Originally Posted by Bwana:
Once again, don't come in this thread with some kind of political agenda, or you will be shown the door. If you want to go that route, there is a thread about this in DC.
Originally Posted by Dartgod:
People, there is a lot of good information in this thread, let's try to keep the petty bickering to a minimum.
We all have varying opinions about the impact of this, the numbers, etc. We will all never agree with each other. But we can all keep it civil.
Thanks!
Click here for the original OP:
Spoiler!
Apparently the CoronaVirus can survive on a inanimate objects, such as door knobs, for 9 days.
California coronavirus case could be first spread within U.S. community, CDC says
By SOUMYA KARLAMANGLA, JACLYN COSGROVE
FEB. 26, 2020 8:04 PM
The Centers for Disease Control and Prevention is investigating what could be the first case of novel coronavirus in the United States involving a patient in California who neither recently traveled out of the country nor was in contact with someone who did.
“At this time, the patient’s exposure is unknown. It’s possible this could be an instance of community spread of COVID-19, which would be the first time this has happened in the United States,” the CDC said in a statement. “Community spread means spread of an illness for which the source of infection is unknown. It’s also possible, however, that the patient may have been exposed to a returned traveler who was infected.”
The individual is a resident of Solano County and is receiving medical care in Sacramento County, according to the state Department of Public Health.
The CDC said the “case was detected through the U.S. public health system — picked up by astute clinicians.”
Officials at UC Davis Medical Center expanded on what the federal agency might have meant by that in an email sent Wednesday, as reported by the Davis Enterprise newspaper.
The patient arrived at UC Davis Medical Center from another hospital Feb. 19 and “had already been intubated, was on a ventilator, and given droplet protection orders because of an undiagnosed and suspected viral condition,” according to an email sent by UC Davis officials that was obtained by the Davis Enterprise.
The staff at UC Davis requested COVID-19 testing by the CDC, but because the patient didn’t fit the CDC’s existing criteria for the virus, a test wasn’t immediately administered, according to the email. The CDC then ordered the test Sunday, and results were announced Wednesday. Hospital administrators reportedly said in the email that despite these issues, there has been minimal exposure at the hospital because of safety protocols they have in place.
A UC Davis Health spokesperson declined Wednesday evening to share the email with The Times.
Since Feb. 2, more than 8,400 returning travelers from China have entered California, according to the state health department. They have been advised to self-quarantine for 14 days and limit interactions with others as much as possible, officials said.
“This is a new virus, and while we are still learning about it, there is a lot we already know,” Dr. Sonia Angell, director of the California Department of Public Health, said in a statement. “We have been anticipating the potential for such a case in the U.S., and given our close familial, social and business relationships with China, it is not unexpected that the first case in the U.S. would be in California.”
It is not clear how the person became infected, but public health workers could not identify any contacts with people who had traveled to China or other areas where the virus is widespread. That raises concern that the virus is spreading in the United States, creating a challenge for public health officials, experts say.
“It’s the first signal that we could be having silent transmission in the community,” said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law. “It probably means there are many more cases out there, and it probably means this individual has infected others, and now it’s a race to try to find out who that person has infected.”
On Tuesday, the CDC offered its most serious warning to date that the United States should expect and prepare for the coronavirus to become a more widespread health issue.
“Ultimately, we expect we will see coronavirus spread in this country,” said Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases. “It’s not so much a question of if, but a question of when.”
According to the CDC’s latest count Wednesday morning, 59 U.S. residents have tested positive for the new strain of coronavirus — 42 of whom are repatriated citizens from a Diamond Princess cruise. That number has grown by two since Messonnier’s last count Tuesday, although the CDC was not immediately available to offer details on the additional cases.
More than 82,000 cases of coronavirus have been reported globally, and more than 2,700 people have died, with the majority in mainland China, the epicenter of the outbreak.
But public health leaders have repeatedly reminded residents that the health risk from the novel coronavirus to the general public remains low.
