Outside Topic Covid-19 considerations - Printable Version

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RE: Covid-19 considerations - Goose - 03-09-2020

One fact everyone in the US needs to clearly understand is that the US does NOT have a national force that is responsible for/capable of  controlling the movements of it's citizens. I do not know the structure of the PLA, but they do have the task of internal as well as external security. Italy has the Caribinieri (and also in a pinch the Gaurdia Finanza) that are federally controlled military police. I know for a fact that the Caribinieri practices cordoning off entire suburbs as a regular exercise. They are good, well trained, and confident in that task.

If a similar cordon is required in the US it will be initially provided by local police. If more help is required, the state based National Guard can be called upon. If the Governor of a state agrees, the Guard can be "federalized" and placed under Federal control. However, the National Guard is not a full-time police force that is well trained and constantly ready to cordon off a part of a city or an entire county/state. They can probably do it, but it will be slow in happening and will be a mess. I don't want to offend anybody that serves with the Guard, but realistically I think most members would agree that they are not really trained to do this and don't practice it in large cities regularly. They also have "day jobs" that will go undone, and there are probably just not enough of them. The CDC plans for a pandemic, whatever they may be/may have been have to work with these facts. They do not have direct control of anything.

Firing the two highest officials in the chain of command for pandemic planning and not replacing them does not, of itself, mean their subordinates are not continuing to do their job. What message it does send is that that function is being deprecated in the eyes of the administration. It would be one thing if the problem was the people in the job were not good. It is another to get rid of them and not replace them. However, if we need to do what China did and Italy is doing, we will have worse problems than a couple of missing administrators.

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RE: Covid-19 considerations - Treefence - 03-09-2020

Forgive me if someone has posted this already but this is scary.  Hopefully it's an outlier and not something that will be replicated, but if meningitis because a symptom of Covid-19 then that's really bad news.  

https://www.reuters.com/article/us-health-coronavirus-japan/japans-7-eleven-worker-infected-with-coronavirus-another-case-likely-caused-meningitis-idUSKBN20V05D

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RE: Covid-19 considerations - BostonCard - 03-09-2020

Because of the nature of this topic, it is sometimes not a big jump to go from a description of what is happening to an evaluation of the competence of the response (or lack thereof) to apportionment of political praise or blame for the response, which can quickly devolve into attacking or defending the administration.

While I think some of this is unavoidable in a discussion (and I myself have waded into issues about government response, though mostly focused on the response in China) and speaking only for myself, I think a "light touch" to moderating this thread is appropriate, I do hope that individual posters will self-moderate and focus first and foremost on the virus and pandemic itself and its implications, especially for Stanford and Stanford athletics.

BC

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RE: Covid-19 considerations - M T - 03-09-2020

(03-09-2020, 08:14 AM)BostonCard Wrote:  I disagree because the "necessary steps" didn't happen until the horse was out of the barn, so to speak.

It appears to me that China responded more quickly than the US.  (IMO, the US opened the barn door and continue to send the horses out to graze on their own.)

1 Dec - patient 0 gets symptoms.
8 Dec - patient 0 seeks medical care.
27 Dec - Dr. Zhang reports a cluster (4) of unusual pneumonia cases
30 Dec - active case finding starts
31 Dec - WHO is notified   (12 new cases/day)
1 Jan - a suspect hotspot is closed
7 Jan -  Virus identified
13 Jan - test kits become available
20 Jan -  WHO reports 278 conf. cases in Wuhan (60 new), 6 deaths
23 Jan - Wuhan shut down
24 Jan - 15 other cities shut down
18 Feb - maximum number of patients (38,000) in hospitals (NOTE: In China, all those with positive tests were put in hospitals.)

If you were to think of King County as the US's Wuhan...
Population: King County 2.2M; Seattle metro 3.5M;   Wuhan: 11M,   metro 19M
King County knew of the disease.  This wasn't something they had to figure out on their own.

