The CardBoard
Outside Topic Covid-19 considerations - Printable Version

+- The CardBoard (https://thecardboard.org/board)
+-- Forum: Emergency (https://thecardboard.org/board/forum-11.html)
+--- Forum: Covid-19 (https://thecardboard.org/board/forum-12.html)
+--- Thread: Outside Topic Covid-19 considerations (/thread-19023.html)

Pages: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

RE: Covid-19 considerations - BostonCard - 03-13-2020

San Mateo Unified School District sent the notice out last night that school was out and kids were expected to learn from home starting Monday.  The Burlingame School District came to the same conclusion earlier in the day.

LA Unified announced it was closing today.

Thanks to 2006alum for posting the biohub discussion.  One thing I disagree with them is about closing schools.  The schools shouldn't be closed for the kids' benefit; their mortality is low and you could take kids out who have risk factors.  The reason to shut down the schools is to protect their parents and (especially) grandparents.  You can look at kids as a vector of disease, to use a crude analogy.  They themselves aren't a problem, but if they spread it among themselves and take it home and then infect folks who are otherwise socially isolating.  It's not something I would take lightly, but the more aggressive the measures we take now, the faster we can get on top of the pandemic.

BC

RE: Covid-19 considerations - cardcrimson - 03-13-2020

(03-13-2020, 02:28 PM)BostonCard Wrote:  San Mateo Unified School District sent the notice out last night that school was out and kids were expected to learn from home starting Monday.  The Burlingame School District came to the same conclusion earlier in the day.

LA Unified announced it was closing today.

Thanks to 2006alum for posting the biohub discussion.  One thing I disagree with them is about closing schools.  The schools shouldn't be closed for the kids' benefit; their mortality is low and you could take kids out who have risk factors.  The reason to shut down the schools is to protect their parents and (especially) grandparents.  You can look at kids as a vector of disease, to use a crude analogy.  They themselves aren't a problem, but if they spread it among themselves and take it home and then infect folks who are otherwise socially isolating.  It's not something I would take lightly, but the more aggressive the measures we take now, the faster we can get on top of the pandemic.

BC

Agree. Looks like many additional school districts are closing in the East Bay as well. Daughter will be home for the next two weeks, at least. . . .

RE: Covid-19 considerations - JJJ - 03-13-2020

Updated from the mother ship today:

There's actually more than this excerpt:

