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Old 26 March 2020, 09:11 PM   #3931
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The answer to this is undoubtedly complex and probably not completely understood for what is a new pathogen. Iím certainly no expert in immunology or virology but itís likely that the variation in severity (which is also seen with seasonal influenza) relates more to the host response than to the virus itself.

When you get an infection you generally feel ill because of the response mounted by your immune system. Some peopleís immune systems over-react to the presence of a pathogen and it causes collateral damage and itís these people that can become seriously unwell. Why do a minority react this way whilst most donít? Genetics almost certainly plays a part. Certain environmental factors may be at play e.g. smoking. Advanced age degrades every system in your body, including response to infections.

The observation about more young people being affected is related to the increasing number of cases over time. It was never the case that young people could not become seriously unwell (the first notable death of the entire pandemic was a young, healthy Chinese doctor) but simply that their odds are much, much better than older people. Again to analogise with Ďflu - itís known as a disease that seriously afflicts older people but it certainly does also kill young people - 674 annually in the U.K. in the 15-44 age group according to this:

https://www.sciencedirect.com/scienc...63445313003733

Itís just that you never hear about them.
Could it just be that some were exposed to a higher viral load due to either multiple exposures or someone in a higher infectious condition?
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Old 26 March 2020, 09:12 PM   #3932
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the Coronavirus outbreak thread

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Certain environmental factors may be at play e.g. smoking. Advanced age degrades every system in your body, including response to infections.

Good point among the other points you posted. I only highlighted this part to ask how vaping might have any differential influence?

Here in US (maybe elsewhere too), before the pandemic, people in the 18-45 bracket had been to ER/EDís in respiratory distress without pre-existing conditions. Vitamin E acetate in vaping solutions was closely linked. https://www.cdc.gov/mmwr/volumes/69/...cid=mm6903e2_w

The workups on the 18-45 bracket COVID-19 fatalities might yield some learnings to explain how seemingly healthy ones expired. Could it be that vaping has created a high rate of that cohort as ďwalking near-COPDĒ individuals?


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Old 26 March 2020, 09:41 PM   #3933
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Could it just be that some were exposed to a higher viral load due to either multiple exposures or someone in a higher infectious condition?
Yes you’re right of course, this is almost certainly a factor, certainly in clinical environments and it explains why doctors seem to be disproportionately impacted by severe illness despite their relative youth.

Even the very simple procedure of administering high flow oxygen appears to aerosolise the virus and increase the exposure of those in the vicinity. I’m aware that hospitals in London (if not country wide) have implemented a protocol whereby COVID-19 patients are not to be administered oxygen at a flow rate of more than 5L/min for this reason.

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Good point among the other points you posted. I only highlighted this part to ask how vaping might have any differential influence?
The spate of illnesses and deaths affecting a small minority of young, healthy vapers you mention (reported hereabouts too) was associated with pulmonary pneumonitis. As has been discussed on here, there are various published studies which show that many people who have succumbed to COVID-19 experienced severe pulmonary inflammation - effectively pneumonitis.

It’s possible to speculate that vaping might confer (a probably very small) additional risk versus a non smoker/vaper? Or maybe it again reflects the fact that a small minority of people’s physiologies will react to a pulmonary insult in an aggressive and atypical way.
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Old 26 March 2020, 10:30 PM   #3934
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Thanks for sharing - not a fun read. But have been at the edge of that decision as a family member many times over the past few years. I can’t imagine how hard this will be for families touched by the eventuality.

That is very sobering - I wonder what has been the corollary in China, So. Korea, and Italy. Hadn’t seen that in print yet about their experience.



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Paul.

I agree this can be a gut wrenching issue to confront in the best of times.

I have not seen reports from China or S.K. either. And I am not fluent enough with their laws and cultural expectations regarding DNR's do know if their approach easily translates to the US and other western societies.

However, having been involved in the representation of several providers in my state where uninvolved family members object to valid DNR orders I can say two things. First, although the process varies state by state, DNR orders are usually entered pursuant to a state statute which normally requires knowing consent from the patient or the patient's rep. And even when orders comply with this process, many family members object and want the patient keep alive, no matter the prognosis or the cost.

But these are not normal times. The dangers to medical providers posed by resuscitation appear to be significant. And we may not have enough resources to keep people alive no matter the cost.

So, we may be headed into a situation where these decisions have to be made even if the patient or their rep do not agree. Query if the bulk of our population in the US understands this.