Jan 19 - First case in US, in Washington State. (date of sample; announced 2 days later). Not in King County.
Feb. 26 - First death in King County (retrospective; undiagnosed)
Mar 5 - 20 new cases, 51 total, 10 deaths 
Mar 8 - 12 new cases, 83 total, 17 deaths

Seattle on March 8 has a higher density of cases & deaths than Wuhan on January 20.
Anyone thinking Seattle will be shut down in 3 days?

The US is far worse off than China of January 20.  China outside of Wuhan only had 24 cases.

P.S. I spoke to a prominent doctor that could not even imagine all the positive cases going into the hospital in the US or elsewhere.


Useful links:
EPA's list of disinfectants for Covid-19
Handwashing & wiping down surface tips  It pointed out some things I had been doing wrong.

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RE: Covid-19 considerations - cardcrimson - 03-09-2020

For all intents and purposes, Israel has closed it's borders. They now require a 14 day quarantine for anyone entering the country.

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RE: Covid-19 considerations - burger - 03-09-2020

As an alternative to a massive quarantine, South Korea has been doing massive numbers of tests (over 100,000 I believe).  They've also been doing an incredible job at contact tracing (e.g. https://www.latimes.com/world-nation/story/2020-02-27/south-korea-coronavirus-cases-surveillance ; saw another excellent news article on this but I can't recall where now). 

And now their numbers of new cases are on the decline: https://www.cnn.com/2020/03/09/asia/south-korea-coronavirus-intl-hnk/index.html They are not out of the woods yet, but I'd rather be in Seoul now than in California, health-wise at least.

It's probably far to late for the CDC to do anything like this now in the US.  The federal response on this so far has been non-existent--I mean, can anyone even point me to anything the CDC has done aside from a few quarantines in the initial phases and massively botching the test kit rollout (while failing without explanation to use the WHO developed tests)?  They're useless so far.

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RE: Covid-19 considerations - 2006alum - 03-09-2020

For what it's worth, the complete lockdown of Wuhan on January 23rd occurred when China had 571 positive diagnoses and 17 deaths. The United States passed those numbers sometime yesterday. Wuhan is still locked down as of today.

Think about that.

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RE: Covid-19 considerations - Snorlax94 - 03-09-2020

As if we needed more frustrating news...

St. Louis’s first case of covid could lead to many — a college student traveling in Italy landed in Chicago and took Amtrak back to St. Louis, arriving in the main train/bus transportation hub for the region. Friday, her symptoms were so severe a 20 year old had to go to the hospital.

Saturday, her father and younger sister violate their quarantine by attending a father-daughter school dance at the St. Louis Ritz Carlton. The dance was for two schools that together teaches girls PK-8. Before the dance, the father and younger daughter attend a pre-party with students from many other St. Louis schools. The father and daughter did this all AFTER being quarantined because the older daughter had to be hospitalized after traveling in Italy.

https://www.stltoday.com/lifestyles/health-med-fit/coronavirus/family-of-missouri-s-first-coronavirus-patient-broke-self-quarantine/article_94fe6bf6-f679-5b88-870c-18c5f79d019b.html

Of course people in St Louis are really pissed

https://www.stltoday.com/news/local/metro/furious-st-louis-responds-to-quarantine-failure-by-family-of/article_8a2201a5-0557-5dda-8a4a-850f66ed5005.html

This reminds me of the the cult-church case in S Korea, and of that Andrew Speaker guy many years ago who, after learning he had treatment-resistant tuberculosis, added new countries to his itinerary to sneak back into the US by driving in through Canada.

It is maddening to think a small group of people or individuals can cause so much potential damage due to ignorance and or selfishness.

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RE: Covid-19 considerations - magnus - 03-09-2020

I've been following closely since mid January and one thing that I'd caution would be to trust China's numbers completely, especially early on. 

Rumors/reports in the early going about severe underreporting (classification method; don't test, don't tell).   Projections by some universities that numbers were actually 10-100x (Lancelot?)

How much of that was true and how much was fear mongering,  I don't know but I wouldn't be surprised if numbers were underreported.