“While COVID-19 has a high transmission rate, it has a low mortality rate,” the state Department of Public Health said in a statement Wednesday. “From the international data we have, of those who have tested positive for COVID-19, approximately 80% do not exhibit symptoms that would require hospitalization. There have been no confirmed deaths related to COVID-19 in the United States to date.”
CDC officials have also warned that although the virus is likely to spread in U.S. communities, the flu still poses a greater risk.
Gostin said the news of potential silent transmission does not eliminate the possibility of containing the virus in the U.S. and preventing an outbreak.
“There are few enough cases that we should at least try,” he said. “Most of us are not optimistic that that will be successful, but we’re still in the position to try.”
Originally Posted by mdchiefsfan:
I live in MD, so I’m not certain. I don’t think liquor is sold in grocery stores in PA. It isn’t in MD.
It is now due to a loophole. You can put a table down with a chair and technically you qualify, so grocery stores have a chair with a table, and certain convenience stores do the same now.
Edit: My fault read too fast. Hard liquor is state stores only. The above only applies to beer. [Reply]
Originally Posted by TLO:
So when do we see the social distancing impact come into play?
You're always two weeks behind. The numbers on Monday will be less (and hopefully a lot less) than what they would have been because of the infections prevented through distancing. [Reply]
Originally Posted by Chiefs4TheWin:
It is now due to a loophole. You can put a table down with a chair and technically you qualify, so grocery stores have a chair with a table, and certain convenience stores do the same now.
Edit: My fault read too fast. Hard liquor is state stores only. The above only applies to beer.
Beer isn’t sold in grocery stores in MD, so you guys have that going for you. [Reply]
Originally Posted by TLO:
It was a Prisma Health emergency room physician who first came up with the idea of using a single machine on multiple people, according to Marjorie Jenkins, chief academic officer for Prisma Health-Upstate and dean of the University of South Carolina School of Medicine Greenville.
:-) BS, 29 years ago in RT school we were practicing running a single vent on two patients in case of emergency. But, that aside....
Originally Posted by TLO:
Check this out..
‘Lifesaving’ ventilator device developed by Prisma Health gets emergency FDA approval
A team of doctors at Prisma Health has developed a device that allows a single ventilator to be used on up to four patients, potentially saving thousands of lives in the midst of the current COVID-19 pandemic.
On Wednesday, March 25, Prisma Health officials announced that the device, dubbed the VESper™, or ventilation expansion splitter, had received emergency use authorization from the U.S. Food and Drug Administration.
“We believe the device can be lifesaving,” said Peter Tilkemeier, chair of the Department of Medicine at Prisma Health-Upstate.
Produced using 3D printing technology, the device is developed with material already used in existing medical devices and produced at minimal cost.
Upstate Business Journal: Greenville-based laboratory named first SC commercial laboratory validated for COVID-19 testing
Prisma Health experts are now working with national COVID-19 teams that have no more ventilator capacity and can initiate emergency use of the prototype.
Emergency use authorization can offer critical care patients access to a medical device that hasn’t gone through normal FDA approval, Tilkemeier said at a news conference late Wednesday. It’s only used when no comparable or satisfactory alternative options are available.
Hospitals around the country are already facing a critical shortage of ventilators, which help patients breathe and can mean the difference between life or death for those suffering from the most severe respiratory effects of the novel coronavirus.
Nationally, more than 65,285 cases of the virus have been reported, and at least 926 people have died, according to a John Hopkins University database tracking the spread of the outbreak.
It was a Prisma Health emergency room physician who first came up with the idea of using a single machine on multiple people, according to Marjorie Jenkins, chief academic officer for Prisma Health-Upstate and dean of the University of South Carolina School of Medicine Greenville.
Prisma coronavirus ventilator
The VESper™ device being tested on medical manikins at Prisma Health’s Healthcare Simulation Center. -Provided
Working collaboratively with her husband, a software engineer, and a Prisma Health pulmonologist, the trio began developing specifications for a “Y” splitter tubing that could be easily produced on a 3-D printer.
