Outside Topic Covid-19 considerations - Printable Version
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RE: Covid-19 considerations - BostonCard - 03-05-2020
(03-05-2020, 12:48 PM)OutsiderFan Wrote: There is now community spread in San Francisco. Two cases confirmed today with no connection to any known infected person and no travel to high infection areas. A 90 yo man and a 40 yo woman, not related in any way.
Just hope the heath care workers have proper protection, not just for themselves, but how easily they can infect others.
I find it absurd that any health care professional wouldn't be alarmed by what is happening. It's not the case fatality rate (with proper care) that is the concern. It's the potential of overrunning hospitals with sick people needing significant medical intervention. I read yesterday people are on waiting lists for hospital beds in South Korea. How many are gonna die who would have been saved if not for inundated hospitals?
This is why taking drastic measures to stop spread even when it doesn't appear the outbreak is that big, makes sense.
One of my colleagues is a former ER physician, and occasionally still works shifts when needed. He was asked to fill in for former colleague who treated a patient that was diagnosed with Covid-19. His colleague was placed on a 14-day quarentine. So, yes, there is awareness about the potential for infecting others.
Of course, as the disease spreads, and more physicians come in contact with patients with Covid-19, you aren't going to be able to be so picky, or the entire healthcare staff will be on quarentine (then again, once the virus becomes widespread, the added benefit of shutting down this particular mode of transmission is a bit moot). The crap will hit the fan once a substantial number of nurses, physicians, and other healthcare staff become infected. What if you don't have enough nurses to run the hospital?
BC
(03-05-2020, 01:39 PM)burger Wrote: Interesting post on a virology forum (though posted by a virus scientist/statistician): it sounds like the paper reporting that there are two strains of the virus jumped to conclusions not supported by evidence:
Quote:However, they further claim that these two types have differing transmission rates: “Thus far, we found that, although the L type is derived from the S type, L (~70%) is more prevalent than S (~30%) among the sequenced SARS-CoV-2 genomes we examined. This pattern suggests that L has a higher transmission rate than the S type.” The abstract of the paper goes even further, stating outright that: “the S type, which is evolutionarily older and less aggressive…”
It is, however, important to appreciate that finding a majority of samples with a particular mutation is not evidence that viruses with that mutation transmit more readily. To make this claim would, at very minimum, require a comparison to be made to expectations under a null distribution assuming equal transmission rates. As this has not been performed by the authors, I believe there is insufficient evidence to make this suggestion, and that it is incorrect (and irresponsible) to state that there is any difference in transmission rates. Differences in the observed numbers of samples with and without this mutation are far more likely to be due to stochastic epidemiological effects.
tldr: there is no evidence for aggressive/non-aggressive strains
http://virological.org/t/response-to-on-the-origin-and-continuing-evolution-of-sars-cov-2/418
Note, generally speaking as infectious agents mutate, they tend to increase their ease of transmission (natural selection; easier to transmit viruses get transmitted more), and decrease their virulence and mortality (because dead people can't transmit the virus).
BC
RE: Covid-19 considerations - oldalum - 03-05-2020
alarming report from Germany in this week's New England J of Medicine confirming transmission of infection early in its asymptomatic incubation period. Patient "1"(who had been infected by a then-asymptomatic index patient who had traveled to Germany from China) then infected another work colleague with whom he had contacts only the same day or the day after patient 1 himself became infected--and 3 or 4 days before patient 1 became symptomatic. If such early transmission soon after infection is common, it will spread quickly and widely. All the patients in this cluster had short, mild cases.
article
RE: Covid-19 considerations - burger - 03-05-2020
(03-05-2020, 02:26 PM)BostonCard Wrote: Note, generally speaking as infectious agents mutate, they tend to increase their ease of transmission (natural selection; easier to transmit viruses get transmitted more), and decrease their virulence and mortality (because dead people can't transmit the virus).I agree, but as oldalum noted, this virus seems to spread when patients are still asymptomatic. Also, the death rate is not so high that it's killing people before it can spread. So I doubt that there is much selective pressure for less virulence or mortality right now. Perhaps that will change as control measures improve.
