're staying at XYZ hotel, or that you're going to stay in your house.

Originally Posted by TswaneNguni

Had to go to the supermarket quickly ....

Armed with an N95 and hand liquor ..

1) When I wear a face mask ,people keep their social distance more.
2) If you ad a few coughs ..they get the f... outta there !

A face mask works !!

I shall have to remember this when I show up for jury duty in a couple of weeks. Although, people here are slightly more accustomed to seeing face masks in general. I do have a very mild, lingering cough from my smoking days of the past.

[airchitect]

What’s really getting me is the fact that we are literally allowing everything to tank due to this. I get it, it’s huge, people will die, hell I could, but it seems we are sacrificing the majority for the minority here. Are we all really going to stay locked up for a year while a vaccine is being developed? Are we really going to allow people to lose their lively hoods for an indeterminate amount of time? Not to mention every other thing this effects. Currently I believe the death rate in the US is ~1.4% or so...... I’m no mathematician but that seems pretty low (?). How wrong am I?

[Ichiran]

Originally Posted by Brenngun

The only thing moving faster than Covid 19 is this thread. Trying to keep up with all thought processes is making my head spin. After reading every post I have a couple of random comments.

When it comes to health related issues in this circumstance and knowing when I should follow the suggested actions I always keep in mind the Bomb Squad T-Shirt that reads "If you see me running .. you should keep up". In this case I'll follow the advice of our front line health care professionals over any other professional group because they're the Bomb Squad in this case. They're not running away but they're trying to help us run.

As for the "economic sky is going to fall" if we close it down for a few weeks or a month. Well if we don't get a hold of this pandemic the economy will be the least of our concerns and will ultimately fail anyway. I'm not saying its not an important component to our well being I'm just saying we need to prioritize the most concerning issue and deal with it first. You can rebuild an economy as the great depression shows but you can't bring people back from the grave. Of the 2 evils I would rather fight off the fallout of massive unemployment versus an out of control Pandemic that may start to circle around again and again. I believe we can get past the economic problems faster. There are financial strategies that can help unlike the virus issue.

Regardless of what you believe to be the best course of action we all must stay positive and work together to defend against this unfolding tragedy while we still can.

Absolutely spot on.

[BNABOD]

Originally Posted by airchitect

What’s really getting me is the fact that we are literally allowing everything to tank due to this. I get it, it’s huge, people will die, hell I could, but it seems we are sacrificing the majority for the minority here. Are we all really going to stay locked up for a year while a vaccine is being developed? Are we really going to allow people to lose their lively hoods for an indeterminate amount of time? Not to mention every other thing this effects. Currently I believe the death rate in the US is ~1.4% or so...... I’m no mathematician but that seems pretty low (?). How wrong am I?

Vaccines isn’t anywhere near ready ,at best you are looking at early immunogenicity results in June of this year and then final results q3 2021. That is the three arm ph1 dose ranging study from healthy folks 18 to 55 happening now so yeah vaccine at your doc office available for injection not any time soon and god knows where we will be in 1.5 years . So to answer your question I don’t think destroying the economy and handing out money we don’t have is a solution but we also have a morale obligation to those suffering so short answer is I don’t know .

[77T]

Originally Posted by airchitect

What’s really getting me is the fact that we are literally allowing everything to tank due to this. I get it, it’s huge, people will die, hell I could, but it seems we are sacrificing the majority for the minority here. Are we all really going to stay locked up for a year while a vaccine is being developed? Are we really going to allow people to lose their lively hoods for an indeterminate amount of time? Not to mention every other thing this effects. Currently I believe the death rate in the US is ~1.4% or so...... I’m no mathematician but that seems pretty low (?). How wrong am I?

Can’t say right or wrong for your feelings.

I can say that the actions we see are similar to a fog of war. And people are beginning to let it get to them.

Today a 70+ y.o. man in the ATL area pulled out a weapon in a post office to confront two women wearing masks and gloves. He feared they could give him coronavirus.

Some feel they can’t control this situation and that helplessness leads to fearful reactions.




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[CalSRQ1]

Originally Posted by airchitect

What’s really getting me is the fact that we are literally allowing everything to tank due to this. I get it, it’s huge, people will die, hell I could, but it seems we are sacrificing the majority for the minority here. Are we all really going to stay locked up for a year while a vaccine is being developed? Are we really going to allow people to lose their lively hoods for an indeterminate amount of time? Not to mention every other thing this effects. Currently I believe the death rate in the US is ~1.4% or so...... I’m no mathematician but that seems pretty low (?). How wrong am I?

