Coronavirus Discussion Thread

[FiremanMike]

US just jumped mortality by 100.

Intensive care specialist Hugh Montgomery: The average flu is about 1.3 to 1.4 contagious. that is in a community each person who contracts it will pass it on to 1.3 to 1.4 people on average. So 10 generations of transmission causes about 20 infections. 1 > 1.4 > 1.96 > 2.74 > 3.84 > 5.37 > 7.52 > 10.54 > 14.75 > 20.66
Covid-19 is much more contagious. In the community each person will pass it on to 3 people. So 10 generations of transmission can cause about 59,000 infections. 1 > 3 > 9 > 27 > 81 > 243 > 729 > 2187 > 6561 > 19683 > 59094

Maybe, but if that infection rate was accurate, don't you think our worldwide infection rate would be significantly higher? China alone, with 1.386 billion people, didn't lock down the country until 3 months after the virus was identified, yet they still only report 81,000 cases to the WHO as of yesterday morning.

Sure, but the flu season is a bit more spread out don't you think?

Everything sucks right now frankly. I rarely dislike going to work, but I don't like being here now. Will all of the attempts to slow this matter? I doubt we'll ever know.

The flu season is said to be 6 months, we're now at about 4 months into COVID.. while it's possible that we jump from 300,000 to 35m+ (will have to look at worldwide flu stats at some point to be fair), it seems unlikely.

Add those stats the Covid-19. While you are at it, could you include motor vehicle accidents?
BTW, mortality for the common (seasonal) flu is .1% Present Covid-19 mortality 4.1+%
Let's use your stats, 2018-2019: 34,200 / 35.5m infected * 100 = .096 deaths per 100 infections in the US. Average world wide is about the same.
Covid-19: 16567 / 382612 * 100 = 4.32 deaths per 100 infections (March 23 numbers)

The difference is, seasonal flu is multiple source in the wild. Covid-19 is single source. Consider Covid-19 with a few hundred thousand sources like the common flu, like we have right now. Consider how naive that comparison is.

Why would I look at auto accidents? I'm striking debate over our response to infectious diseases. I think there's evidence to show the flu is just as virulent and deadly, but for some reason we don't have this worldwide panic every year for the flu.

The bottom line is we'll likely NEVER know how many worldwide infectious there are of COVID, but what we can compare is the patients who are tested which has been, for the most part, the patients who are really sick with symptoms..

Flu - patients who are hospitalized, 2019 - 6.9% mortality, 2018 - 7.6% mortality, 2017 - 7.7% mortality, 2016 - 8.2% mortality

It's my understanding that confirmed cases reported by the WHO are ones with positive test results back, not those who simply are assumed based on screening. Speaking for my area, which is likely similar to the rest of the world, the only patients who have had testing completed and returned are the ones who are severely ill.

Worldwide COVID - 332,930 cases, 14,510 deaths = 4.4% mortality rate (which includes countries with poor access to healthcare).

Now, whether or not the confirmed cases is a fair comparison to the number of folks who are hospitalized with the flu is unclear. But that number of 332,930 worldwide cases seems shockingly low to me given how virulent covid is reported to be.

MY OPINION - there's really only two realities to the above number.. First, it really is as virulent (or more) as the the flu, and there are actually tens if not hundreds of millions of people worldwide already infected, meaning the mortality rate is dramatically lower than is being reported. The other possibility is that the mortality rate is high, but the infection rate is significantly lower than what they led on.

At this point, I lean more towards my first conclusion, but who knows.

 

[RedBlanketRunner]

Unofficial word I have received from the medical quarter is Covid-19 contagiousness will not be significantly lowered by hot weather. This need further information and verification.

 

[Carlos Danger]

Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.

By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"

 

[FiremanMike]

Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.

By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"

The thing I worry about more than saying "ehh, we overreacted" is that people will conclude that this reaction was appropriate and is the new norm for next year's outbreak of (insert pathogen here), and the one in 2021, and 2022...

 

[RedBlanketRunner]

S l o w... o n ... t h e... u p t a k e...
My only snack: Lays sour cream and onion potato chips. Sitting at dinner tonight wifey asked me why there is 4 or 5 opened bags each mostly uneaten. I hypothesized they had to have changed the recipe. Really blah. Up there with unflavored rice cake. Dig in the trash and find an old bag and compare ingredients. No difference.
Wife asks if the dinner she brought home was good. Told her it was okay. Nothing special. Just blah. She tells me the only restaurant open was that place where I hate their cooking. Going upstairs while trying to gag down Lays sour cream and onion rice cake when I had a PING! Maybe?? Give it the ultimate taste test: grab the jar of Vegemite and suck on a glop. Nada. Might as well have been Vaseline.
Yup. Dang virus can blow your sense of taste and smell all to heck. Hope it doesn't stay this way but in the meantime I'm heading straight for the rip-the-top-of-your-head-off-and-frightens-the-cat Thai dishes I usually shunned.

 

[Peak]

The problem with trying to develop any reasonable epidemiologic model is that we don't have adequate testing.

Of course if we only test those who present to the hospital or their PCP then we are going to have sicker appearing COVID patients.