BC
RE: Covid-19 considerations - stupac2 - 03-05-2020
(03-05-2020, 09:53 AM)2006alum Wrote:(03-05-2020, 09:37 AM)stupac2 Wrote: Regarding the insouciance of doctors, one of my friends is an infectious disease doctor in Oakland and is so far at the "mildly intrigued" level on this virus. Mostly he thinks it's boring. Very normal "wash your hands, take normal precautions" advice. Not sure what that's worth, but it does seem like most medical professionals aren't super worried.Given the high mortality rates in places like Iran and Italy, where the virus has been transmitting for longer, is your friend's view that this is just a more morbid version of the flu? When I see mortality rates in the 10-15% range for folks in their 70s and 80s, that worries me a lot, even if my own chance of serious complications remains very low. And it seems like even at the very lowest end of the estimated mortality rate that I've seen (approx. .3-.4% vs. the 3.4% the WHO reported) would be very serious on a nationwide scale. That's double the mortality rate of the flu, and would be coupled with the flu such that treating facilities would be even more strapped to provide high quality care than ordinary. There's also no herd immunity, so the likelihood of many older individuals getting it would seem much higher than with flu strains, which have been circulating and mutating for decades.
Right, my impression is that he thinks it's just a flu that hits old people harder and children less hard. But I will note that questions about it rated a "pshh" and a scoff in previous weeks, and more of an "eh" this week, so it's an evolving situation.
(This isn't to say that he, or anyone I've seen, is against taking reasonable precautions to protect yourself.)
RE: Covid-19 considerations - Snorlax94 - 03-05-2020
For what it's worth, here's what I've been seeing/hearing:
1) Today, with almost no notice, my son's middle school soccer game was cancelled. It feels like the entire season will be called off, because tonight's orchestra concert was cancelled, and all upcoming field trips have been cancelled. I have not heard anything about any cases at this school district, which is a smallish public K-8 district in the South Bay.
2) Today, for my allergy shot at the Palo Alto Medical Foundation, the waiting room for my allergy shot was empty, but the parking lot was very full. That doesn't necessarily mean that everyone is in Urgent Care, but it makes me wonder.
It could just mean everyone who has the slightest cold is panicking and heading to the emergency room. It would have been helpful if the federal government hadn't made so many statements supporting the anti-vaxxer movement these past few years.
Maybe the public officials know something I don't know (maybe there was a case in the district that hasn't been publicized yet, maybe there is a mutated strain that is more transmissible and deadly), but I personally feel I haven't seen enough evidence to take these actions in Santa Clara County yet. Cancelling school (which they haven't done yet) should be reserved for the critical times, and should require a high bar. Soccer is a sport that takes place in the open air, and there is at least 20 feet between attendees.
RE: Covid-19 considerations - terry - 03-05-2020
Santa Clara County just issued new guidance as follows:
At this time, we recommend postponing or canceling mass gatherings and large community events where large numbers of people are within arm’s length of one another.
In a Q&A session, county officials mentioned concerts and arena events as examples of such "mass gatherings and large community events." They did not discuss college or youth sports events. They are not closing schools.
https://www.sccgov.org/sites/phd/news/Pages/new-guidance-new-covid-19-3-5-2020.aspx
RE: Covid-19 considerations - TreeWeird - 03-05-2020
(03-05-2020, 04:46 PM)terry Wrote: Santa Clara County just issued new guidance as follows:
At this time, we recommend postponing or canceling mass gatherings and large community events where large numbers of people are within arm’s length of one another.
In a Q&A session, county officials mentioned concerts and arena events as examples of such "mass gatherings and large community events." They did not discuss college or youth sports events. They are not closing schools.
https://www.sccgov.org/sites/phd/news/Pages/new-guidance-new-covid-19-3-5-2020.aspx
I would emphasize this quote from county: I want to remind the public that the vast majority of people who become infected with COVID-19 do not become seriously ill, and fully recover. We are making these recommendations to protect the most vulnerable members of our community from the virus, and slow its spread,” said Dr. Sara Cody, County Public Health Officer.
RE: Covid-19 considerations - M T - 03-05-2020
(03-05-2020, 04:23 PM)Snorlax94 Wrote: It could just mean everyone who has the slightest cold is panicking and heading to the emergency room.