“Immediately, we realized we had an opportunity to impact patient outcomes all over the country, and potentially beyond the U.S.,” Jenkins said.
Physicians used Prisma Health’s Healthcare Simulation Center to begin testing the VESper™ device with medical manikins, allowing for the simulation of multiple clinical scenarios. The device was able to deliver the appropriate breathing parameters without difficulty, officials said.
With Jenkins’ help, the team was able to secure FDA approval within a matter of days.
“It truly has taken a village to develop this device,” Jenkins said.
Anyone can download the source code and printing specifications for the device. Hospitals can apply by registering on Prisma Health’s website. The health system is also collaborating with other companies such as HP Inc. and its Digital Manufacturing Network to quickly scale 3D production and distribution to COVID-19 “hot spots” designated by the Federal Emergency Management Agency.
Specifications for the device can even be shared globally, Tilkemeier said.
Basically it looks like this new device is able to use 4 different expiratory ramps on 4 differnt patients. The issue with COPD and ARDS is that if you blow the air in or out too fast you can collapse the lung. You have to get your ramp right or the patient can die.
Why this matters for cornovirus is that Supdock reported that he had seen data that 40% of coronavirus patients on vents ended up with ARDS(Adult Respiratory Distress Syndrome).
ARDS makes it really hard to get the air in and out without damaging the lungs and if we don't get the air in and out, your going to die. ARDS is basically inflammation inside the lungs but that's really an oversimplification. To us it was like trying to get air in and out between two slabs of concrete but it was soft tissue in the lungs. You really need your best RT's on patients with ARDS to get the ramp correct and correlate it with breath sounds.
Just know, it's bad, really bad. 35%-50% survival rate when I was in the field. If we have better control of the ramp, we will definitely get that survival rate up. So this is really good news. [Reply]
Originally Posted by cdcox:
PA has always had a puritan view of alcohol. When I lived there in the late 80's the liquor stores were all run by the state. In some of them, you had to look up what you wanted in a book and tell the clerk the number, then they would go into the back and bring it out.
It's still that way. My wife is from Western PA, and it was a shocker for me when I first went there, coming from CA, buying a bottle of liquor. Missouri was a bit draconian when I left, but still nothing like PA. MO is pretty much "normal" now.
When I was in Philly in January, I wasn't surprised that I had to go to a State Store, or at least a dedicated liquor store, for booze...wanted to get a bottle for my hotel room. Not a big deal, just not as convenient as I am used to...Texas is similar. [Reply]
The Hammer involves very tight control measures "shelter in place" type restrictions, needed for 3 to 7 weeks. Since this thing got such a hold here, I'm guessing the longer time period will be needed. After that, we can loosen restrictions (the Dance) where some forms of social distancing are still needed (no large crowds, no conferences, no sporting events) but bars and restaurants and schools could open. The point of the dance is to drop R to less than 1. The Dance can't be effective until we are capable of wide scale testing and contact tracing. The Dance is what South Korea was able to do. They skipped the hammer because they got on top of it quickly. The dance is going to have to be maintained until a vaccine is developed. But we can't get to that until we have the cases under control. That will not happen for a number of weeks to come.
Have you seen the most recent Oxford model? They changed the assumption regarding the rate of severity and showed a model that fit the reality in the UK but was based on it having almost peaked at this point.
That is something I am having a problem reconciling when experts make projections based on us being in the very early phases of this. That assumption seems off to me. We know it spreads ridiculously fast. We know that it was in the wild in the US for AT LEAST 2 months (more likely 3) with little to no mitigation. Not just wishful thinking here, but the revised Oxford model simply makes more sense to me.
Another issue is with testing. Since we aren't testing for antibodies, we have no clue what the negatives mean. Are those people susceptible to the virus or people who are now immune? [Reply]