That percentage is based on known cases and deaths. Thousands- perhaps tens of thousands have been undiagnosed. “Symptomless carriers means a percentage of the population has it. So the death rate may in fact be a small fraction. We don’t know. But we do know we are destroying the world economy by insisting on a complete shutdown. Silly.

[Fleetlord]

Originally Posted by airchitect

What’s really getting me is the fact that we are literally allowing everything to tank due to this. I get it, it’s huge, people will die, hell I could, but it seems we are sacrificing the majority for the minority here. Are we all really going to stay locked up for a year while a vaccine is being developed? Are we really going to allow people to lose their lively hoods for an indeterminate amount of time? Not to mention every other thing this effects. Currently I believe the death rate in the US is ~1.4% or so...... I’m no mathematician but that seems pretty low (?). How wrong am I?

It's hard to imagine a functioning economy with a freely spreading virus.

Hospitals are getting overrun...they are already short of supplies and staffing, so the point of shutting things down is the keep the medical system from failing. That means if you have a heart attack, car accident..etc the resources to help you would be absorbed by the victims of the virus, so you're in big trouble.

It basically comes down to bust the economy or break the healthcare system..

Odds are when the healthcare system breaks, people will see this and be so fearful of the virus that they will finally lock themselves down to avoid it (without being told) and bust the economy anyway.

[dimag333]

Originally Posted by CalSRQ1

That percentage is based on known cases and deaths. Thousands- perhaps tens of thousands have been undiagnosed. “Symptomless carriers means a percentage of the population has it. So the death rate may in fact be a small fraction. We don’t know. But we do know we are destroying the world economy by insisting on a complete shutdown. Silly.

Tonight’s q and a said it was well below 1%, on world meter you can see a trend where it looks like we might be headed for the plateau. I believe Italy started seeing their first decrease per day recently after 2 week shutdown, I could totally be wrong on that

I can only comment on my personal experiences from family.

1-my sister in law works at the hospital where that family Nj had the family members die, they don’t seem over crowded or overwhelmed

2-my mother in law just retired from being a nurse for 30+ years and also taught the nursing program at local university. No one had called her back to work

3-our schools just gave us 2 more weeks for the kids of home work to send us into spring break, email had a tone kids would be back after that

4-my sister, mother & brother all work in same school district and echo that sentiment

5-my neighbor works at the other local hospital in er, says it’s a ghost town and the hospital is literally hiding supplies to make sure they have them Incase it gets out of ����

Again I can only comment on what I have personally seen or heard directly. Not from my sisters kids school teachers aunt who she used to work with knows someone who......

I’m not saying this is everywhere, just what I see where I am, abojt an hour south of New York, 15 minutes from a large drive through testing facility

I know this all comes off as unpopular right now because it’s positive

To put my views on this into perspective, I pulled my kids from school 3 weeks ago, so in no
Way am I taking this lightly

https://www.worldometers.info/coronavirus/country/us/

steve

[pickettt]

There's a large Kaiser hospital less than 2 miles from my house. It is not overrun. In fact, it's calmer than normal, I assume because of "self quarantine."

[McLovin]

We’re in a horror movie and this is just the end of the first act. Business as usual is not possible.

[airchitect]

Ok so it seems a few folks get my point.....at some point, on a primal, animal level, this is simply survival of the fittest no matter what we do. Not to mention, don’t a huge number of us need to get this before we can ever develop herd immunity? Anyway, no I don’t want anyone to be hurt or die, that sucks, but for s$&@ sakes we cannot let the entire world collapse because of this mess. It’s a bad example, but watch nat geo to get some perspective of what happens in the rest of the animal kingdom when s$&? hits the fan.

[JasoninDenver]

It is easy to say the restrictions being put in place are an overreaction - until it is you or someone you love suffering from this.

If everyone who feels this is an overreaction (such as the Florida Spring Breakers) pledges not to seek medical care in the event that they, or someone in their immediate family, gets seriously ill, I could at least see some moral responsibility for their positions. But they won’t.

If people don’t respect common sense measures put forth by dang near every medical professionals out there then they should not expect those same medical professionals to risk their own lives to save the lives of the ignorant.

We have a duty to our fellow human beings to slow this virus as much as possible.

[sokoloka]

Originally Posted by pickettt

There's a large Kaiser hospital less than 2 miles from my house. It is not overrun. In fact, it's calmer than normal, I assume because of "self quarantine."

I spend every day going in and out of multiple hospitals in the area - not a single is overrun, including those with multiple COVID-19 positive patients.

[77T]

I hope you both don’t mind me posting a screenshot of your adjoining posts earlier tonight.

I was taken by the dichotomy. I believe both of you are genuinely correct in your own feelings.

This is how different people in different circumstances can have a different reaction to a singular disease. The truth is, in my opinion, that all reactions are localized.

I respect both of your points, and only time will tell...


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[hcivic91]

I hate to be a wet blanket but any plateau or pause in infection rates is transitory.

First, with an R-0 of ~2.5 there is no relief until 60% is immune either by antibodies or vaccine. I wish like hell it was not true but these are the first principals of outbreak modeling. While Korea and China have seemingly made progress once people are moving again en-mass the progression to 60% resumes.

Second, flattening the curve is just that: same number of cases (remember 60%) just a longer time to get there.

Finally, we need some form of treatment and summer in the northern hemisphere. Both will buy doctors time to lower case severity and scientists time to progress towards vaccine.

This is just one mathematician's understanding and I'd love to hear other evidence or counter-factuals.

[RNHC]

Originally Posted by Fleetlord

It's hard to imagine a functioning economy with a freely spreading virus.

Happens every flu season.

[Star Ferry]

Originally Posted by JasoninDenver

It is easy to say the restrictions being put in place are an overreaction - until it is you or someone you love suffering from this.

If everyone who feels this is an overreaction (such as the Florida Spring Breakers) pledges not to seek medical care in the event that they, or someone in their immediate family, gets seriously ill, I could at least see some moral responsibility for their positions. But they won’t.

If people don’t respect common sense measures put forth by dang near every medical professionals out there then they should not expect those same medical professionals to risk their own lives to save the lives of the ignorant.

We have a duty to our fellow human beings to slow this virus as much as possible.

Jason, I got many symptoms of this. Fever, fatigue, and breathing like I just aged 20 years. Several of my friends and extended family in NY and NJ have tested positive. We can't assume that everybody with an opinion contrary to our own has not been affected by COVID-19. I know someone who lost a great uncle and is still anti-shutdown.

Soon, many members will know someone with this or will get it personally. Then their views might be tested. But everyone is entitled to their own viewpoint.

[Fleetlord]

Originally Posted by RNHC

Happens every flu season.

Flu numbers are probably overblown.

Posted links to that in my numerous previous posts.

[Fleetlord]

Originally Posted by sokoloka

I spend every day going in and out of multiple hospitals in the area - not a single is overrun, including those with multiple COVID-19 positive patients.

Still in San Diego?

If so, not for long.

https://www.kpbs.org/news/2020/mar/2...l-be-overfill/

Unless they are wrong??

[pickettt]

Originally Posted by 77T

I hope you both don’t mind me posting a screenshot of your adjoining posts earlier tonight.

I was taken by the dichotomy. I believe both of you are genuinely correct in your own feelings.

This is how different people in different circumstances can have a different reaction to a singular disease. The truth is, in my opinion, that all reactions are localized.

I respect both of your points, and only time will tell...


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I'm not entirely sure McLovin' is referencing the disease, so much as the effect of it. My comment was not a feeling, but a quantifiable observation, and a theory as to why. Incidentally, my observation is contrary to many stories I hear from people who've been nowhere near a hospital lately.

[mjr24]

Originally Posted by 77T

I hope you both don’t mind me posting a screenshot of your adjoining posts earlier tonight.

I was taken by the dichotomy. I believe both of you are genuinely correct in your own feelings.

This is how different people in different circumstances can have a different reaction to a singular disease. The truth is, in my opinion, that all reactions are localized.

I respect both of your points, and only time will tell...


Sent from my iPhone using Tapatalk Pro

Great screenshot here. Great example of kind of what we are dealing with in terms of two sides to this whole thing. The first person seems to make an unbiased observation. He may not be a doctor or a medical professional, but I think most of us would recognize a hospital in stress if we walked into one. It seems like an honest observation.

Then there is the other person....who has the nickname of fake character in a 20-year old stupid comedy...who makes a strong clickbait worthy generalization based off presumably zero facts. Yet, most people react to this guy way more than the first person.