IF ANYONE HERE feels they may have COVID-19 now or in the future, do NOT just go to urgent care or the ER or your doctor unannounced. Call ahead. Let them know you are coming, so they can meet you before you walk in where others are. They will, at the very least, give you a mask and maybe escort you in through a side door. (Heck, for all I know, they may come to you, what with the apparent protocol of home "isolation".)
From the SCC guidance:
Quote:Do not go to the emergency room unless essential. Emergency rooms need to be able to serve those with the most critical needs. If you have symptoms like cough, fever, or other respiratory problems, contact your regular doctor first.
6 more today; total of 20. No information as to source yet. (IMO, it doesn't matter much any more whether case #21 traveled overseas. The majority of cases have gotten the disease in SCC.)
Edit: SCC has updated their website and took away any information other than the total number of infections. None of the HIPAA-allowed information such as gender, age, 3-digit zipcode, etc.
RE: Covid-19 considerations - BostonCard - 03-05-2020
The more cases that are reported, the less the individual details of the cases matter.
BC
Lowell closed tomorrow.
SFGate has a good tracker of cases in the Bay Area.
https://www.sfgate.com/bayarea/article/where-coronvirus-bay-area-covid-19-santa-clara-15103180.php
BC
RE: Stanford Athletics Coronavirus Update March 3rd - UltimateCard - 03-05-2020
the latest from Stanford Athletics:
https://gostanford.com/news/2020/3/3/stanford-athletics-coronavirus-update.aspx
Venues will be limited to 1/3 capacity. County advises folks at risk, including anyone over 50, to stay away. Guess I’ll be watching from home.
RE: Covid-19 considerations - magnus - 03-05-2020
(03-05-2020, 02:59 PM)burger Wrote: I agree, but as oldalum noted, this virus seems to spread when patients are still asymptomatic. Also, the death rate is not so high that it's killing people before it can spread. So I doubt that there is much selective pressure for less virulence or mortality right now. Perhaps that will change as control measures improve.
Actually, the NEJM conclusion on asymptomatic transmission was later questioned by the Washington Post when it was discovered that the original lady did have symptoms.
https://www.washingtonpost.com/health/2020/02/04/key-evidence-coronavirus-spread-is-retracted-public-health-decisions-loom/
RE: Covid-19 considerations - BostonCard - 03-05-2020
Now 11 deaths in the US but only 200 or so diagnosed cases. Either we have the worst healthcare system in the world, or there are hundreds of undiagnosed cases out there spreading disease.
BC
RE: Covid-19 considerations - magnus - 03-05-2020
(03-05-2020, 09:47 PM)BostonCard Wrote: Now 11 deaths in the US but only 200 or so diagnosed cases. Either we have the worst healthcare system in the world, or there are hundreds of undiagnosed cases out there spreading disease.And/or the first cluster was in a very poor location.
BC
RE: Covid-19 considerations - oldalum - 03-05-2020
(03-05-2020, 09:40 PM)magnus Wrote: Actually, the NEJM conclusion on asymptomatic transmission was later questioned by the Washington Post when it was discovered that the original lady did have symptoms.
I can't read the article, but the "original lady" (aka the index patient) was not who I was talking about. I was focusing on the spread of the virus from "patient 1" to another person, which occurred within one day of patient 1 acquiring the infection. No way patient 1 was symptomatic then.
RE: Covid-19 considerations - burger - 03-05-2020
(03-05-2020, 09:40 PM)magnus Wrote:This is really nitpicky. The woman had mild vague symptoms like back pain? No one is going to think they have coronavirus based on mild back pain or whatever. There have also been other presumed asymptomatic cases plus cases with documented high viral loads and no symptoms. It's far better to assume the worst about transmission and be wrong than to overlook this possibility.(03-05-2020, 02:59 PM)burger Wrote: I agree, but as oldalum noted, this virus seems to spread when patients are still asymptomatic. Also, the death rate is not so high that it's killing people before it can spread. So I doubt that there is much selective pressure for less virulence or mortality right now. Perhaps that will change as control measures improve.