Stay safe.
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Old 26 March 2020, 11:40 PM   #3935
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Dummies:


Louisiana pastor defies COVID-19 stay-at-home order, holds services for hundreds

https://www.latimes.com/world-nation...irus?_amp=true


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Spain did something very similar back when they only had 589 conformed cases around March 8th 2020 (and Italy was on lockdown). There's an article on Bloomberg about this, outlining it all. It seems as if a public gathering of 120,000 people (among other things) helped them get to where they are today because the numbers doubled after and it truly began. This is why even more people seem to be following the guidelines of the WHO and local public health officials. There's a serious impact on society when these orders get ignored and I'm sad to see this as I would like the globe back to normal, ASAP.

My heart breaks for those suffering globally for any reason. Hopefully the countries still in the early stages can heed the warnings as a massive COVID-19 outbreak in 3rd world / developing nations could be devastating.

On the bright side it's good to see how this has brought people together and how many are practicing physical distancing along with other safety measures.
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Old 27 March 2020, 12:00 AM   #3936
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Paul.

I agree this can be a gut wrenching issue to confront in the best of times.

I have not seen reports from China or S.K. either. And I am not fluent enough with their laws and cultural expectations regarding DNR's do know if their approach easily translates to the US and other western societies.

However, having been involved in the representation of several providers in my state where uninvolved family members object to valid DNR orders I can say two things. First, although the process varies state by state, DNR orders are usually entered pursuant to a state statute which normally requires knowing consent from the patient or the patient's rep. And even when orders comply with this process, many family members object and want the patient keep alive, no matter the prognosis or the cost.

But these are not normal times. The dangers to medical providers posed by resuscitation appear to be significant. And we may not have enough resources to keep people alive no matter the cost.

So, we may be headed into a situation where these decisions have to be made even if the patient or their rep do not agree. Query if the bulk of our population in the US understands this.

Stay safe.
I think it's prudent to have this discussion among providers. Even the most efficient resuscitative efforts are not as effective as we'd like to believe. I'm not an intensivist and not versed with the numbers, but it's probably safe to say that greater than 50% of patients who would require CPR for an arrhythmia will die despite best efforts, and that a significant portion of those who survive initially may not survive until discharge. The studied populations tend to have cardiovascular disease and often accompanying chronic lung disease if they were smokers.

When you compound the situation with patients who have severe ACUTE on chronic respiratory compromise in addition to cardiovascular disease and arrhythmia, I'm sure the numbers are much worse. In this case, the calculus needs to be done. Is it worth throwing a team of 10-15 healthcare workers into the exercise of CPR when you may only save 1 in 5, or more likely 1 in 20 patients, with the risk of infecting at least 10% of that team in the best case? When the virus is aerosolized, it is remarkably infectious. There are anecdotal reports from the ENT community in Iran where a sinus surgery performed with protective gear (N95 masks, gown, gloves, hair covers, face shields, but not full PPE with PAPR) likely resulted in the infection of an entire team.

It's a horrible set of decisions and policies that are being made and penned now respectively. There is no good or palatable choice, only several bad options. I have several friends from medical school on the front lines right now, and they are giving everything they've got. I don't think it's unreasonable to consider nurses, respiratory therapists, docs, environmental cleaning, etc. services to be irreplaceable resources. We need time to get proper protective gear for providers, and part of that will be making these tough decisions up front, rather than too late.
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Old 27 March 2020, 01:38 AM   #3937
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Relaying what a doctor just told me: It's possible that people with COVID-like symptoms could have primarily a bacterial infection, or could have secondary bacterial infection stemming from a viral infection. Many of these infections could go untreated right now, because otherwise healthy people with non life-threatening cold/flu symptoms are (in many cases) being asked not to appear in-person at hospitals or urgent care clinics.

He prescribed me an antibiotic. He thinks it's a reasonable precaution, given persistent community-acquired pneumonia symptoms.
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Old 27 March 2020, 01:40 AM   #3938
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Thanks for updating us on this situation. It's certainly unfortunate and alarming but I hope all continues to go well for you and the many others in similar situations.
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Old 27 March 2020, 02:25 AM   #3939
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Relaying what a doctor just told me: It's possible that people with COVID-like symptoms could have primarily a bacterial infection, or could have secondary bacterial infection stemming from a viral infection. Many of these infections could go untreated right now, because otherwise healthy people with non life-threatening cold/flu symptoms are (in many cases) being asked not to appear in-person at hospitals or urgent care clinics.