Quote:Guide to self-care: Coping with coronavirus
March 13, 2020
By Lane McKenna and the BeWell staff
As Stanford works to reduce the spread of COVID-19 (novel coronavirus), it is also important that we each take care of ourselves in every possible way and that we assist in individual and community efforts to prevent further spread of this virus.
While this BeWell guide summarizes important medical facts and strategies, we lead with the issue of how to cope with the anxiety and mental stress that many are experiencing in this difficult time.
Staying calm, managing anxiety
Even on a “normal day” in history, emotional stress can prove very challenging. So add in COVID-19, and it’s really tough. How can we stay calmer and make wiser choices?
Firstly, bear in mind that as COVID-19 news spreads, it has created heightened stress for many of us. (For others, it has added to existing anxieties.) As James Kendall, LCSW, CEAP, of Vanderbilt University states, “sensationalized stories add to our angst and panic. The stock market has responded with a downturn, and many are unsure whether to travel or attend social gatherings. It may be similar to our response to other stressful world events: HIV, H1N1, SARS, mass shootings and 9/11.” It may therefore be wise for some to limit news overexposure: Sensational news stories can perpetuate unnecessary anxiety.
On the other hand, staying educated means something more than just watching TV news: To help your state of mind as you process current events, we hope the following advice from several Stanford experts will also prove helpful:
Self-care: The gift that keeps on giving
Tending to your emotional health
Rough day: Be grateful
As was recently summed by in an recent article published by The Greater Good Science Center at the University of California, Berkeley:
“One way is to use whatever tools you have at your disposal for keeping a cool head — like practicing mindfulness, which has been shown to both lessen emotional reactivity and help us make better decisions. We might take a walk in the park or nearby woods and let nature soothe us. Or we could talk to a friend — a calm friend, that is — who can help us reduce our anxiety. Of course, our normal ways of connecting socially — like singing together at a concert or going to large parties — may have to change. But whatever we can do to maintain an air of calm, and to spread it to those around us, the better. After all, our emotions tend to be contagious in our social circles, and we should do our best to keep fear and panic contained.”
Lastly, BeWell has also long advocated that each of us carve out “alone time” — enhanced even more when combined with fresh air and exercise. Simplistic as this may sound, now more than ever, this strategy is a useful tool. Take yourself away — both physically and mentally — from coronavirus for at least a while by going out for a run or long walk, alone.
See:
Runners on running at Stanford
Why walk?
[b]Still having difficulty with emotional stress?[/b]
  • Faculty, staff, and postdocs can contact the HELP Center at 723-4577.  All scheduled sessions are being held remotely (Zoom).
  • Santa Clara County maintains an anonymous crisis line that is available 24 hours, 7 days a week, at 1-800-704-0900 (Mental Health Services). 
  • SAMHSA’s Distress Helpline (related to any natural or human-caused disaster) is accessible 24/7 at 1-800-985-5990 or via text (send TALKWITHUS to 66746; Press 2 for Spanish).
 Do what you can to help prevent the spread of the virus  
Within the healthalerts.stanford.edu website, Stanford has a list of preventative strategies that include:
  • Get a flu shot. We strongly recommend that everyone obtain seasonal flu vaccination. (While it will not prevent COVID-19, influenza is currently in widespread circulation in California, and initial symptoms can be similar to novel coronavirus.) Members of the Stanford community can contact the SU Occupational Health Center (Stanford employees) or go to Vaden Health Center (Stanford students) to get a flu shot.
  • Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Don’t share food and drinks.
  • Clean and disinfect shared surfaces and objects that are touched frequently (e.g. door knobs, desks, phones).
  • If you can, avoid close contact with anyone with cold or flu-like symptoms.
On “social distancing”: Take that as far as you can
Expanding on the recommendation to “avoid close contact with anyone with cold or flu-like symptoms,” physicians speaking at the March 11 Stanford Department of Grand Rounds pointed to “the 6-feet rule,” otherwise known as social distancing, or the strategy of maintaining a minimum of 6 feet between yourself and any other individual. Why?  When someone coughs or sneezes they spray small liquid droplets from their nose or mouth which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease.
Going beyond social distancing
While clearly it is not BeWell’s nor Stanford’s job to tell you how to live your life outside of work or our campuses, readers may be interested in Stanford Medicine’s advice regarding COVID-19 as it pertains to community spread. Quite simply, the advice is not to get on an airplane, and even to avoid groups of people altogether. While it may be emotionally challenging to cancel a family reunion or other large gathering, the risks are considerable. See Stanford’s Self-Isolation Guidelines.

https://healthalerts.stanford.edu/2020/03/13/guide-to-self-care-coping-with-coronavirus/

RE: Covid-19 considerations - BostonCard - 03-13-2020

Worst case scenarios from the CDC:

https://apple.news/ATIiJ5HFZTGmvuNbrWT9mpw

160 - 214 million infected and 200,000 to 1.7 million dead.

This is the worst case.

BC

RE: Covid-19 considerations - terry - 03-13-2020

(03-13-2020, 10:05 AM)cardcrimson Wrote:  Yes, the NSC's Global Health Security Team was reassigned in 2018. Does it matter that is was created in 2017 and didn't even exist under the prior administration?

According to the article linked below, the NSC's Directorate for Global Health Security and Biodefense was established under the Obama administration. It was led by Beth Cameron. Cameron describes her office's work in the linked article. That office was dissolved in 2018.

https://www.washingtonpost.com/outlook/nsc-pandemic-office-trump-closed/2020/03/13/a70de09c-6491-11ea-acca-80c22bbee96f_story.html?fbclid=IwAR2ALKM7x8hfdhwoDxYkmNQr1aiZcMYdkZzaF8KTw74ykIxdC0d80q_FP9s

RE: Covid-19 considerations - magnus - 03-13-2020

Not a look forward, but a look back...