Tests are taking over a week to get back now, even on our oncology and transplant patients. We have discharged several inpatients before we even know if they were positive or negative.

We are starting to diagnose based on chest xray, CT, and clinical appearance and are basically just sending off the test as a formality at this point.

Essentially any data the state is reporting is inaccurate for the past week, we can't even know how many positive patients there are.

I've seen older adults who present in significant ARDS to the ED who have been at home with several family members who present no symptoms, and said adult hasn't been out of the house in weeks. There is clearly a large amount of subclinical/asymptomatic spread, especially in kids and young adults, but we have zero idea what it even is because it is impossible to create any real kind of epidemiologic model.

 

[RocketMedic]

The problem with trying to develop any reasonable epidemiologic model is that we don't have adequate testing.

Of course if we only test those who present to the hospital or their PCP then we are going to have sicker appearing COVID patients.

Tests are taking over a week to get back now, even on our oncology and transplant patients. We have discharged several inpatients before we even know if they were positive or negative.

We are starting to diagnose based on chest xray, CT, and clinical appearance and are basically just sending off the test as a formality at this point.

Essentially any data the state is reporting is inaccurate for the past week, we can't even know how many positive patients there are.

I've seen older adults who present in significant ARDS to the ED who have been at home with several family members who present no symptoms, and said adult hasn't been out of the house in weeks. There is clearly a large amount of subclinical/asymptomatic spread, especially in kids and young adults, but we have zero idea what it even is because it is impossible to create any real kind of epidemiologic model.

Exactly what you’d expect from a politically-sensitive and considerate testing model.

 

[E tank]

Not seeing a lot of Covid, but H1N1 is declaring itself among the 20-40- ish set...

 

[Summit]

Seeing COVID, Flu A, hMPV, RSV, PIV, in that order of prevalence..

 

[silver]

Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.

By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"

I don't know, currently in NYC and seeing a rapid rise of critically ill patients will little availability of PPE. Hospitals are not able to increase their surge capacity quickly enough and only have a limited number of ventilators left. Kind of wishing we took stronger measures sooner.

 

[RocketMedic]

I don't know, currently in NYC and seeing a rapid rise of critically ill patients will little availability of PPE. Hospitals are not able to increase their surge capacity quickly enough and only have a limited number of ventilators left. Kind of wishing we took stronger measures sooner.

It’s almost as if a hazardous novel virus has emerged...

 

[RedBlanketRunner]

That's nice to hear. Covid-19 no big deal. Trump administration triage: you are expendable, the economy isn't.

 

[Achilles]

By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"

Is all of this a fact (including the part about looking back on it in the Summer, or are you spreading misinformation? Asking for a friend...

 

[Sled Driver]

I don't know, currently in NYC and seeing a rapid rise of critically ill patients will little availability of PPE. Hospitals are not able to increase their surge capacity quickly enough and only have a limited number of ventilators left. Kind of wishing we took stronger measures sooner.

This is a fair assessment

 

[DrParasite]

That's nice to hear. Covid-19 no big deal. Trump administration triage: you are expendable, the economy isn't.

Translation: Orange man bad, twist his words to make yourself sound like you could have done any better. Let me guess: is he also not your president? Your TDS is on full display there

Lets leave the overtly political comments to facebook and twitter.

 

[mgr22]

It's kind of hard to separate politics from COVID-19. In my opinion, politics has had at least as much of an impact as medicine in how the U.S. has been reacting to the disease. I don't think assessing the COVID-19-related actions of any politician should be out of bounds. For example, when elderly patients refuse care and/or transport because they've heard the Lt. Governor of Texas suggest grandparents should be willing to sacrifice their health for the good of the economy, how should we respond?

There are going to be smart things and stupid things done by politicians during this crisis. We should be able to discuss and learn from both.

 

[GMCmedic]

Is anyone seeing ECMO or CRRT in these critical patients?

 

[SandpitMedic]

Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.

By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"

This! FFS! This! And as someone else said-
will this National/worldwide reaction be the new normal?

 

[DesertMedic66]

Is anyone seeing ECMO or CRRT in these critical patients?

Pretty sure a COVID patient I transported yesterday will end up on ECMO. PEEP of 12 and FiO2 of 1.0 and a crappy SpO2/SaO2.

 

[Gurby]

Man, I'm gonna have to just not use the internet at all for a few weeks because I'm pretty close to my limit with the constant exposure to all the keyboard epidemiologists / infectious disease experts spreading misinformation and generating so much unnecessary noise and stress.

By the middle of summer we are gonna look back on this and likely, and those who think critically and are able to look at the numbers rationally are going to say "man, we overreacted substantially and will now be paying for that hysteria for a long, long time" while the sheeple who believe everything they see on CNN or Fox News will of course thank the government for the months of 20%+ unemployment and ensuing economic destruction because "this thing could have killed us all!! Trump should have acted faster!!"

What should the country do, if not lock down?

Do we shrug and say "oh well, guess a bunch of people will just have to die" as the virus burns itself out?

How are hospitals supposed to handle the surge of patients?

I think I asked the same questions a while ago, and you said the virus wasn't affecting your hospital. Is that still the case?