That said,  even in the US we have experts saying that we're likely 10x-100x below reality, so maybe we can compare.  =/

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RE: Covid-19 considerations - 2006alum - 03-09-2020

All of Italy is now under lockdown. I suspect this is just the first of a number of dominoes to follow.

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RE: Covid-19 considerations - BostonCard - 03-09-2020

(03-09-2020, 12:31 PM)M T Wrote:  It appears to me that China responded more quickly than the US.  (IMO, the US opened the barn door and continue to send the horses out to graze on their own.)



1 Dec - patient 0 gets symptoms.

8 Dec - patient 0 seeks medical care.

27 Dec - Dr. Zhang reports a cluster (4) of unusual pneumonia cases

30 Dec - active case finding starts

31 Dec - WHO is notified   (12 new cases/day)

1 Jan - a suspect hotspot is closed

7 Jan -  Virus identified

13 Jan - test kits become available

20 Jan -  WHO reports 278 conf. cases in Wuhan (60 new), 6 deaths

23 Jan - Wuhan shut down

24 Jan - 15 other cities shut down

18 Feb - maximum number of patients (38,000) in hospitals (NOTE: In China, all those with positive tests were put in hospitals.)

I am not at all suggesting that the United States' response has been appropriate.  At all.  Just that I would not look at China's response as a model.  For example, you forgot several things in your timeline:

30 Dec: Li Wenliang posts to a WeChat group of medical school classmates about a mysterious illness that had stricken seven patients.  One of his classmates responded "So freightening.  Is SARS coming again?"
30 Dec: Overnight, Li was summoned by the local health authority asking why he had shared the info.
31 Dec: Local police announce that they were investigating eight people for spreading rumors about the outbreak.
2 Jan: Li was forced to sign a statement that he made the whole thing up and that he would stop spreading "dangerous rumors".'
6 Jan: Li noticed that one of his colleagues likely had the infection on a scan (I assume CT scan).  He was ordered not to report it.
7 Jan: An infected patient was operated on, spreading the disease to 14 medical workers.
15 Jan: Guan Yi, a respected professor of infectious diseases at the University of Hong Kong, having seen no new cases reported by officials in Wuhan said "If there are no new cases in the next few days, the outbreak is over,”
19 Jan: Wuhan went ahead with a massive annual potluck banquet for 40,000 families from a city precinct (to quote Teejers, AYFKM?)
20 Jan: More than a month after the first symptoms spread, Dr. Zhong Nanshan (semiretired epidemiologist who was instrumental in the fight against SARS) announced in an interview on state television that there was no doubt that the coronavirus spread with human contact. Worse, one patient had infected at least 14 medical personnel.  This was the first Chinese acknowledgement that there was person to person spread of the virus, even though that day there were 278 confirmed cases and 6 deaths.
7 Feb: Li Wenliang dies

https://www.nytimes.com/2020/02/01/world/asia/china-coronavirus.html
https://www.theatlantic.com/technology/archive/2020/02/coronavirus-and-blindness-authoritarianism/606922/

No one can say for sure what would have happened had Chinese officials not tried to hide the epidemic.  Maybe it still manages to spread widely, maybe it spreads but more slowly, maybe it gets contained within Wuhan.  But I find it unconscionable that doctors trying to sound the alarm were silenced, and I honestly don't get how one can praise the Chinese response to the virus as if the "Chinese response" began on Jan 20, 2020.

BC

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(03-09-2020, 01:47 PM)2006alum Wrote:  All of Italy is now under lockdown. I suspect this is just the first of a number of dominoes to follow.

At least they had the decency to wait until the stock market ended trading for the day.
(I should be clear that I am engaging in a little gallows humor; obviously the coronavirus is very serious and hundreds of people have died from coronavirus in Italy, which is a tragedy.)

BC

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RE: Covid-19 considerations - OutsiderFan - 03-09-2020

It's too late for the U.S. The dithering response from federal AND state and local officials has doomed us. This leads to people like Dan Gavitt saying "we have no plans to cancel March Madness."