He prescribed me an antibiotic. He thinks it's a reasonable precaution, given persistent community-acquired pneumonia symptoms.
Well that is some positive news. Best wishes!
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Old 27 March 2020, 02:44 AM   #3940
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Saw this morning that many hospitals are thinking of instituting universal Do Not Resuscitate (DNR) orders for all Coronavirus patients.
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Old 27 March 2020, 03:17 AM   #3941
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Saw this morning that many hospitals are thinking of instituting universal Do Not Resuscitate (DNR) orders for all Coronavirus patients.
Yes. See comment and link above.

Stay safe.
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Old 27 March 2020, 04:40 AM   #3942
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News doesn't seem to be getting any better. Italy is still not able to curb the amount of deaths today and by tomorrow we will surpass Italy in the number of cases here in the USA
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Old 27 March 2020, 05:10 AM   #3943
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News doesn't seem to be getting any better. Italy is still not able to curb the amount of deaths today and by tomorrow we will surpass Italy in the number of cases here in the USA
Lots of good news. You just have to choose to look for it.
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Old 27 March 2020, 05:15 AM   #3944
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News doesn't seem to be getting any better. Italy is still not able to curb the amount of deaths today and by tomorrow we will surpass Italy in the number of cases here in the USA
Oh, I donít think the US will pass them soon. Italy isnít testing no symptoms or mild symptoms cases- they lack test capacity.

I think China still has the most cases, even though they stopped testing (but not quarantining) contacts with positives and mild symptoms subjects.
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Old 27 March 2020, 05:23 AM   #3945
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Oh, I don’t think the US will pass them soon. Italy isn’t testing no symptoms or mild symptoms cases- they lack test capacity.

I think China still has the most cases, even though they stopped testing (but not quarantining) contacts with positives and mild symptoms subjects.
That is true, Italy has slowed down on testing patients. China is starting to tighten up again. They don’t seem to be reporting most of the new cases. I was told by a manufacturer out of Yiwu that I’ve done business with for years that once the factories started up again there was a whole bunch of workers getting sick. Also I have family in Beijing that has told me there are new cases popping up but they’re very quick to get on top of it and quarantine the individuals into their homes. It seems as long as they can keep it under control they’re willing to make a few sacrafices.

We are still far behind on testing in the USA as well. No one will ever know the real numbers of any country.
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Old 27 March 2020, 05:29 AM   #3946
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Lots of good news. You just have to choose to look for it.
Agree. There is actually quite a bit. A lot depends on perspective too. But that is true during normal times as well.

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Old 27 March 2020, 05:30 AM   #3947
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News doesn't seem to be getting any better. Italy is still not able to curb the amount of deaths today and by tomorrow we will surpass Italy in the number of cases here in the USA
Perspective. Italy population 60Million.....USA population 330 Million
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Old 27 March 2020, 05:36 AM   #3948
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The "total number of cases" data that people love to focus on is flawed/not useful for a number of reasons. The only way to make it a valid metric would be to test literally every person in every country on a daily or weekly basis and then adjust it for population. So in other words, not possible.
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Old 27 March 2020, 05:38 AM   #3949
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Perspective. Italy population 60Million.....USA population 330 Million


True - even with the current effort in US and potentially extending it an extra 2 weeks - itís likely we will eclipse Italyís reported case count.

Italy policy in testing will also have an impact of new case reports.

Where I hope US can hold the line is keeping the number/ratio of fatalities below the 10.1% Italy has reported as of today.


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Old 27 March 2020, 05:44 AM   #3950
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True - even with the current effort in US and potentially extending it an extra 2 weeks - itís likely we will eclipse Italyís reported case count.

Italy policy in testing will also have an impact of new case reports.

Where I hope US can hold the line is keeping the number/ratio of fatalities below the 10.1% Italy has reported as of today.
The bolded isn't a useful statistic either, because we have no idea how many total cases there actually are.
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Old 27 March 2020, 05:50 AM   #3951
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David Lat, 44, founder of popular legal blog Above The Law, has COVID-19 and is now on a ventilator at NYU Langone. I haven't always agreed with the editorial stance of his website, but it does a good job holding law firms and schools accountable, and it's sad he's taken this turn for the worse.
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Old 27 March 2020, 05:59 AM   #3952
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True - even with the current effort in US and potentially extending it an extra 2 weeks - itís likely we will eclipse Italyís reported case count.

Italy policy in testing will also have an impact of new case reports.

Where I hope US can hold the line is keeping the number/ratio of fatalities below the 10.1% Italy has reported as of today.


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Isnít it currently around 2% based on what information we have?
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Old 27 March 2020, 06:03 AM   #3953
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Not sure if anyone has shared this yet. The Imperial College report author backtracks quite a bit.


https://www.dailywire.com/news/epide...-revises-model


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Old 27 March 2020, 06:10 AM   #3954
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The bolded isn't a useful statistic either, because we have no idea how many total cases there actually are.