Patient zero traced back to potentially Nov 17th
https://www.scmp.com/news/china/society/article/3074991/coronavirus-chinas-first-confirmed-covid-19-case-traced-back

RE: Covid-19 considerations - Papa John - 03-13-2020

Santa Barbara Unified now closed until at least April 6. The week after next is spring break, so they will be missing two weeks of school, although, per my son, some of his teacher's will be giving homework (the school distributes i-pads to every student).

RE: Covid-19 considerations - GoodGrief - 03-13-2020

Thank you all for this wonderful discussion. Repeating Cardcrimson's question, can anyone explain what the excerpt at the bottom means?

My 86 year-old mother currently takes Losartan (an ARB, which is also cited along with ACE Inhibitors as possibly being linked to severe Covid-19). She also takes Carvedilol (beta blocker) and Amlodipine Besylate (calcium blocker), as well as Metformin and Simvastain. Does anybody have an opinion if we should ask her doctor if she should stop taking the Losartan for now?

(03-11-2020, 03:25 PM)cardcrimson Wrote:  
(03-11-2020, 02:57 PM)burger Wrote:  This article (https://www.bmj.com/content/368/bmj.m810/rr-2) suggests that ACE inhibitors taken for blood pressure control may play a role in the high Covid-19 mortality for older people and people with cardiovascular disease.  I've seen this speculation elsewhere, and it's interesting enough that someone needs to be looking into this.

Quote:Is a link between these observations possible? Is the expression of ACE2 receptor in the virus targeted cells increased by the use of ACE-inhibitor/angiotensin-receptor blocker and is the patient therefore more at risk for a severe course? We need rapid epidemiological and preclinical studies to clarify this relationship. If this were the case, we might be able to reduce the risk of fatal Covid-19 courses in many patients by temporarily replacing these drugs

Can one of the doctors out there please translate for those of us on these drugs. . . .

"On the one hand, it has been shown that the Covid-19 agent (also known as SARS-CoV-2), uses the SARS-COV receptor angiotensin converting enzyme (ACE) 2 for entry into target cells [4]. The interface between ACE2 and the viral spike protein SARS-S has been elucidated and the efficiency of ACE2 usage was found to be a key determinant of SARS-CoV transmissibility [4]. 

On the other hand, it could be shown in animal experiments that both the ACE-inhibitor lisinopril and the angiotensin-receptor blocker losartan can significantly increase mRNA expression of cardiac ACE2 (5-fold and 3-fold, respectively) [5]. Further, losartan also significantly increases cardiac ACE2 activity [5].
Is a link between these observations possible? Is the expression of ACE2 receptor in the virus targeted cells increased by the use of ACE-inhibitor/angiotensin-receptor blocker and is the patient therefore more at risk for a severe course? We need rapid epidemiological and preclinical studies to clarify this relationship. If this were the case, we might be able to reduce the risk of fatal Covid-19 courses in many patients by temporarily replacing these drugs."


RE: Covid-19 considerations - 82lsju - 03-13-2020

Quote:A team of researchers from Sunnybrook, McMaster University and the University of Toronto has isolated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent responsible for the ongoing outbreak of COVID-19.

https://sunnybrook.ca/research/media/item.asp?c=2&i=2069&f=covid-19-isolated-2020

RE: Covid-19 considerations - cardcrimson - 03-13-2020

(03-13-2020, 03:35 PM)terry Wrote:  
(03-13-2020, 10:05 AM)cardcrimson Wrote:  Yes, the NSC's Global Health Security Team was reassigned in 2018. Does it matter that is was created in 2017 and didn't even exist under the prior administration?