Actually, the NEJM conclusion on asymptomatic transmission was later questioned by the Washington Post when it was discovered that the original lady did have symptoms.
https://www.washingtonpost.com/health/2020/02/04/key-evidence-coronavirus-spread-is-retracted-public-health-decisions-loom/
RE: Covid-19 considerations - 76lsjumb - 03-05-2020
(03-05-2020, 04:23 PM)Snorlax94 Wrote: It would have been helpful if the federal government Robert F. Kennedy, Jr. hadn't made so many statements supporting the anti-vaxxer movement these past few years.
There... fixed it for you.
RE: Covid-19 considerations - akiddoc - 03-06-2020
What medical facilities should be doing is advising patients who may have the virus to stay home unless they are beginning to have life threatening symptoms or symptoms that are likely to lead there. There is nothing we can do about it in the outpatient setting. We have no medication to slow the infection or defeat it. If a patient has asthma and they begin to wheeze most patients already have the medication they need at home. If they are having respiratory distress beyond the ordinary they will potentially need hospitalization. Going to the doctor's office or an urgent care center just infects a lot of other people.
Today, my office was flooded with kids with mild cold symptoms whose parents thought they might have Covid-19. Absolutely nothing I can do about it one way or another. Under normal circumstances most of these kids would have stayed at home.
Doctors are not being cavalier about this. But we're all exposed to life threatening infections and we know it is part of the job. It's part of staying calm and doing our jobs when you don't see us overreacting. I have a 3-5% chance of dying this year instead of the usual 1% that 63 year olds have. Not a good thing but I do have a job to do so I'm going to do it. In the back of your mind you know you could catch something deadly when you sign on for this career, but we're more likely to die of suicide than an infectious disease.
This not "just another flu." It's not an influenza virus at all. The death rate for Influenza is about 1/20 of the death rate for Covid-19 across all age groups except for the under 10 year old group where Influenza appears to be much more deadly 34,000 people died from Influenza in the USA last year. Since we seem unwilling to clamp down on commercial activity like the Chinese did, we're likely to see a lot more deaths than that from C-19.
(03-05-2020, 11:57 PM)76lsjumb Wrote:(03-05-2020, 04:23 PM)Snorlax94 Wrote: It would have been helpful if the federal government Robert F. Kennedy, Jr. hadn't made so many statements supporting the anti-vaxxer movement these past few years.
There... fixed it for you.
Ha! Good one.
RE: Stanford Athletics Coronavirus Update March 3rd - Mick - 03-06-2020
(03-05-2020, 09:22 PM)UltimateCard Wrote: the latest from Stanford Athletics:
https://gostanford.com/news/2020/3/3/stanford-athletics-coronavirus-update.aspx
Venues will be limited to 1/3 capacity. County advises folks at risk, including anyone over 50, to stay away. Guess I’ll be watching from home.
Great. I'm in Chicago, flying from O'Hare through Dallas to San Jose. Bringing with me more wipes than a mom of sextuplets.
Airports and planes 2/3 full. Maybe 1/3 full by the time I return to DC.
RE: Langdude - Mick - 03-06-2020
Might be more to protect the teachers and staff than the students.
(03-04-2020, 10:04 PM)Genuine Realist Wrote: That seems wild overkill, particularly because of the low incidence among children under 15.
(03-04-2020, 09:54 PM)Langdude Wrote: Seattle area. The district just closed all schools indefinitely, beginning tomorrow. Transitioning to online teaching. This will be very difficult for those families that rely on school for childcare... We are lucky in that my wife and I have intentionally shaped our lives so that one of us can always be home with the kids (we have 4)...
-m.
RE: Langdude - 82lsju - 03-06-2020
or to minimize the number of older people people at home that the kids could infect if they caught it.
(03-06-2020, 03:48 AM)Mick Wrote: Might be more to protect the teachers and staff than the students.
(03-04-2020, 10:04 PM)Genuine Realist Wrote: That seems wild overkill, particularly because of the low incidence among children under 15.
(03-04-2020, 09:54 PM)Langdude Wrote: Seattle area. The district just closed all schools indefinitely, beginning tomorrow. Transitioning to online teaching. This will be very difficult for those families that rely on school for childcare... We are lucky in that my wife and I have intentionally shaped our lives so that one of us can always be home with the kids (we have 4)...
-m.