We could play an even funner game and say that Dr. Fauci was the person who made the first comment and Kim Kardashian was McLovin....and maybe 2% of people would even look at Fauci's comment.

[JasoninDenver]

Originally Posted by Star Ferry

Jason, I got many symptoms of this. Fever, fatigue, and breathing like I just aged 20 years. Several of my friends and extended family in NY and NJ have tested positive. We can't assume that everybody with an opinion contrary to our own has not been affected by COVID-19. I know someone who lost a great uncle and is still anti-shutdown.

Soon, many members will know someone with this or will get it personally. Then their views might be tested. But everyone is entitled to their own viewpoint.

I certainly agree that everyone is entitled to their own viewpoint and have been very impressed with the scope of well reasoned opinions expressed herein as well as the respect extended.

My simple concern is is that my wife is one who will be called to help people when they are infected. Our friends are ER doctors and anesthesiologists and they are ALL scared for their patients, themselves and their families.

They are being asked to place their own health and, indirectly, that of our families, at risk just doing their jobs. Why should we as a society expect them to do this if we then state that their commitment should be subject to an economic cost benefit analysis?

People are comfortable taking risks on their own behalf. I am fine with that but only to the point that it adversely impacts someone else.

This is not like daredevil activities where the risk of a bad decision is borne only by the risk-taker. With this virus, the risk is borne by everyone who comes into contact with that person.

It is very similar to the anti vaxxer movement where it only takes a few people disregarding established medical evidence, based on their own personal view, to weaken herd immunity. Recent cases in this country ((NY and TX) has shown the danger of this.

I really find it disappointing that people are now discussing how many people are we willing to sacrifice in the hopes of minimizing economic damage.

There will come a time when we can start returning to a more normal life, even with the understanding that this will invariably lead to an increase in the number of cases.

My hope is simply that people will understand that this time is best delayed until we have the ICU beds, respirators and PPE gear for our medical professionals to be able to handle this increased load at a later time. We do not have anything close to this now.

I understand your view may be different.

[CRM114]

Originally Posted by SMD

Those numbers don't prove what you think they prove. Are you saying that in 5 days you think there were 10,200 new infections?

Perhaps maybe, and I am just spit balling here, that they might demonstrate that the numbers of March 17 were completely inaccurate because NY wasn't conducting many tests? And that these infections existed even on March 17 but we just didn't know it??

The numbers prove exactly what I think they prove...places like NYC sat for almost 2 months doing almost nothing to prepare, educate the populace, or advocate and adopt anti-spreading behavior until only recently when it was obviously upon them.

Wider testing/skyrocketing numbers merely reveals how ill-prepared and how deep heads were buried in the sand despite the evidence, warnings, and most of all, common sense from the municipal and health care leaders all the way down the the person on the street.

When a hurricane approaches a city but despite ample warnings and evidence everyone grasps onto any straw that allows them to remain in a state of denial or excuses themselves for failing to prepare in the belief it will somehow pass them by, then when it hits the death and destruction are far worse than a city and populace that are proactive. That's a fact, not an unproven theory.

I saw it first hand in NYC and SF on trips in early March prior to the initiation of the responses. The difference between there and here in Hong Kong was night and day. There were certainly fewer people on the streets in tourists spots frequented by those from Europe and Asia, but mostly locals were acting out the same unhygienic and close-contact behaviors.

The current response is, by and large, completely reactionary and even now there are too many who still don't "get it" as far as behavior and an unwillingness to put up with inconveniences unless forced to do so.

Even now there's debate as to whether it does any good to wear a mask in public. Even now some are still having extended family dinners, birthday parties, etc etc. with those one normally lets their guard down around and thus are most likely to transmit it to and fro.

It was common knowledge that carriers could be asymptomatic and that it was highly transmissible by having the benefit of seeing and studying what was happening elsewhere. In the face of that knowledge what NOT to do in a congested city is sit around hoping it will pass one by, doubly so when almost nobody is being tested yet.

With an asymptomatic virus there should be no link between proactive behavior modification and testing. One doesn't need testing to do the things that will reduce the chance of communicating an unseen disease. Beating the drum now for resources after it's suddenly becoming overwhelming and obvious because broader testing is revealing how ill-prepared the populace was serves as a good example of what happens when wishful thinking, denial, a mindset of "someone will figure out something save the day...just like a Hollywood movie", and a general disbelief in science are given credence.