According to the article linked below, the NSC's Directorate for Global Health Security and Biodefense was established under the Obama administration. It was led by Beth Cameron. Cameron describes her office's work in the linked article. That office was dissolved in 2018.

https://www.washingtonpost.com/outlook/nsc-pandemic-office-trump-closed/2020/03/13/a70de09c-6491-11ea-acca-80c22bbee96f_story.html?fbclid=IwAR2ALKM7x8hfdhwoDxYkmNQr1aiZcMYdkZzaF8KTw74ykIxdC0d80q_FP9s

Yes, it was established under Obama, as I pointed out earlier. My understanding, and I could be mistaken, is that Ziemer had a staff with direct reports. Cameron, according to her own linkedin profile, "Led a matrixed team of independent, highly trained professionals". When Ziemer was removed by Bolton, his staff was reassigned to other agencies. Interestingly the directorate or a facsimile appears to be active at least as late as last year: https://www.whitehouse.gov/wp-content/uploads/2019/05/GHSS.pdf . Clearly, somebody was doing something regarding the matter.

RE: Covid-19 considerations - M T - 03-13-2020

1.  I felt today's press conference by the President was mixed.  2. Beware, there are sites out there that purport to show a map of the outbreak that actually deliver malware.

3. Ah, the joys of online grocery shopping.  The majority of what Safeway was to deliver was out of stock.  They substituted dog food for cat food.  I gave up after 40 minutes on hold to customer support.   Hint: ask for morning delivery.

RE: Covid-19 considerations - cardcrimson - 03-13-2020

(03-13-2020, 06:07 PM)M T Wrote:  1.  I felt today's press conference by the President was mixed. 
  • The promise of lots of test kits "next week' seemed like hearing someone call "Wolf!" for the third time. 
  • The attitude that you have to have symptoms in order to get tested scares me as those with the disease have been spreading it before thedy have symptoms (see my post early this morning for the medical article indicating the early massive virus shedding).  This attitude will lead to explosive growth.
  • There was the announcement on the relaxing of regulations.  I generally thought that was good FOR THIS CRISIS, not permanently. It sounds like they will bring in virtual doctors from out of state, and in general allow more remote diagnosis.  (Oh, it just struck me, one of those companies' line of business is providing such service.  Ah, so, next year, will we be outsourcing Granny's health care to some doctor in another state?)
  • They are banning visitors to nursing homes.  Ouch... That is not good, IMO.  They screw up so much in those places, and the patient-victims (like "student-athletes") are people that may be confused, and surely aren't listened to.   I'm afraid a lot of mistakes will just get buried with no witnesses.   Well, hey, be glad that they'll let visitors in for end-of-life situations.
  • I had walked off and only heard little bits about the President treating himself differently than other people, in regard to being exposed to the virus.
2. Beware, there are sites out there that purport to show a map of the outbreak that actually deliver malware.

3. Ah, the joys of online grocery shopping.  The majority of what Safeway was to deliver was out of stock.  They substituted dog food for cat food.  I gave up after 40 minutes on hold to customer support.   Hint: ask for morning delivery.

In reverse order. 

Suit up, and hit Safeway very early in the morning. They're there early stocking shelves, easy to find the necessities between 6 and 8am. They have plentiful wipes and hand sanitizers around the store, just none that you can buy.

There are sites everywhere that deliver malware. Viruses, especially now, are pretty scary tho.

Test kits are one thing, the ability to test is another. Seems that both are being addressed. Time will tell. Nice to see the CEOs of all the involved companies there, working together with the government.

Your points to seem be contradictory. Point one not believing that plenty of tests will be available soon. Point two complaining that everyone that wants a test should be able to get one. In a time of scarcity, shouldn't the tests be prioritized to those with a real possibility of having the virus? Just a thought.

RE: Covid-19 considerations - 2006alum - 03-13-2020

To me, the most striking part about the press conference is the following interaction, as articulated by the Atlantic:

Quote:A series of CEOs came to the microphone to describe what their companies were doing to speed testing or help out in other ways. Trump caught the first three or four of them unawares, by shaking their hands as they moved away from the podium. All seemed startled, as you can see in the video.

Then the other CEOs began to catch on, and a following group of them scuttled away from the podium before Trump could grab them for a handshake, or held their own hands clenched together, in a protective prayer-style grasp.