You are definitely right - their denominator is way off. I do believe their number of fatalities is fairly accurate

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Isnít it currently around 2% based on what information we have?

Seth - if you mean here in US, yes I believe it is just under 2% by 1/2%.



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Old 27 March 2020, 06:13 AM   #3955
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UK has just done the "Clap for Carers" thing at 2000hrs there. To show their support of the NHS Doctors, Nurses and Staff.

A lot of people out on their front gardens clapping. Some fireworks being set off.
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Old 27 March 2020, 06:19 AM   #3956
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Not sure if anyone has shared this yet. The Imperial College report author backtracks quite a bit.


https://www.dailywire.com/news/epide...-revises-model


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Had trouble with the link but found the story and wow - talk about a turnaround. His original study was widely reported and scared the pants & skirts & kilts off everyone...

Here is the salient point and his excuse for flubbing his study with bad data.

ďEpidemiologist Neil Ferguson, who created the highly-cited Imperial College London coronavirus model, which has been cited by organizations like The New York Times and has been instrumental in governmental policy decision-making, offered a massive revision to his model on Wednesday.

Fergusonís model projected 2.2 million dead people in the United States and 500,000 in the U.K. from COVID-19 if no action were taken to slow the virus and blunt its curve.

However, after just one day of ordered lockdowns in the U.K., Ferguson is presenting drastically downgraded estimates, revealing that far more people likely have the virus than his team figured.

Now, the epidemiologist predicts, hospitals will be just fine taking on COVID-19 patients and estimates 20,000 or far fewer people will die from the virus itself or from its agitation of other ailments, as reported by New Scientist Wednesday.

Ferguson thus dropped his prediction from 500,000 dead to 20,000.Ē


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Old 27 March 2020, 06:19 AM   #3957
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Not sure if anyone has shared this yet. The Imperial College report author backtracks quite a bit.


https://www.dailywire.com/news/epide...-revises-model
Respectfully, I'm not sure "backtracks" is an accurate term to use. He is now stating that because of the social distancing measures that have been adopted + an anticipated increase in medical system capacity, the UK should (probably) be able to handle the load. The original report contained projections based on several different scenarios, one of which was the world literally doing nothing to stop the spread. Many people/media outlets latched onto the most dire projection, which is not the fault of the authors as the report clearly stated what the projections were based on.
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Old 27 March 2020, 06:27 AM   #3958
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The article also states:

ďEssentially, what has happened is that estimates of the viruses transmissibility have increased ó which implies that many more people have already gotten it than we realize ó which in turn implies it is less dangerous.Ē


I think this just goes to show there are a lot of variables that go into these projections and models, and one input assumption can drastically change the output.

Iím not taking away the seriousness of this virus, however it seems the magnitude of death that was projected was overstated, even if the world did absolutely nothing.


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Old 27 March 2020, 06:42 AM   #3959
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I searched and did not locate an existing thread about this, beyond those essentially asking ďwill this outbreak get me a Daytona quicker?Ē J/K. Sort of.

Anyway, I figure itís high time for a thread. This eveningís development:

https://www.cnbc.com/2020/01/28/whit...-outbreak.html

The spread of the virus has practically put the world to a stand still, so many cities over the wold locked down, first of its kind....fingers crossed while we expect good results.
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Old 27 March 2020, 07:03 AM   #3960
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Had trouble with the link but found the story and wow - talk about a turnaround. His original study was widely reported and scared the pants & skirts & kilts off everyone...

Here is the salient point and his excuse for flubbing his study with bad data.

ďEpidemiologist Neil Ferguson, who created the highly-cited Imperial College London coronavirus model, which has been cited by organizations like The New York Times and has been instrumental in governmental policy decision-making, offered a massive revision to his model on Wednesday.

Fergusonís model projected 2.2 million dead people in the United States and 500,000 in the U.K. from COVID-19 if no action were taken to slow the virus and blunt its curve.

However, after just one day of ordered lockdowns in the U.K., Ferguson is presenting drastically downgraded estimates, revealing that far more people likely have the virus than his team figured.

Now, the epidemiologist predicts, hospitals will be just fine taking on COVID-19 patients and estimates 20,000 or far fewer people will die from the virus itself or from its agitation of other ailments, as reported by New Scientist Wednesday.

Ferguson thus dropped his prediction from 500,000 dead to 20,000.Ē


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Well Ė I donít know who and what to believe but I have always said I donít believe the stats or the worst case scenario death toll.

I hope there is some truth in this report.
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