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 'Hamas' Jenkins:
The models of bed capacity are based upon occupancy only. Bed capacity isn't functional capacity where people are receiving adequate care. Hospitals also plan for surge scenarios (mass casualty incidents, etc.) to ensure that there is always true flex built into the system to sustain such events.
Regarding healthcare workers: 14 percent of those infected in Spain as of last week were healthcare professionals, around 3000 of the reported cases in China were in healthcare, and at least 200 in NYC were sick (from a NYT article on 3/30). That's a lot of infections, and moving it up to true 100% capacity would have made only increased the probability of additional infections further.
We're gonna hit at/near 100% capacity in NYC. I never said the point was to stay at 100% capacity - I said the point was to eventually bump right against it. Like I said - apex the turn. If your worst day climbs you right to the brink of your capacity, you've done it damn near perfectly.
And do you really feel qualified to speak to what steps/processes/policies Spain undertook before declaring them remotely useful as a comparison? And FFS...China again. Why do we care about anything China is saying?
My point regarding healthcare workers in NYC is that they are going to get sick anyway. They're surrounded by it - but how many of those got it BECAUSE of a PPE shortage? How many of them didn't just take a mask off right? Or get it in the subway? Or at home? Or would've gotten it with brand new equipment because the stuff isn't 100% effective. Again, there's little evidence right now that the one place we can point to as ground zero has experience a massive shock to their healthcare system BECAUSE of an equipment shortage. Or even that time would ultimately have solved said shortage because again - we have equipment RIGHT NOW that we just aren't getting to them (hurray bureaucracy!). [Reply]
Originally Posted by DJ's left nut:
Then your discussion becomes the definition of 'capacity', then. And the supply issue doesn't seem to be working itself out anyway, despite the fact that we seem to have a lot of PPE in various places that we simply aren't getting to the places that need it. Time doesn't seem likely to solve that (as a nationwide lockdown instead of an organic spread has anyplace that HAS spare equipment holding onto it like grim death).
Moreover, we have little evidence yet that medical providers are being hit inordinately hard right now due to a lack of PPE. The situation on the ground appears to be that things aren't ideal, but they also aren't critical. Yes, some healthcare providers are contracting it, but compare their rates to transit workers or retail workers and they're not out of line (especially when compared to the rates of exposure).
They're pushing equipment right to the edge of its functional envelope, but the results thus far aren't that they're not being protected at all because of that. They're using every inch of runway in most cases, but there's still little indication that planes are driving off the edge. If outcomes have been worse because of these shortages, it's a damn small amount. Which again gets back to the definition of capacity - isn't that consideration baked into the cake already?
Probably most big city hospitals aren't following OSHA guidelines in regards to PPE and haven't for awhile. There is going to be a massive amount of lawsuits happening after this is over because of that. I know your a lawyer you might want to jump on that gravy train. [Reply]
Originally Posted by 'Hamas' Jenkins:
How about we just have enough patience to see if this really is the peak. And if it is the peak, from there we have enough patience to coast down the other side of the peak until we put out the first to a great extent. And from there, we can work much harder on isolating and contact tracing any new cases that pop up as we gradually open up with greater social distancing and use of PPE in public.
Patience. This is NYC getting to and over the peak, hopefully. It's not every region in the country.
I think a whole lot of people were busting their ass trying to do this early on in this outbreak and still couldn't do it. What additional tools are going to surface that suddenly make it more likely later on?
First blush is that yes, heavy testing, both fast-response infection and serological, combined with significant contact tracing and isolation efforts is the best path forward.
But as you think more and more about the numbers involved and the scope of that endeavor, it just seems less and less feasible when you're still at an N north of 300 million.
So we just ride this coaster up and down for a year? Hoping that every hill is just a little smaller because of a reduced N and increased ability to test/isolate?
I don't think that takes human nature into account very well... [Reply]
Originally Posted by DJ's left nut:
We're gonna hit at/near 100% capacity in NYC. I never said the point was to stay at 100% capacity - I said the point was to eventually bump right against it. Like I said - apex the turn. If your worst day climbs you right to the brink of your capacity, you've done it damn near perfectly.).
That only applies if the analogy applies. It's not a race. It's damned easier to provide adequate care for 10 patients than 30, even if you can theoretically care for 30. You may be able to verify 500 orders in a shift, but your error rate will go up substantially compared to verifying 100 because you can't cross-check to the extent necessary. You may be able to intubate a dozen patients, but that's still a dozen exposures compared to six, and that's twice as much medication you'll need to use to induce.
The point behind the distancing measures isn't to get the hospitals to peak capacity--the point behind the measures is to get the R0 as low as possible so the virus dies out and the hospitals don't have to reach peak capacity.
If all of the hospitals in this area end up not needing a separate COVID isolation unit that's a big fucking win, not a waste. [Reply]
Originally Posted by dirk digler:
Probably most big city hospitals aren't following OSHA guidelines in regards to PPE and haven't for awhile. There is going to be a massive amount of lawsuits happening after this is over because of that. I know your a lawyer you might want to jump on that gravy train.
Gonna have virtually impossible causation problems. Even the ol' res ipsa approach will fail.
Best bet would probably be a wave of class-actions to muddy the causation arguments that will yield massive damage to the hospitals but only serve to make the attorneys rich while the plaintiffs end up getting a few thousand each and maybe some medical bills written off.
I mean yeah, you're gonna have late night 'mesothelioma' style cottage industry commercials popping up for years, but I don't think this will yield a true sea change. [Reply]
Originally Posted by 'Hamas' Jenkins:
That only applies if the analogy applies. It's not a race. It's damned easier to provide adequate care for 10 patients than 30, even if you can theoretically care for 30. You may be able to verify 500 orders in a shift, but your error rate will go up substantially compared to verifying 100 because you can't cross-check to the extent necessary. You may be able to intubate a dozen patients, but that's still a dozen exposures compared to six, and that's twice as much medication you'll need to use to induce.
The point behind the distancing measures isn't to get the hospitals to peak capacity--the point behind the measures is to get the R0 as low as possible so the virus dies out and the hospitals don't have to reach peak capacity.
If all of the hospitals in this area end up not needing a separate COVID isolation unit that's a big fucking win, not a waste.
'The virus dies out...'?
Oh...that's their plan? That it just goes away?
Well I guess that changes everything.
I don't think that's their plan at all because I don't think anybody expects that to happen. Ultimately I think you're working from a seriously faulty premise in trying to analyze their approach. At least I hope you are because if THEY are working from that premise, I think we're proper fucked. [Reply]
Originally Posted by DJ's left nut:
I think a whole lot of people were busting their ass trying to do this early on in this outbreak and still couldn't do it. What additional tools are going to surface that suddenly make it more likely later on?
First blush is that yes, heavy testing, both fast-response infection and serological, combined with significant contact tracing and isolation efforts is the best path forward.
But as you think more and more about the numbers involved and the scope of that endeavor, it just seems less and less feasible when you're still at an N north of 300 million.
So we just ride this coaster up and down for a year? Hoping that every hill is just a little smaller because of a reduced N and increased ability to test/isolate?
I don't think that takes human nature into account very well...
Your N isn't 300 million. Your actual N is anyone with a confirmed infection and their contacts, which makes it much more manageable (similar to what SK did).
You reduce the R0 by implementing the distancing measures and utilizing masks in public to a far greater extent. If you have greater mask wearing in public, you have less exposure, which then makes it easier to track and trace. [Reply]
Originally Posted by DJ's left nut:
'The virus dies out...'?
Oh...that's their plan? That it just goes away?
Well I guess that changes everything.
I don't think that's their plan at all because I don't think anybody expects that to happen. Ultimately I think you're working from a seriously faulty premise in trying to analyze their approach. At least I hope you are because if THEY are working from that premise, I think we're proper fucked.
If the R0 is less than 1, the virus dies out. That's the entire point behind all of the distancing measures--give the hospitals time to cope with the influx of the already infected, and break the spread to the point where the virus isn't spreading fast enough to propagate. From there, implement stricter controls as you open society back up to keep any other flareups limited and the R0 as low as possible. [Reply]
Originally Posted by O.city:
I think the issue with the models is we’re finding out there is some natural innate immunity to this thing. Also the asymptomatic carriers and such.
The at home test would have to be serology tests anyway.
Originally Posted by O.city:
I wouldn’t spike the ball in the first quarter here yet
Originally Posted by 'Hamas' Jenkins: Your N isn't 300 million. Your actual N is anyone with a confirmed infection and their contacts, which makes it much more manageable (similar to what SK did).
You reduce the R0 by implementing the distancing measures and utilizing masks in public to a far greater extent. If you have greater mask wearing in public, you have less exposure, which then makes it easier to track and trace.
SK was able to do that because they had that one super-isolated outbreak that gave them a much more clearly defined starting point.
I just don't see that happening here. We're gonna need dozens of similarly outfitted and capable 'response teams' to pull of anything approaching that.
Again, just seems far-fetched to me. You're looking at an unprecedented level of man-power and intervention. And even then, it's only slowed for as long as all of those measures remain in place; so years. The 'N' isn't necessarily the people you're 'investigating' but rather their contacts. Those remain unwieldy unless you maintain things at the level they are now (which then again gets back to definitions; how do you define your 'social distancing' measures above? And for how long?).
I'd like it to work - sure. I simply don't think it can. Not on this scale and not for any appreciable period of time. [Reply]
Originally Posted by 'Hamas' Jenkins:
If the R0 is less than 1, the virus dies out. That's the entire point behind all of the distancing measures--give the hospitals time to cope with the influx of the already infected, and break the spread to the point where the virus isn't spreading fast enough to propagate. From there, implement stricter controls as you open society back up to keep any other flareups limited and the R0 as low as possible.
It will die out (in theory) over an extraordinary timeline. And if we haven't been able to do that with literally dozens (hundreds) of infectious diseases, why should we expect we can here? Shit, HIV has an R0 around 2 and it's a hell of a lot harder to get than this is.
Again, I don't think that's the plan because it simply never has been.
And because of the novel nature of this one, it's going to even more difficult/impossible to pull off. I mean getting it below 2 seems plenty doable, but the idea that we're putting policies in place with the idea of driving it below 1 over any timeline of less than 2-3 years seems completely out there to me. That's ambitious to the point of folly. [Reply]