Finally, (at 1:06 in the video) you can see Bruce Greenstein, of the LHC group, surprise Trump with an elbow-bump rather than a hand shake. Trump himself seemed completely oblivious to the idea of social distancing. It was also notable that one speaker after another touched and moved around the same microphone, and put his her hands on the sides of the same podium.


It's especially striking since he has thus far disavowed testing to see whether he may possibly have COVID-19 himself. I can't imagine how quickly those folks raced to scrub their hands and use hand sanitizer...

Setting the crossfire aside, one other striking aspect of today's emergency declaration is what the Stafford Act permits the government. Quoting the statutory language, the act precludes liability "for any claim based upon the exercise or performance of or the failure to exercise or perform a discretionary function or duty on the part of a Federal agency." 42 U.S.C. § 5148.

I'm not familiar enough with laws and regs that covered testing and treatment in ordinary times, but one thing's for sure, it's going to be a lot harder to hold the government accountable for errors now. This same liability exclusion was extensively relied on by the Government to make post-Katrina-related claims go away. I'm sure there are other nuggets of sovereign power in relevant provisions of the Stafford Act that we may want to look out for down the road, as the Atlantic also presaged over a year ago.

RE: Covid-19 considerations - cardcrimson - 03-13-2020

That was your most important take away from the press conference?!? 


(03-13-2020, 07:42 PM)2006alum Wrote:  To me, the most striking part about the press conference is the following interaction, as articulated by the Atlantic:

Quote:A series of CEOs came to the microphone to describe what their companies were doing to speed testing or help out in other ways. Trump caught the first three or four of them unawares, by shaking their hands as they moved away from the podium. All seemed startled, as you can see in the video.

Then the other CEOs began to catch on, and a following group of them scuttled away from the podium before Trump could grab them for a handshake, or held their own hands clenched together, in a protective prayer-style grasp.

Finally, (at 1:06 in the video) you can see Bruce Greenstein, of the LHC group, surprise Trump with an elbow-bump rather than a hand shake. Trump himself seemed completely oblivious to the idea of social distancing. It was also notable that one speaker after another touched and moved around the same microphone, and put his her hands on the sides of the same podium.


It's especially striking since he has thus far disavowed testing to see whether he may possibly have COVID-19 himself. I can't imagine how quickly those folks raced to scrub their hands and use hand sanitizer...

Setting the crossfire aside, one other striking aspect of today's emergency declaration is what the Stafford Act permits the government. Quoting the statutory language, the act precludes liability "for any claim based upon the exercise or performance of or the failure to exercise or perform a discretionary function or duty on the part of a Federal agency." 42 U.S.C. § 5148.

I'm not familiar enough with laws and regs that covered testing and treatment in ordinary times, but one thing's for sure, it's going to be a lot harder to hold the government accountable for errors now. This same liability exclusion was extensively relied on by the Government to make post-Katrina-related claims go away. I'm sure there are other nuggets of sovereign power in relevant provisions of the Stafford Act that we may want to look out for down the road, as the Atlantic also presaged over a year ago.


RE: Covid-19 considerations - 2006alum - 03-13-2020

(03-13-2020, 08:03 PM)cardcrimson Wrote:  That was your most important take away from the press conference?!? 

Striking ≠ most important.

Striking: "adjective 1. attracting attention by reason of being unusual, extreme, or prominent."

To put it bluntly, it was an exemplary display of "do as we say, not as I do." The Sovereign Exception indeed...

RE: Covid-19 considerations - fullmetal - 03-13-2020

Surely the Stafford Act does not apply ex post facto...?

RE: Covid-19 considerations - Goose - 03-13-2020

(03-13-2020, 06:07 PM)M T Wrote:  
  • The attitude that you have to have symptoms in order to get tested scares me as those with the disease have been spreading it before thedy have symptoms (see my post early this morning for the medical article indicating the early massive virus shedding).  This attitude will lead to explosive growth.