Today a top hedge fund manager said he's out of the stock market until we have a level of testing that can accurately tell us what is happening. So the lack of testing is now impacting how people's 401Ks are valued. Unreal.

Of course, the Seattle area rehab facility that has killed so many people said this yesterday.  All the patients at the facility. have been tested and are waiting for results?  I wonder how many will die while waiting for them?  Worse, the health care workers ARE NOT BEING TESTED!!! 

They STILL are having absurdly high bars for testing. NOBODY without symptoms is being tested, when the reality is it is this population likely spreading the most. Oh the irony of pin-head politician who mocked the virus last week, traveling on Air Force One and now being self-quarantined because he shook hands with someone who tested positive at a conference for people denying reality.

The United States well on its way to suffering the most damage from this outbreak of any G7 country.

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RE: Covid-19 considerations - burger - 03-09-2020

A little gallows humor from xkcd (and, possibly, an accurate depiction of the current state of things):



https://xkcd.com/2278/

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RE: Covid-19 considerations - BostonCard - 03-09-2020

Alt text: "I actually came in in the middle so I don't know which topic we're briefing on; the same slides work for like half of them."

XKCD is brilliant.  My favorite:



BC

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RE: Covid-19 considerations - cardcrimson - 03-09-2020



The Shanghai Composite over the last year. . . .

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RE: Covid-19 considerations - OutsiderFan - 03-09-2020

OK, this is SERIOUS, and WHY all events simply must be cancelled until we can do adequate surveillance testing:

Laurie Garrett, Pulitzer Prize winning reporter who specializes in infectious disease reporting. She appears to be in midst of writing a story and tweeted this out while still writing, ostensibly to sound the alarm that this virus can spread in the air for 3 hours!

[tweet]https://twitter.com/Laurie_Garrett/status/1237133633309343744[/tweet]

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RE: Covid-19 considerations - burger - 03-09-2020

Watching the White House press briefing.  All they have to offer is tax cuts.

I don't even know what to say.  I work from home.  My wife works in a health care-adjacent field and sees a lot of people each day.  I'm going to suggest she quit, and we'll try to ride it out at home.  Good luck, everyone.  We'll need it.

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RE: Covid-19 considerations - Treefence - 03-09-2020

In listening to the White House briefing, did Trump sound congested?

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RE: Covid-19 considerations - 2006alum - 03-09-2020

FWIW, congestion is an uncommon COVID-19 symptom. While we're at it, here's a handy primer I found on COVID-19 vs. cold vs. flu symptoms:

[tweet]https://twitter.com/juliaoftoronto/status/1236967717535731712?s=20[/tweet]

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Also, a colleague of mine is friends with a molecular virologist who has worked specifically on coronaviruses for much of the past 40 years. He sent this to his friends, including my colleague, who passed it along. As you can tell, it was first sent a while ago, and let's just say "this post  aged well." In case anyone finds it helpful, there were a few tips I hadn't seen elsewhere and that I'm implementing now:

Quote:ubject: What I am doing for the upcoming COVID-19 (coronavirus) pandemic.

Dear Colleagues,  as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.

The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.

Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.:

1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.

2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove.

3) Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.

4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.

5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.

6) Keep a bottle of sanitizer available at each of your home's entrances. AND in your car for use after getting gas or touching other contaminated objects when you can't immediately wash your hands.

7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

What I have stocked in preparation for the pandemic spread to the US:

1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average - everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.

2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you - it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth - it is only to keep you from touching your nose or mouth.

3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.

4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY "cold-like" symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.

I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.

I hope these personal thoughts will be helpful during this potentially catastrophic pandemic.

You are welcome to share this email.

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RE: Covid-19 considerations - BostonCard - 03-09-2020



Interesting, this data is from Hong Kong.  The upshot of all the social distancing that was done in response to coronavirus is that infections with pretty much all viruses came to a halt, including influenza and cold viruses (mostly rhinovirus)

BC

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