Does anybody here know at what point in the process of getting sick the current test(s) can detect the disease fairly reliably? If T designates the first day with detectable symptoms, does the test indicate positive on day T - 1, T - 2, T -4, ...? If anybody knows, please enlighten us and share your info. It may be out there, but I haven't seen it.

RE: Covid-19 considerations - chrisk - 03-13-2020

What could the US have learned from Taiwan / could still learn?

https://www.businessinsider.sg/coronavirus-taiwan-case-study-rapid-response-containment-2020-3

RE: Covid-19 considerations - PalmTree - 03-13-2020

Meanwhile, back on the Farm, the first confirmed positive test for an undergrad.  I understand there is also consideration of severely restricting research activity to help protect grad students and postdocs.  Bottom line, it'll be a spring quarter, unlike ANY other:

https://healthalerts.stanford.edu/2020/03/13/new-covid-19-actions-letter-from-university-president-marc-tessier-lavigne/

RE: Covid-19 considerations - akiddoc - 03-14-2020

(03-13-2020, 04:29 PM)GoodGrief Wrote:  Thank you all for this wonderful discussion. Repeating Cardcrimson's question, can anyone explain what the excerpt at the bottom means?

My 86 year-old mother currently takes Losartan (an ARB, which is also cited along with ACE Inhibitors as possibly being linked to severe Covid-19). She also takes Carvedilol (beta blocker) and Amlodipine Besylate (calcium blocker), as well as Metformin and Simvastain. Does anybody have an opinion if we should ask her doctor if she should stop taking the Losartan for now?

(03-11-2020, 03:25 PM)cardcrimson Wrote:  
(03-11-2020, 02:57 PM)burger Wrote:  This article (https://www.bmj.com/content/368/bmj.m810/rr-2) suggests that ACE inhibitors taken for blood pressure control may play a role in the high Covid-19 mortality for older people and people with cardiovascular disease.  I've seen this speculation elsewhere, and it's interesting enough that someone needs to be looking into this.

Quote:Is a link between these observations possible? Is the expression of ACE2 receptor in the virus targeted cells increased by the use of ACE-inhibitor/angiotensin-receptor blocker and is the patient therefore more at risk for a severe course? We need rapid epidemiological and preclinical studies to clarify this relationship. If this were the case, we might be able to reduce the risk of fatal Covid-19 courses in many patients by temporarily replacing these drugs

Can one of the doctors out there please translate for those of us on these drugs. . . .

"On the one hand, it has been shown that the Covid-19 agent (also known as SARS-CoV-2), uses the SARS-COV receptor angiotensin converting enzyme (ACE) 2 for entry into target cells [4]. The interface between ACE2 and the viral spike protein SARS-S has been elucidated and the efficiency of ACE2 usage was found to be a key determinant of SARS-CoV transmissibility [4]. 

On the other hand, it could be shown in animal experiments that both the ACE-inhibitor lisinopril and the angiotensin-receptor blocker losartan can significantly increase mRNA expression of cardiac ACE2 (5-fold and 3-fold, respectively) [5]. Further, losartan also significantly increases cardiac ACE2 activity [5].
Is a link between these observations possible? Is the expression of ACE2 receptor in the virus targeted cells increased by the use of ACE-inhibitor/angiotensin-receptor blocker and is the patient therefore more at risk for a severe course? We need rapid epidemiological and preclinical studies to clarify this relationship. If this were the case, we might be able to reduce the risk of fatal Covid-19 courses in many patients by temporarily replacing these drugs."

Corona viruses gain entry to lung tissue by bonding to ACE-2 receptors. There are several drugs known to increase the production of ACE-2 receptors throughout the body, including ACE inhibitors, Angiotensin II Receptor Blockers (ARB'S), and Ibuprofen. The theory is that this allows an increase in the ability of Covid-19 to enter lung cells and leads to more likelihood of overwhelming infection. Nothing is yet proven. It's a theory. It is a concern, though.

I am also on an ARB. It is a cause for concern for me as well. I'm letting my physician and his consultants hash it out for the moment. 

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf